Destructive tuberculosis. Iii

02.04.2020

Tuberculosis is called destructive, accompanied by a decay phase. n The frequency among newly diagnosed TB patients is about 50% (mainly in adults and adolescents). n

Mechanism of cavity formation: Caseous masses liquefy under the action of enzymes, the wall of the draining bronchus is destroyed, expectoration of caseosis is formed by fresh destruction - 2 layers (pyogenic and granulation) formation of a fibrous wall transformation into a true cavity.

continued n n The phase of disintegration occurs in any clinical form of tuberculosis. It is rare with primary tuberculosis, focal, not often with tuberculoma. Often accompanied by a phase of disintegration: infiltrative tuberculosis (70%), disseminated (70%). Always, in 100% of cases, caverns are present in cavernous and fibrocavernous TB.

The dimensions of the caverns: * small - up to 2 cm in diameter; * medium - 2 -4 cm; * large - 4 - 6 cm; * giant -\u003e 6 cm.

Decay phase (cavity) syndrome includes clinical and radiological signs Clinical signs: n n n cough with phlegm; pulmonary bleeding; wet medium and large bubbling rales (localized)

Radiological signs Direct - enlightenment against the background of darkening or a ring-shaped shadow with closed contours, determined by two types of X-ray examination. - lack of pulmonary pattern in the area of \u200b\u200benlightenment. - incongruence of the contours. Indirect - seeding around - fluid level - lumen of the draining bronchus

Difficulties in the diagnosis of cavities Absence of wheezing ("mute cavities"; n no signs of decay on a plain radiograph. N Requires tomography, CT.

Types of decay cavity involution Formation of a linear scar. n Stellate scar. n False tuberculoma. n Post-tuberculous cyst (sanitized cavity). n

Cavernous tuberculosis Thin-walled decay cavity without pronounced infiltration and fibrotic changes in the surrounding lung tissue... The clinic is poor. MBT +. Treatment is mainly surgical.

Fibrous-cavernous tuberculosis is characterized by several, less often one cavity with thick fibrous walls and pronounced fibrous changes in the surrounding lung tissue. Varieties in prevalence: n limited process - no more than a share; n common - more than a fraction. n

n Histotopographic section of the lung in fibrocavernous tuberculosis: 1 - chronic cavities; 2 - pneumocirrhosis; 3 - thickening and sclerosis of the pleura; staining with hematoxylin and eosin.

Frequency of FCT Among newly diagnosed patients - 2, 5%. Among all contingents of patients - 17%. The reasons for the formation of FKT: - late detection of the process; - refusal of patients from sufficiently long-term treatment.

Clinic n n Long course with exacerbations and remissions. Intoxication syndrome, increasing with exacerbations. DN syndrome, later SLS. Pulmonary symptoms: cough with sputum, often painful, harsh (due to the defeat of the bronchi of TB). Hemoptysis and pulmonary hemorrhage, chest pain is possible.

Objective data General condition from satisfactory to moderate and heavy; - Habitus phtisicus - asthenic physique, reduced nutrition, sinking over and subclavian spaces, pale skin, often with acrocyanosis, muscle wasting; - affected half chest (or more affected) lags behind in breathing;

continuation - - percussion-dullness due to gross fibrosis; in unaffected sections - box sound (compensatory emphysema); auscultation - breathing is hard, bronchial, sometimes amphoric, moist medium or large bubbling rales, sometimes localized dry rales.

Laboratory data n n n Massive bacterial excretion; often multidrug resistance (MDR); significantly increased ESR; lymphopenia; possible hypochromic anemia; possible pathology in the analysis of urine (due to toxic nephropathy, amyloidosis).

X-ray signs of FCTL n n n Annular shadow with thick walls, determined in 2 projections against the background of inhomogeneous darkening. Reducing the volume of lung tissue by replacing it with fibrous strands. The presence of bronchogenic seeding in the same or another lung.

n X-ray of the chest organs in fibrocavernous pulmonary tuberculosis: the right pulmonary field is narrowed, the mediastinum is displaced to the right, a giant cavity with thick dense walls is determined at the apex of the right lung (indicated by the arrow), in the middle and lower parts of the left lung - multiple merging areas of shading ( dropouts).

n n The upper lobe of the right lung is reduced in volume, the small interlobar pleura is at the level of p. 2 ribs. In S 1 -S 2 of the right lung against the background of local coarse pneumofibrosis, a cavity of 2.5 * 3.5 cm of irregular shape is determined, with different wall thicknesses (0.5 - 1.5 cm), with an uneven internal contour and the presence of a "path" to the root (draining bronchus); around multiple polymorphic foci of different sizes. In S 1 -2 of the left lung and S 9 of the right lung, foci with indistinct contours, of low and medium intensity, are prone to fusion. The right outer sinus is uniformly shaded to the level of the dome of the diaphragm with a clear upper contour. Pleuroapical layers on the right. The roots of the lungs are not dilated, have little structure, the right one is deformed and pulled up. The trachea is somewhat displaced to the right. Conclusion: Fibrous-cavernous tuberculosis of the upper lobe of the right lung with S 1 -2 seeding of the left lung and S 9 of the right lung, complicated by exudative pleurisy on the right.

n A tomogram of the chest organs in frontal projection of a patient with fibrous-cavernous tuberculosis of the right lung and left-sided caseous pneumonia: the left lung is reduced in volume, diffusely shaded, in its upper sections multiple decay cavities are determined (1); the right lung is enlarged in volume, in its middle sections, the foci of dropout are determined (2), at the level of the second intercostal space - a cavity (3); the shadow of the mediastinum is shifted to the left.

Other types of examination n n Reaction to the Mantoux tuberculin test is normal; FBS-N or signs of specific lesions of the bronchi; FVD - DN; ECG - signs of HPS are possible.

Epidemic danger n Due to constant massive bacterial excretion and frequent MDR, patients with fibrocavernous tuberculosis pose the greatest epidemic danger.

Treatment and outcomes Chemotherapy (CT) is not very effective. With limited forms surgery... Transition to cirrhotic tuberculosis is possible with chemotherapy. More often the prognosis is poor. The causes of death are complications.

Complications of FCT Specific caseous pneumonia hematogenous seeding of TB of the bronchi, trachea, tongue pleurisy, empyema, pneumothorax Nonspecific DN CLS pulmonary bleeding amyloidosis abscess formation of the cavity DIC syndrome

Deaths are mainly caused by the progression of the process in the form of specific complications. The most common such complications are: caseous pneumonia (70%), hematogenous seeding (20%).

Conclusion on FKT n n n Fibrous-cavernous TB is a chronically ongoing destructive process that develops as a result of the progression of other forms of tuberculosis. This process is difficult to treat and is the leading cause of death in tuberculosis. Leading directions for the prevention of this form of tuberculosis: timely detection and adequate treatment of other forms.

Cirrhotic tuberculosis Growth of coarse connective tissue in the lungs and pleura while maintaining the activity of the process: foci, tuberculomas, cavities (bronchiectasis, bullae and sanitized cavities), emphysema Clinic n n n Tuberculous intoxication, moderate; a picture of nonspecific inflammation (COPD); recurrent hemoptysis; LSN (shortness of breath, HLS, NK); undulating course with rare or frequent exacerbations.

the right lung is shaded and reduced in volume due to fibrosis and massive pleural layers, calcifications are determined in the costal pleura (1), a chronic cavity is visible at the level of the clavicle in the right lung (2), the pulmonary pattern is sharply deformed on both sides, there are scattered in the left lung high-intensity shadows of old foci (3), the shadow of the trachea is shifted to the right, the middle shadow is deformed.

Any form of tuberculosis can be complicated by the melting of caseosis, the release of caseous masses through the bronchi and the formation of a cavity, i.e. the transition of the process into a destructive form. When caseosis melts along the edge of the tuberculous focus, caseous masses can be separated as a sequestration.

Such a cavity is called sequestering. When masses of caseosis are melted by the type of autolysis, the cavity has an autolytic character. The formed cavity is characterized by a three-layer structure of the walls: the inner caseous-necrotic layer faces the cavity lumen; it is followed by a layer of specific granulations containing epithelioid, lymphoid and giant cells of Pirogov-Langhans.

By genesis, caverns can be pneumoniogenic, formed at the site of the focus of tuberculosis pneumonia, bronchogenic, formed at the site of bronchi affected by tuberculosis, hematogenous, arising in hematogenous-seminated tuberculosis. Depending on the structure of the walls, the severity of the fibrous layer of the cavity can be elastic, easily collapsing, with poorly developed fibrosis, and rigid with dense fibrous walls.

During the healing process of the cavity, the lumen of the draining bronchi may be obliterated; in this case, an encapsulated focus of caseosis of the tuberculoma type is formed at the site of the cavity. Under unfavorable conditions, caseosis in such a focus can again undergo melting with the opening of the lumen of the bronchus and a cavity forms again, therefore this type of healing is defective.

Rigid cavities during healing most often transform into a cyst-like cavity. In these cases, there is a rejection of the caseous-necrotic layer and the replacement of a layer of specific granulations with a nonspecific connective tissue... The cavern turns into a cyst-like cavity.

The progression of destructive tuberculosis is expressed in an increase in the caseous-necrotic layer, which can pass to the layer of specific granulations and fibrosis. Changes in the bronchi also progress with the appearance of foci of acute bronchogenic dissemination.

Cavernous pulmonary tuberculosis is characterized by the presence of an isolated formed cavern without pronounced fibrous changes in its walls and surrounding lung tissue.

More on the topic Destructive tuberculosis .:

TOPIC: FIBROCAVERNOUS TUBERCULOSIS. CIRRHOTIC TUBERCULOSIS.
Diagnosis of tuberculosis. Application of immunological methods for solving clinical problems of tuberculosis diagnostics.

It is generally accepted that the outcome lung resection surgery for tuberculosis is determined to a large extent by the phase of the tuberculous process, that the use of the operation in the active phase is fraught with severe bronchopulmonary complications and results in low efficiency. This is evidenced by the results of studies by N.M. Amosov, L.K-Bogush, I. B. Nazarova, M. I. Perelman, M. L. Shulutko and others. In our work we adhere to the same point of view and, as a rule, , we undertake surgical treatment during the period of relative stabilization of the tuberculous process, which is confirmed by good general condition patient, data laboratory research, lack of X-ray dynamics of the process during the previous 1.5-2 months, etc.

At the same time, in the practice of everyone's work phthisiological surgeon there are observations when the resection of the lung, performed during the period of exacerbation of the process, is not accompanied postoperative complications and ends with a good healing effect.

Interest in this problem due to the fact that in a number of cases it is the surgeon who has to decide on the admissibility of the operation as the only chance to stop the progression of tuberculosis if antibiotic therapy is unsuccessful.

As selected clinical observations cannot serve as a basis for conclusions and conclusions, we turned to the archival data of the sanatorium pulmonary-surgical department of the Sverdlovsk Institute of Tuberculosis and developed materials for lung resections over several years.

In view of the fact that the pathomorphological picture most reliably characterizes the phase of the tuberculous process before the operation, together with Dr. Sciences TI Kazak reviewed and examined the data of the pathological examination of the preparations of the resected lungs for the period from 1958 to 1973. In total, about two thousand lung resection operations of various lengths were performed.
It turned out that annually up to 10-12% of operations of the type lung resection performed by patients in the active phase of the tuberculous process.

Two reasons for using active phase operations... Firstly, due to underestimation of the degree of activity of the process before the operation. Secondly, in cases of failure and futility of antibacterial treatment, when the operation is used as the only possible way stopping the steady progression of tuberculosis.
The active phase of tuberculosis was represented by two morphological variants: the active stage and the progression stage.

Detailed analysis the materials of 150 patients operated on for progressive destructive forms of the lung were examined. It is this group of patients that is most epidemiologically dangerous. Comprehensive treatment patients with progressive destructive tuberculosis are often ineffective.

Morphological picture progressive destructive tuberculosis characterized by an exacerbation of the process in the wall of the cavity, the tuberculoma capsule, areas of destruction of the cavity wall, tuberculoma capsule, seeding of lung tissue with focuses of specific pneumonia, common infiltrative ulcerative tuberculous endobronchitis.
Dynamic X-ray study in persons with a histological picture, the progress of tuberculosis was usually revealed by an increase in the size and number of destruction, an increase in seeding.

"... Destructive forms of tuberculosis are any form of tuberculosis with a radiographically determined decay cavity; with adequate conservative treatment it is possible to achieve clinical cure, in some cases - surgical treatment ... "

(approved by the Ministry of Health and Social Development of the Russian Federation on July 20, 2007 N 5589-РХ)

- artificially obtained forms of bacteria, completely or partially devoid of the cell wall. Formed under the influence of some chemicals. substances ...
Microbiology Dictionary
- L-forms of bacteria, altered forms of bacteria, characterized by complete or partial loss of the cell wall, the same type of growth on semi-liquid and semi-solid nutrient media, polymorphism ...
Veterinary encyclopedic dictionary
- ...
- ...
Saint Petersburg (encyclopedia)
Culinary Dictionary
- General term for cooking and pastry auxiliaries to facilitate standardization appearance culinary products ...
Pokhlebkin's Big Encyclopedia of Culinary Arts
- DESTRUCTIVE POEMS - verses in which the metric structure is violated, as a result of which the rhythmic outlines of the verse become vague, unclear ...
Poetic Dictionary
- 1.final waste forms - high level waste forms for final disposal - insoluble non-metallic materials consisting of crystalline oxides, e.g. synroc ...
Nuclear power terms
- see Forms of bacteria ...
Big Soviet encyclopedia
- M., which are thin sticks, stained according to Tsil-Nelsen, slowly growing on nutrient media with the formation of dry wrinkled colonies; aerobes, spores and capsules do not form ...
Large Medical Dictionary
- "... an infectious form of tuberculosis is an active form of tuberculosis, in which mycobacterium tuberculosis is excreted; ..." Source: Federal Law of 18.06 ...
Official terminology
- ".....
Official terminology
- adverb for form are. goals razg. To comply with the established order, established rules ...
Explanatory dictionary Efremova
- plural forms colloquial 1. Outlines of parts of the human body, figures. 2. Outlines of the body of the animal ...
Efremova's explanatory dictionary
- Spread. For the sake of compliance with the established order, rules. - You will trade under my control, and we divide the profit in half ...
Phraseological dictionary of Russian literary language
- become, physique, build, constitution, complexion, figure, ...
Synonym dictionary

"Destructive forms of tuberculosis" in books

Section 2 Clinical forms of primary respiratory tuberculosis

author Pak F.P.

Section 2 Clinical forms primary respiratory tuberculosis Clinical forms of tuberculosis are divided into primary and secondary. The former are more common in childhood and adolescence, much less often in adults, secondary forms -

Section 3 Clinical forms of respiratory tuberculosis of the secondary period

From the book Phthisiology. Directory author Pak F.P.

Section 3 Clinical forms of secondary respiratory tuberculosis

Section 4 Extrapulmonary forms of tuberculosis

From the book Phthisiology. Directory author Pak F.P.

Section 4 Extrapulmonary forms of tuberculosis Extrapulmonary forms of tuberculosis are found in the general structure of morbidity in the population in 10% of cases, but among children and adolescents they are detected more often and amount to 15–20% in different epidemic territories. Timely detectability

52. Clinical forms of tuberculosis. Intrathoracic tuberculosis

author Pavlova NV

52. Clinical forms of tuberculosis. Intrathoracic tuberculosis Pathogenesis and pathomorphology. Primary infection develops most often after inhalation of live virulent tuberculous mycobacteria. The body of a non-immune child reacts to infection

53. Clinical forms of tuberculosis. Progressive primary pulmonary tuberculosis

From the book Infectious diseases author Pavlova NV

53. Clinical forms of tuberculosis. Progressive primary pulmonary tuberculosis Reactivation of tuberculosis. Pleural effusion 1. Progressive primary pulmonary tuberculosis In some cases, the primary focus formed in the lungs does not heal, but increases

54. Clinical forms of tuberculosis. Extrathoracic and miliary tuberculosis

From the book Infectious Diseases author Pavlova NV

54. Clinical forms of tuberculosis. Extrathoracic and miliary tuberculosis 1. Extrathoracic tuberculosis respiratory tract... Tuberculosis of the larynx in a child almost always occurs against the background of cavernous pulmonary tuberculosis, its symptoms are persistent

Question 9. Clinical classification of tuberculosis. Clinical forms of primary tuberculosis

author Mostovaya Elena Sergeevna

Question 9. Clinical classification tuberculosis. Clinical forms of primary tuberculosis 1. Main clinical forms Group 1. Primary tuberculosis: 1) prelocal: tuberculous intoxication in children and adolescents; 2) local: a) intrathoracic tuberculosis