Lec 7.ppt
- 1. Secondary tuberculosis. Focal tuberculosis. Tuberculoma. Infiltrative tuberculosis. Lecture № 7. The Department of Tuberculosis of KSMA. Doc. Fydorova S.V.
- 2. Secondary tuberculosis develops in persons which have been infected with MBT ill with primary TB or before.
- 3. Endogenous reactivation is reactivation of old TB infection in residual TB changed sometimes Erlich’s tetrad may be detected by sputum microscopy (changed MBT, elastic fibers, calcium, cholesterol)
- 4. Exogenous superinfection repeated (sometimes numerous) infection with new strains of MBT development of new tuberculous foci in intact areas of lung tissue elimination of drug-resistant strains of MBT (primary drug resistance) in new TB cases
- 5. High risk factors of tuberculosis Hereditary factor – presence of disease- susceptibility genes are located mainly in B-, D-, R-locus HIV-infection drug-abuse alcoholism diabetes mellitus and other severe diseases long taking of steroids, cytostatics malnutrition etc.
- 6. Secondary tuberculosis mainly occurs in adults older than 30 tuberculin skin test is usually positive (10-12 mm) process is located in only single system or organ (mainly lungs) TB process spreads by natural canals (in pulmonary TB – by bronchi, in TB of kidneys – by ureters, etc.) or by contact way
- 7. Secondary tuberculosis secondary TB doesn’t have tendency to recovery without treatment. Usually there is tendency to the destruction of affected organ and impairment of it’ s function.
- 8. Limited forms of secondary tuberculosis When not more than two segments of lung tissue are affected only. The size of opacity on the chest X-ray film is not more than 10 cm² (squarer cm). Classical limited forms of secondary TB are focal TB and tuberculoma .
- 9. Focal tuberculosis is specific tuberculous inflammation of lung tissue with size until 10 mm. Focal TB may be as independent form as outcome of different forms of TB. Mainly productive reaction is typical. It is the most favourable form of secondary TB.
- 10. Classification of focal tuberculosis new or soft focal TB old or fibrous focal TB
- 11. Clinical symptoms of focal tuberculosis Asymptomatic pathway is usually observed in about 35% of patients. So focal TB is mainly detected by prophylactic fluorographic examinations.
- 12. Clinical symptoms of focal tuberculosis Patients with focal TB sometimes may have cough, a little of mucous sputum, subfebrile fever, chest pain. The pain is associated with breathing. Muscle’s tenderness of chest wall during palpation may be detected in affected side. By percussion – dullness of sound over the upper areas of lungs may be observed. By auscultation - a little of wheezes. But usually physical findings are negative.
- 13. Diagnosis of focal tuberculosis MBT are detected in sputum by microscopy only in 5% of cases, informativeness increases to 50% by cultural method. Tuberculin skin test is usually 10-12 mm as in infected asymptomatic persons.
- 14. X-ray – findings Innumerous focal shadows are observed, their size is from 1-2 to 10 mm, their intensity is usually low, form is irregular, contours are unclear. Transparency of surrounded lung tissue may decrease. Soft focal tuberculosis of the left upper lobe
- 15. X-ray – findings Intensity of foci is high, their borders are clear. Fibrosis of surrounding lung tissue increases. Usually the first, the second and the sixth segments of lungs are affected – typical localization. Fibrous focal tuberculosis of the left upper lobe
- 16. Differential diagnose: focal pneumonia echinococcus at early stage tumor at early stage focal fibrosis etc.
- 17. Tuberculoma area of caseous necrosis with size more than 10 mm surrounded with connective tissue capsule and elements of specific granulations.
- 18. Tuberculoma may form in young people with high immune response specific treatment at early stage of disease may cause changes of exudative stage of inflammation to proliferation – tuberculoma formation
- 19. Classification of tuberculoma Morphological types: infiltrative-pneumonic tuberculoma (is a consequence of infiltrative TB – productive reaction predominates) caseoma (alterative reaction predominates) pseudotuberculoma (when tuberculous cavity is crowded with caseous mass)
- 20. Classification of tuberculoma Morphological structure: homogenous and heterogeneous with layers of connective tissue and caseous necrosis solitary and conglomerate homogenous solitary tuberculoma heterogeneous solitary tuberculoma conglomerate tuberculoma
- 21. Classification of tuberculoma Size: small (diameter is from 1 to 2 cm) medium (diameter is from 2 to 4 cm) large (diameter is from 4 cm to 6 cm) gigantic (diameter is from 6 cm and more)
- 22. Classification of tuberculoma Clinical course: stable pathway – without any clinical symptoms progressive pathway – exacerbations, sometimes destruction of lung tissue and formation of tuberculous cavity regressive pathway – dissolving of granulations and consolidation of caseous necrosis, fibrosis and sclerosis of lung tissue
- 23. Clinical picture of tuberculoma Patients with tuberculoma are usually asymptomatic, so this clinical form is detected by preventive fluorography examination Sometimes patients may have progression of disease – pulmonary symptoms and intoxication appear
- 24. Diagnosis of tuberculoma Tuberculoma may be detected by occasional X-ray or fluorographic examination Tuberculin skin test may be positive or hyperergic X-ray diagnosis – round opacity is detected in the lung tissue, it is usually located in the 1st, 2nd, 3rd segments, it’s intensity may be medium or high, it may be heterogeneous with calcifications. Sometimes there are calcifications in the root and surrounded lung tissue
- 25. Radiological signs of progressive tuberculoma borders are getting unclear size of round shadow is getting bigger appearance of destruction appearance of bronchogenous foci in surrounded lung tissue relation between round focus and lung root as road-like shadow numerous round opacities
- 26. Differential diagnosis tumor echinococcus abscess pneumonia fungal diseases etc.
- 27. Infiltrative tuberculosis is area of caseous necrosis with size more than 1 cm and wide zone of exudation around it.
- 28. Infiltrative tuberculosis may develop in intact lung tissue, but often it forms in the area of old specific lesions. Exacerbation of TB- infection in calcified lymph nodes can cause formation of infiltrative TB in pulmonary tissue too. TB-infection usually spreads by lymphatic and bronchial ways.
- 29. Morphological types of infiltrative TB broncholobular infiltrate
- 30. Morphological types of infiltrative TB round or oval infiltrate (Assman’s infiltrate)
- 31. Morphological types of infiltrative TB own cloudy-like infiltrate
- 32. Morphological types of infiltrative TB periscissuritis
- 33. Morphological types of infiltrative TB pseudotumorous infiltrate
- 34. Morphological types of infiltrative TB lobitis
- 35. Diagnosis of infiltrative tuberculosis MBT are often detected in sputum by microscopy tuberculin skin test is usually positive or hyperergic X-ray-findings – syndrome of total or subtotal opacity of lung tissue
- 36. Differential diagnose pneumonia lung cancer or lung tumor with atelectasis fungal disease mycobacteriosis viral diseases infectious diseases (rheumatism, brucellosis, tularemia) etc.
- 37. Thank you for your attention!