Classification of tuberculosis in the ICD-10 is as follows.

TUBERCULOSIS (A15-A19) The changes

Including infections caused by M. tuberculosis and M. bovis

Excluded:

– Congenital tuberculosis (R37.0);

– Pneumoconiosis associated with tuberculosis (J65);

– Consequences of tuberculosis (V90.);

– Tuberculosilicosis (J65).

ICD-10

A15 Respiratory tuberculosis, bacteriologically and histologically confirmed

A15.0 Pulmonary tuberculosis, smear confirmed the presence or absence of culture growth

A15.1 Pulmonary tuberculosis, confirmed only the growth of culture

A15.2 Pulmonary tuberculosis, confirmed histologically

A15.3 Tuberculosis of lungs, unspecified methods confirmed

A15.4 Tuberculosis of intrathoracic lymph nodes, confirmed bacteriologically and histologically

Excluded if specified as primary (A15.7)

A15.5 Tuberculosis of larynx, trachea and bronchus, confirmed bacteriologically and histologically

A15.6 Tuberculous pleurisy, confirmed bacteriologically and histologically

Deleted tuberculous pleurisy in primary pulmonary tuberculosis, confirmed bacteriologically and histologically (A15.7)

A15.7 Primary respiratory tuberculosis, confirmed bacteriologically and histologically

A15.8 Tuberculosis of other respiratory organs, confirmed bacteriologically and histologically

A15.9 Tuberculosis of the respiratory unspecified location, confirmed bacteriologically and histologically

A16 Respiratory tuberculosis, not confirmed bacteriologically or histologically

A16.0 Pulmonary tuberculosis with negative results of bacteriological and histological study

A16.1 Pulmonary tuberculosis without bacteriological and histological studies

A16.2 Pulmonary tuberculosis without mention of bacteriological or histological confirmation

A16.3 Tuberculosis of intrathoracic lymph nodes without mention of bacteriological or histological confirmation of tuberculosis is excluded intrathoracic lymph nodes, specified as primary (A16.7)

A16.4 Tuberculosis of larynx, trachea and bronchus, without mention of bacteriological or histological confirmation

A16.5 Tuberculous pleurisy, without mention of bacteriological or histological confirmation

Deleted tuberculous pleurisy in primary pulmonary tuberculosis (A16.7)

A16.7 Primary respiratory tuberculosis without mention of bacteriological or histological confirmation

A16.8 Tuberculosis of other respiratory organs without mention of bacteriological or histological confirmation

A16.9 Tuberculosis of the respiratory unspecified location without mention of bacteriological or histological confirmation

+ A17 Tuberculosis of nervous system

+ A17.0 Tuberculous meningitis (G01 *)

A17.1 + Meningeal tuberculoma (G07 *)

A17.8 + Tuberculosis of nervous system other sites

A17.9 + Tuberculosis of nervous system, unspecified (G99.8 *)

A18 Tuberculosis of other organs

A18.0 + Tuberculosis of bones and joints

A18.1 + Tuberculosis urogenital

A18.2 Tuberculous peripheral lymphadenopathy

Excluded:

tuberculosis of lymph nodes:

mesenteric and retroperitoneal (A 18.3);

intrathoracic (A15.4, A16.3);

tuberculous tracheobronchial adenopathy (A 15.4 A 16.3)

A18.3 Tuberculosis of the intestine, peritoneum and mesenteric lymph nodes

A18.4 Tuberculosis of skin and subcutaneous tissue Excludes:

lupus erythematosus (L93. -)

systemic lupus erythematosus (M32. -)

A18.5 + Tuberculosis eyes

Deleted lupus century pine (A 18.4)

A18.6 + Tuberculosis ear

Deleted tuberculous mastoiditis (A18.0 +)

A18.7 + Tuberculosis of adrenal glands (E35.1 *)

A18.8 + Tuberculosis of other organs of refined

A19 Miliary tuberculosis

Included:

generalized tuberculosis;

Disseminated tuberculosis polyserositis

A19.0 Acute miliary tuberculosis, a refined localization

A19.1 Acute miliary tuberculosis of multiple localization

A19.2 Acute miliary tuberculosis, unspecified location

A19.8 Other forms of miliary tuberculosis

A19.9 Miliary tuberculosis, unspecified location

 

Classification of Tuberculosis in the Russian Federation, points out the following form of the disease.

Tuberculous intoxication in children and adolescents

Primary tuberculous complex

Tuberculosis of intrathoracic lymph nodes

Disseminated tuberculosis

Miliary tuberculosis

Focal pulmonary tuberculosis

Infiltrative pulmonary tuberculosis

Cheesy pneumonia

Lung tuberculoma

Cavitary disease

Fibro-cavernous pulmonary tuberculosis

Cirrhotic pulmonary tuberculosis

Tuberculous pleurisy (including empyema)

Tuberculosis of bronchi, trachea, upper respiratory tract, etc. (nose, mouth, pharynx)

Pulmonary tuberculosis, combined with the dust occupational lung diseases (koniotuberkulez)

Tuberculosis of meninges and central nervous system

Tuberculosis of the intestine, peritoneum and mesenteric lymph nodes

Tuberculosis of bones and joints

Tuberculosis Urinary and genital

Tuberculosis of skin and subcutaneous tissue

Tuberculosis of peripheral lymph nodes

Tuberculosis eyes

Tuberculosis of other organs

 

PRIMARY FORMS OF TUBERCULOSIS

 

1. PATHOGENESIS

Distinguished between primary and once again revealed tuberculosis. Primary tuberculosis ill previously infected M. tuberculosis people, but not all in contact with batsillovydelitelem, but only 7-10% of them.Recall that in tuberculosis often enough valid point: Infected – not to get sick.The term primary indicates in its pathogenesis, ie the occurrence of the disease during primary infection and, therefore, in the absence of specific immunity.The term newly revealed only shows that the earlier a person was diagnosed with tuberculosis, he is not registered in a tuberculosis institution.The newly detected tuberculosis can be both primary and secondary. Among newly diagnosed patients with primary disease is about 1% of cases.

Penetration of Mycobacterium tuberculosis in the human body gives rise to a chain of events that are defined over time.• The primary causative agent of tuberculosis from entering the lungs or other organ of the body previously uninfected causes an acute nonspecific inflammatory reaction rarely recognizable clinically as symptoms are scarce or clinical signs did not exist.Macrophages absorb mycobacteria and transfer them to regional lymph nodes. At the local primary infection during the first week 50% of macrophages contain Mycobacterium tuberculosis infection during the second (with immunity) is quickly destroyed most bacteria, Mycobacterium tuberculosis contains only 3% of macrophages. As a facultative intracellular parasite, the majority of M. tuberculosis phagosomes in macrophages.Phagocytosis is incomplete, because the mycobacterium capable of producing an enzyme that inhibits fusion of phagosomes with lysosomes. If the spread of the pathogen does not stop at the level of lymph nodes, mycobacteria through the thoracic duct into the bloodstream and spread throughout the body. In most cases, contamination sites M. tuberculosis, as well as lung damage at the site of the primary lesion, independently organized, but they remain a potential source of reactivation of tuberculosis late during the entire life of the patient.Dissemination may lead to miliary tuberculosis or tuberculous meningitis with a high risk of severe course and fatal outcome, especially in infants and young children.

Within 2-8 weeks. after primary infection, while bacilli continue to multiply inside macrophages, the human body develops T-cell mediated DTH. Immunocompetent lymphocytes enter the zone of penetration of the pathogen, where they secrete chemotactic factors such as interleukins and lymphokines.In response, monocytes migrate to the same here and transform into macrophages, and then – in the histiocytic cells (macrophages in situ), later organized in the granuloma.Mycobacteria can persist in macrophages for many years, in spite of the intensive synthesis of lysozyme by these cells, but further reproduction and distribution of primary infection was limited to phagocytosis.

The subsequent healing of primary affect is often accompanied by calcination, visualized on plain film of the chest.The combination of calcification in the lung lymph node with soda in the lung root is called a complex Gon (Ghon).

In the U.S., 90-95% of the population with good immunity observed complete healing of primary tuberculous passion without any further manifestations of tuberculosis. In countries where infection with a massive, inadequate nutrition, or there are other adverse factors, 5-10% positive note incomplete healing of primary affect. Malnutrition and related diseases adversely affect healing and pose a threat to the reactivation of changes, remaining at the site of a primary tuberculous lesion.

Formation of the primary forms of tuberculosis, like the swell of stormy sea.Outwardly, all was well, the child is happy and looks healthy, but turn tuberculin skin test has already sounded the starting shot for the development of disease.

If, within 4-8 weeks. in the body formed by a little man trained clone of T lymphocytes, a terrible disease will not develop, and die in a dynamic equilibrium, referred to as non-sterile cellular immunity.Formed mechanism stop, and then cure the lesion, which arose at the site of pathogen penetration and lymph nodes. Now – if they happen reactivation process – the disease will develop in the presence of immunity, ie, on pathogenesis will be secondary. It was during the infection of the appointment of chemoprophylaxis may be decisive in such a happy end.Isoniazid reduces the amount of the population of mycobacteria in the body, but left after the development of complete phagocytosis of the information matrix will serve to teach T-cells.

If it happens that the population of M. tuberculosis in the body is large (massive infection and was repeated many times), it is still imperfect mechanisms immunogenesis child can not cope with the creation of a specific security.Mycobacteria produce humoral factors that inhibit fusion of lysosomes with phagosomes in macrophages, ie, the completion of phagocytosis, which is essential representation of the genetic information of the exciter immunocompetent cells. Mycobacteria produce toxins that violate the metabolic processes in children’s body and lead to a vegetative shifts. Then the disease progresses, the primary affect the lymph nodes may be increased by engaging in the process of new areas of tissue or adjacent organs. Progressive primary tuberculosis is most typical for newborns and persons infected with HIV-1. Affected lymph nodes may cause further infection, bacteremia, dissemination, and even the generalization process.

Thus, the primary disease occurs when infection of M. tuberculosis previously uninfected individuals and is characterized by axillary lymph nodes, limfogematogennoy dissimination agent and high reactivity of the organism to the pathogen of the disease.

Suspicion of TB in children should occur in the following cases described by F. Miller (1984):

Cessation weight gain, weight loss gradual, lethargy for 2-3 months. And sometimes intermittent fever.

The sudden rise in body temperature (temperature of formation), sometimes in conjunction with erythema nodosum and tuberculous-allergic (phlyctenular) conjunctivitis. The temperature of formation can last up to 3 weeks.

Cessation weight gain in children combined with poor hoarse breathing, persistent cough, sometimes.

Abrupt onset of fever and pain with pleural effusion.

Abdominal distention and ascites.

Dense and painful education in the abdominal cavity.

Lameness and painful swelling in large joints.

Difficulties when tilted, stiff and sore back, it is possible deformation and girdle pain.

Painless swelling of peripheral lymph nodes, surrounded by smaller lymph nodes.

Any abscesses, which is localized in the peripheral lymph node, especially developed gradually.

Subcutaneous abscesses or ulcers on the skin without apparent reason.

The sudden and unexplained changes in mood and behavior of the child (such as excessive irritability), accompanied by a rise in body temperature, nausea and sometimes headaches.

Weight loss and lethargy in older children and adolescents, combined with a productive cough.

Long-term recovery after undergoing prolonged measles, whooping cough, streptococcal tonsillitis or other intercurrent infections.

Signs of intracranial volume process or diffuse encephalitis in children.

Painless hematuria or sterile pyuria in a child.

The structure of the clinical forms of tuberculosis in children and adolescents in many countries fall short of.

In Russia, children’s primary tuberculosis – the main form in adolescents and young adults it is 10-20% of cases, and in adults is much rarer.

The structure of childhood TB in India on the example of children’s ward at the Medical College Rotake in 1996 was as follows: tuberculous meningitis – 52.04%, pulmonary tuberculosis – 26.53%, disseminated tuberculosis – 7.04%, tuberculosis, gastro-intestinal tract (GI) – 3.06%, tuberculous lymphadenitis – 2.04%.

This distribution of diagnoses clearly reflects the effect of mass vaccination with BCG, significantly reduces the proportion of tuberculous meningitis and leads to a change in the structure of primary tuberculosis.

There are the following clinical forms of primary tuberculosis:

tuberculous intoxication in children and adolescents;

Tuberculosis of intrathoracic lymph nodes;

Primary tuberculous complex;

chronically current primary tuberculosis.

 

 

1. CLINICAL FORMS

Primary TB infection usually is asymptomatic. Nonspecific pneumonitis is commonly found in middle or lower portions of the lungs. Swollen lymph nodes in the roots of the lungs characteristic of primary tuberculosis in childhood can cause bronchial obstructions and be its first clinical manifestation.

 

Tuberculosis intoxication

Tuberculous intoxication in children and adolescents with fresh infection occurs as early intoxication, and chronic course is called chronic intoxication.This is a clinical syndrome of primary TB infection, caused by functional disorders without local manifestations of tuberculosis, detected radiological or other methods.

 

Early tuberculous intoxication. In the early tuberculous intoxication in children can be depleted excitability.It is easily excited, laughing, but this joy can quickly go into mourning, or apathy. This lability of the nervous system requires differential diagnosis with thyroid cancer, especially in endemic goiter areas. Often the child is examined by the ENT doctor, ophthalmologist, Neve ropatologa before he reveals tuberculous intoxication.This is associated with the development of so-called paraspetsificheskih reactions in tuberculosis. Specific reaction – occurrence of caseous granulomas in the place of introduction of mycobacteria in tissue. Paraspetsificheskaya response – to change the organs and tissues in response to the presence tuberkulotoksinov in the body.Lymphoid nodules and limfogistiotsitarnye and infiltrates, macrophage infiltration, without a specific cellular response and kazeoza can develop in the tissues of the lung, liver, heart, spleen, and in mucous and serous membranes and other organs and tissues. All this leads to a variety of masks primary TB infection, such as frequent upper respiratory tract catarrh, keratoconjunctivitis phlyctenular, erythema nodosum, etc.Characterized by an increase in cervical lymph nodes, submandibular, and axillary groups of up to II-I1I-sized units have soft-elastic consistency. In the peripheral blood often reveal eosinophilia. The most important differential diagnostic feature of early tuberculous intoxication – the coincidence of these functional disorders and morphological changes in superelevation tuberculin reactions.

 

Chronic tuberculous intoxication. In chronic tuberculous intoxication hallmarks are lagging behind in child development, pallor, mikropoliadeniya (6-9 groups of lymph nodes from elastic consistency to the “pebbles”). What is important is the fact that after a bend tuberculin tests was 1 year or more, and maintain a positive tuberculin test or increase.

This form of primary TB requires complex chemotherapy at least 6 months. and can be cured with little or no residual changes. Mycobacteria are present in the body, are transformed into slabovirulentnye or persistent L-forms, but the child remains infected for years to come.

Progression and proliferation of primary TB infection occurs predominantly via the lymphatic system. BCG vaccination has not previously infected person contributes to localization of infection at the level of generalization without lymph node or local organ damage and tissue. First and foremost is the defeat of the intrathoracic lymph nodes.

 

Tuberculosis of intrathoracic lymph nodes

Tuberculosis of intrathoracic lymph nodes are usually morphologically subdivided into infiltrative form, similar to the basal pneumonia, which is characterized mainly perifocal reaction around the affected sites, and tumoroznuyu shape similar to that of neoplastic diseases and is characterized mainly by hyperplasia of the lymph nodes and kazeozom.Intrathoracic lymph nodes taken to subdivide the paratracheal, tracheobronchial, bifurcation, and bronchopulmonary that determines the topographical location of tuberculosis in this clinical form. With a well-functioning pediatric tuberculosis of intrathoracic lymph nodes often detect when examining a child or adolescent on a bend tuberculin tests, but younger children may be acute forms with high body temperature and toxicity.Ftiziopediatry secrete a number of characteristic symptoms.

When viewed from the front chest wall can be seen the expansion of peripheral venous network in the I-II intercostal space with one or two sides. It is a symptom Vidergoffera indicative of compression of azygos vein.

Extension of small surface vessels in the upper third of the interscapular space – a symptom of Frank.

Pain when pressing on the spinous processes of upper thoracic vertebrae (III-VII) – Parsley positive symptom, reflecting the recent inflammatory changes in the posterior mediastinum.

Dullness of percussion sound in children below 2 years I thoracic vertebrae, up to 10 years – lower II, over 10 years – lower thoracic vertebra III (better with percussion quietest on the spine) – a symptom of the Koran, occurring in inflammatory processes of the posterior mediastinum, bifurcation lymph nodes and infiltration of surrounding tissue.

With the defeat of paratracheal lymph nodes and mediastinal pleura, that is, the anterior mediastinum, reveal dullness of percussion sound in the grip of the sternum and the first two intercostal space with the boundary, tapering downwards – a symptom of the cup Filosofova.

Auscultation may detect a symptom d’Espina when Bronhofoniya (pektorilokviya) auscultated on the spinal cord below the thoracic vertebrae to the I bifurcation of the trachea in the pronunciation of sick hissing sounds.

Listening over the spine tracheal breathing in normal young children spent at least VII of the cervical or thoracic vertebrae I, characteristic for bronhoadenita. Hebner is a symptom.

There are also symptoms of Filatov, Geno de Musset and others

Most often the process of identify radiographically. Expansion of the shadow of the root and the violation of its structure are more often unilateral, it is easier to detect these changes in right bronhoadenite. Meet the unilateral expansion of the upper mediastinum. Infiltrative type of tuberculosis of intrathoracic lymph nodes is characterized by vague outlines of an extended root of the lung, the result perinodulyarnogo inflammation. When a tumor in the form of a leading feature of X-ray picture is a significant increase in the lymph nodes – expansion, extension and change the structure of the root of the lung. Outdoor shadow boundaries are convex, wavy, sometimes hilly contours and combined with the inability to differentiate individual lymph nodes within the package.

Reliable picture can be obtained using CT scans of the chest.

Clinical manifestations of tuberculosis of intrathoracic lymph nodes are due to complications of the clinical forms: the breakthrough molten caseous node in the lumen of the bronchus, followed by its obturation and bronchogenic colonization, lung distal to the site pererazdutiem space compression or obstruction, the development of distelektaza and atelectasis. Perhaps the development of pericarditis in breaking and draining lymph node in the pericardium.

Meet more than 30 diseases detected by X-ray examination of the mediastinum and lung roots. Some of them have a favorite location in the chest (see Table. 5.1.

Table 5.1 Favourite localization of pathological processes in the chest

Anterior mediastinum	Average mediastinum	Postmediastinum
Thyroid tumors Thymal hyperplasia Teratomas and dermoid cysts Coelomic pericardial cysts Fatty tumors of the mediastinum Aneurysm ascending aorta	Tuberculosis of intrathoracic lymph nodes Lymphogranulomatosis Lymphosarcoma Lymphocytic leukemia Nonspecific adenopathy with measles, whooping cough, viral infections, sarcoidosis Aneurysm of the aortic arch Aortarctia Hemodynamic instability with heart defects Mediastinal cancer	Neurogenic Education Wandering abscess Aortic aneurysm Tumors of the esophagus Broncho-and duplication cyst

By EN Yanchenko, MS Greymer, 1987

Differential diagnosis

The differential diagnosis of tuberculosis of intrathoracic lymph nodes performed with hilar form of sarcoidosis of the lungs. In favor of sarcoid lesions are symmetric and negative tuberculin test.

When chlamydia swollen lymph nodes is more pronounced in the degree and extent. Predominant lesion sites anterior mediastinum, but not the roots of light, shadow nodes krupnobugristye.

In the anterior mediastinum in children is the thymus gland, it can also simulate an increase bronhoadenit.

Unlike retrosternal goiter without hyperthyroidism phenomena detected by X-ray: in breathing and swallowing crop shifts. Even more significantly radioisotope study of thyroid cancer.

The mainstay of treatment of tuberculosis of intrathoracic lymph nodes – long-term chemotherapy, it is best done in a sanatorium. Large lymph nodes causing compression or pressure sore formation of the mediastinum, subject to surgical removal.

 

PRIMARY TB COMPLEX

Nosological diagnosis ‘primary tuberculous complex’ was proposed by Ranke meant by his primary focus in the lung (pulmonary component), a group of diseased intrathoracic lymph nodes (glandular component) and specific lymphangitis lymphatic vessels extending from the pulmonary component of glandular hairs.Previously, this form of primary tuberculosis was most prevalent. With the widespread use of BCG, it has become less frequent, giving the prevalence of tuberculosis of intrathoracic lymph nodes. In its current primary tuberculous complex goes through four stages:

Initial – pneumatic;

stage of the organization, when resorption begins infiltration zone and appears bipolarity (symptom Redeker);

stage of calcification;

stage of the primary tuberculous complex petrifitsirovannogo.

This clinical form may have a fairly acute onset of intoxication, similar to the start of pneumonia. At the same time are often blurred during the encounter of the disease when diagnosed with TB do not, and when the next X-ray examination in the light and find its root dense foci of calcification or. Adolescents and young adults the primary tuberculous complex may be clinically recognized already at the stage of complications, these include tuberculosis, bronchial atelectasis, bronchopulmonary lesions (equity and segmental processes), and hematogenous dissemination lymphogenic, pleurisy, a primary cavity and caseous pneumonia.

 

CURRENT CHRONIC PRIMARY TUBERCULOSIS

Chronically current primary tuberculosis – a consequence of untimely detection of tuberculosis of intrathoracic lymph nodes arising in childhood or adolescence. The process takes place in waves, exacerbation may appear different. In the event of fistulous forms may bronhoadenita bronchogenic, lymphatic or hematogenous spread. Characterized by long-continued intoxication, tuberculin sensitivity is often increased.

In regions with low prevalence of tuberculosis primary infection often occurs in adults. They have less than children, are formed of large packages cheesy lymph nodes, particularly at the bifurcation, so the trachea, large bronchi, nerve trunks and their endings are rarely involved in the process. More likely to occur bronchopulmonary lesion group.

If reactivation of tuberculosis in the intrathoracic lymph nodes may develop TB adenogennogo bronchial

CONCLUSION

Finally, we note that among the many factors determining the age should be considered for the flow of primary tuberculosis. Newborn Infection Mycobacterium often leads to rapid development of the disease at high risk for the formation of miliary tuberculosis and tuberculous meningitis. Children from 1-2 years before puberty and primary affect is almost always heal, but can be reactivated at puberty or later. Adults in the case of primary infection have the greatest risk of developing the disease within 3 years. Among young patients are women, whereas men are more likely to become ill later in life.

 

Ill. Pleural tuberculosis

As pleurisy in Russia is most often affects young people and accompany primary disease, we dwell on pleural tuberculosis.According to Vladimir Sokolov (1998), the incidence of tuberculosis in the presence of pleural syndrome of 49.6%, while the percentage of pneumonia as a cause of pleurisy is only 17.9%. There are three options for pleural tuberculosis:

Allergic pleurisy occurring as paraspetsificheskaya reaction.In this case, the pleural fluid mycobacteria not be detected.

Perifocal pleurisy – damage to the pleura, directly adjacent to the site of lung tissue that is affected by tuberculosis.

Actually tuberculous pleurisy – hematogenous seeding of pleural tuberculosis bacteria to form on her sheets tubercle tubercles, in this case perhaps bacteriological detection of M. tuberculosis, and at thoracoscopy – visualization of the process and taking biopsies.

Clinic and diagnostics. For general practitioners it is crucial to identify the fluid in the pleural cavity. Pleural effusion, often massive, with pain in his side on the affected side. Symptoms can progress quite rapidly. Most often is unilateral effusion, but there are bilateral. Classically exudative tuberculous pleurisy occurs in young people, who have not bolevshih tuberculosis.

Radiography. To direct plain film in the vertical position of the patient level can be reliably seen only in the presence of 500 ml or more, because effusion is evenly distributed around the perimeter of the dome diaphragm. In the absence of air in the pleural cavity (before the first puncture) precise horizontal level is not visible. Note the intense shading in the lower divisions, gradually shifting the mediastinum organs in the opposite direction of the defeat. If you suspect the presence of effusion in the pleural cavity is necessary to make X-ray photograph of the patient on the patient side (laterogrammu): image must be a direct projection.Then along the costal surface of the rib marks (in the picture – the bottom) will be visible to the liquid. In an interview for advanced treatments, we specifically focus on technology pleural puncture, which serves a key event in the diagnosis and treatment of pleural effusions. GP should not have illusions about the spontaneous resorption of fluid. Frequently pleural effusion without effusion evacuation ends precipitation of fibrin adhesive process and in the worst case – severe chronic purulent processes in the pleural cavity, or empyema.

Pleural puncture. The tubercular pleurisy effusion is in the nature of fluid, protein content of less than 3 g%, in the fluid is usually dominated by lymphocytes, cells of the mesothelium are rarely encountered. When biopsy of the parietal pleura can be found granulomas, which confirms the diagnosis of tuberculous pleurisy. Tuberculin skin test is negative one third of patients, as pleural effusion often occurs before developing hypersensitivity to tuberculin.

Serious complication of untreated tuberculosis – bronchopleural fistula and empyema due to tuberculosis breakthrough content of pulmonary focus into the pleural cavity.In this case, the diagnosis is easier to deliver, as in a liquid are often present mycobacteria.

Treatment Tuberculous pleurisy responds well to specific treatment. Carrying pleural puncture is necessary both for diagnostic and therapeutic purposes. If the liquid is quickly evacuated, and falls are formed fibrin adhesions. Pumping liquid “dry” unjustified, since high risk of injury of the lung. The need for surgical decortication is rare. Treatment consists of draining the pleural cavity, and chemotherapy.

According to researchers the U.S., two thirds of patients after tuberculous pleurisy, within 5 years of developing active tuberculosis.

 

 

Medical Opinion

Based on the above text, lectures can come to the conclusion that the acquisition of theoretical knowledge and practical skills in the classification of clinical forms of tuberculosis, diagnosis and differential diagnosis of primary forms of tuberculosis – tuberculous intoxication in children and adolescents, primary TB complex, and tuberculosis of intrathoracic lymph nodes, one of the highlights of timely diagnosis and treatment of early forms of tuberculosis, prevention of common and chronic forms of tuberculosis, as well as to improve the epidemiological situation, reducing the incidence of tuberculosis.