Disseminated pulmonary tuberculosis - Overview of information

Disseminated pulmonary tuberculosis is characterized by multiple lesions of organs and tissues by the tuberculous process.

Depending on the prevalence of the lesion, there are three main types of disseminated tuberculosis:

• generalized:
• with predominant damage to the lungs;
• with predominant damage to other organs.

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Disseminated pulmonary tuberculosis: epidemiology

Generalized disseminated tuberculosis is observed relatively rarely. Much more often, in approximately 90% of patients, disseminated tuberculosis develops with predominant lung damage.

Disseminated pulmonary tuberculosis is diagnosed in 5% of newly diagnosed tuberculosis patients. Among those registered in anti-tuberculosis dispensaries, patients with this form of tuberculosis make up 12%. Disseminated tuberculosis causes death in 3% of patients dying from this disease.

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What causes disseminated pulmonary tuberculosis?

Disseminated tuberculosis may develop in complicated cases of primary tuberculosis as a result of increased inflammatory response and early generalization of the process. Most often, disseminated tuberculosis occurs several years after clinical cure of primary tuberculosis and formation of residual post-tuberculous changes: Ghon's focus and/or calcification. In these cases, the development of disseminated tuberculosis is associated with late generalization of the tuberculous process.

The main source of mycobacteria spread during the development of disseminated tuberculosis is considered to be residual foci of infection in the intrathoracic lymph nodes, formed during the process of reverse development of the primary period of tuberculosis infection. Sometimes the source of mycobacteria dissemination in the form of a calcified primary focus can be localized in the lung or another organ.

Symptoms of disseminated pulmonary tuberculosis

Various pathomorphological changes and pathophysiological disorders that occur in disseminated tuberculosis cause a wide variety of its clinical manifestations.

Acute disseminated pulmonary tuberculosis usually develops over 3-5 days, reaching full expression by the 7th-10th day of the disease. The first symptoms to appear are intoxication: weakness, increased sweating, loss of appetite, fever, headache, and sometimes dyspeptic disorders. Body temperature quickly rises to 38-39 °C; hectic fever is noted. The increase in intoxication and functional disorders is accompanied by weight loss, adynamia, increased sweating, confusion or temporary loss of consciousness, delirium, tachycardia, and acrocyanosis. A characteristic clinical symptom is shortness of breath. Cough may occur, often dry, sometimes with the release of scanty mucous sputum. In some cases, a delicate roseolous rash appears on the anterior surface of the chest and upper abdomen, caused by the development of toxic-allergic thrombovasculitis.

Diagnosis of disseminated pulmonary tuberculosis

Disseminated pulmonary tuberculosis has a characteristic radiographic sign - focal dissemination. Hematogenous and lymphohematogenous dissemination are characterized by multiple focal shadows, which are located in both lungs relatively symmetrically. In lymphogenous dissemination, focal shadows are often determined in one lung, mainly in the middle sections. Bilateral lymphogenous dissemination is usually asymmetrical.

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