Primary Tuberculosis - Symptoms

Clinical symptoms of primary tuberculosis can be conditionally combined into three main syndromes: intoxication, bronchopulmonary-pleural, and syndrome of damage to other organs and systems.

Intoxication syndrome is caused by metabolic and functional disorders that occur in primary tuberculosis. Early clinical signs of tuberculosis intoxication are considered to be functional disorders of the central nervous system (irritability, emotional lability), vegetative-vascular dysfunction (tachycardia, arrhythmia, tendency to hypotension, systolic murmur over the apex of the heart), loss of appetite, increased sweating. Tolerance to physical and mental stress is often reduced, as is the ability to concentrate. Inconstant fever with short-term isolated increases in body temperature to subfebrile values in the afternoon is characteristic. In adolescent girls, the appearance of the first menstruation is delayed or they stop for the duration of the illness due to neuroendocrine dysfunction. With prolonged intoxication syndrome (5-6 months or more), emotional lability increases, lethargy and adynamia, body weight deficit, and delayed physical development often occur. Paleness and dryness of the skin, decreased skin turgor and muscle tone are noted.

In tuberculous intoxication as a clinical form of tuberculosis, the intoxication syndrome is the predominant (sometimes the only) clinical sign of the disease. Symptoms of primary tuberculosis of local specific inflammation are not detected in patients with tuberculous intoxication. They often have local nonspecific (paraspecific) changes caused by the presence of Mycobacterium tuberculosis in the body. These changes are most pronounced in the peripheral lymph nodes. Palpation can reveal enlarged lymph nodes of five to nine groups, including supraclavicular and cubital, up to 5-14 mm in diameter. The lymph nodes are painless, mobile, of soft elastic consistency without signs of peri-adenitis and inflammation of the skin. Micropolyadenopathy is more pronounced in preschool children and to a lesser extent in adolescents and young adults. Lymphoid tissue hyperplasia may also manifest as enlarged liver and spleen.

In the chronic course of tuberculosis intoxication, the lymph nodes gradually decrease in size and become denser (sometimes to a stony density).

Symptoms of primary tuberculosis caused by damage to the respiratory organs, in tuberculosis of the intrathoracic lymph nodes and the primary tuberculosis complex depend on the prevalence of the process and the caseous-necrotic component of specific inflammation, as well as the phase of the inflammatory reaction. In infants and young children, local forms of primary tuberculosis are characterized by vivid clinical manifestations. In older age, their symptoms are often quite meager.

In small forms of tuberculosis of the intrathoracic lymph nodes, no more than 2 intrathoracic lymph nodes are affected by specific inflammation, and their diameter does not exceed 1.5 cm. Small forms of tuberculosis of the intrathoracic lymph nodes often occur without obvious clinical manifestations. The disease is diagnosed mainly by the sensitivity turn to tuberculin and X-ray data, mainly CT.

Tuberculosis of the intrathoracic lymph nodes with a large lesion volume usually begins subacutely, with a gradual increase in intoxication symptoms. With a pronounced exudative perinodular reaction with the involvement of all groups of lymph nodes of the lung root and mediastinum in the pathological process, the disease develops acutely. In this case, febrile fever and general functional disorders are noted. Patients may develop a characteristic dry whooping cough-like (bitonal) cough. In some patients, the pressure of enlarged lymph nodes on the bifurcation of the trachea and the mouth of the main bronchi causes stridor breathing.

Narrowing of the superior vena cava by enlarged mediastinal lymph nodes leads to a more or less pronounced superior vena cava syndrome: the network of subcutaneous veins on the anterior surface of the chest on one or both sides expands. When the superior vena cava is compressed, other symptoms of primary tuberculosis are sometimes expressed: headache, cyanosis and puffiness of the face, an increase in the volume of the neck. increased venous pressure.

Stetoacoustic symptoms of tuberculous lesions of the intrathoracic lymph nodes are caused by perifocal nonspecific inflammatory changes in the mediastinum. They reveal muffled percussion sound in the parasternal and paravertebral zones, increased bronchophony over the spinous processes of the thoracic vertebrae, venous murmur of the top over the upper part of the manubrium of the sternum when the head is thrown back sharply. Without a perifocal inflammatory reaction, it is impossible to detect an increase in intrathoracic lymph nodes using physical methods.

Primary tuberculosis complex is often diagnosed during examination for mild symptoms of intoxication or a change in sensitivity to tuberculin. With extensive perifocal inflammation around the primary pulmonary focus, the disease develops acutely, which is typical for preschool-age children. Cough with a small amount of sputum and febrile fever are observed.

In case of significant perifocal inflammation, when the extent of the pulmonary lesion exceeds the size of the segment, dullness of the percussion sound can be detected and weakened breathing with increased exhalation can be heard. After coughing, inconstant single fine-bubble rales are heard over the affected area.

In all forms of primary tuberculosis, toxic-allergic, paraspecific changes may develop in various tissues and organs, which are usually associated with the toxic effect of the waste products of tuberculosis mycobacteria. These changes may manifest as conjunctivitis, phlyctena, erythema nodosum, blepharitis, allergic pleurisy, polyserositis or arthritis (Ponce rheumatoid arthritis). Reactive paraspecific hepatitis, detected by ultrasound, is occasionally noted.

Paraspecific reactions are very typical for primary tuberculosis. They are associated with a wide variety of disease manifestations, which in clinical practice are called "masks" of primary tuberculosis. Primary tuberculosis, especially in adults, can occur under the "mask" of bronchial asthma, endocrine, cardiovascular, gastrointestinal diseases, as well as diseases of the liver, kidneys, connective tissue and neurodystrophic disorders.

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