Symptoms of the primary tuberculosis complex

Symptoms of the primary tuberculosis complex are diverse and depend on the severity of morphological changes at the time of the child's examination. The clinical symptomatology depends on the size of the caseous focus, mainly on the severity of the perifocal inflammation zone in the specific process of the intrathoracic lymph nodes.

Inflammatory changes in primary tuberculosis depend to some extent on the child's age. Particularly pronounced propensity to extensive processes in the primary period in children in the age group up to 7 years. This circumstance is due to the fact that at this age the differentiation of the pulmonary tissue has not yet been completed, wide lumens of lymphatic fissures, friable connective septums, rich in lymphatic vessels remain, which promotes the spread of inflammatory changes. Symptoms of the primary tuberculosis complex in children in the younger age group are expressed to the greatest extent and are characterized by widespread and complicated forms.

In cases where the size of the primary focus is small, the perifocal infiltration zone is missing or inconspicuous, the changes in the intrathoracic lymph nodes are limited, the clinical manifestations of the primary complex are erased and are not highly symptomatic. In some cases, the primary complex has an asymptomatic course, and it is detected already in the phase of reverse development - calcification. The evolution of the primary pulmonary focus can be different. A small focus with a predominance of infiltrative, rather than caseous changes can completely resolve. In other cases, lime is deposited in the outbreak with the formation of the so-called Gon focus. However, in such cases, resorption of lime and a significant decrease, and in some cases - complete disappearance of the focus, are possible.

It is accepted to distinguish between the smooth and complicated course of the primary tuberculosis complex. In modern conditions, when the clinical manifestations of tuberculosis become depleted, it is not always possible to strictly classify the nature of the onset of the disease. In some cases, the primary complex can have a gradual development: for several weeks, and sometimes months, note a violation of the child's well-being, he becomes sluggish, whiny or emotionally labile. The appetite decreases, the body weight decreases, when measuring the body temperature, it is usually found that the subfebrile condition is of the wrong type. In some children, the primary complex may have a latent flow, then it is detected as a result of a preventive X-ray study. In the uncomplicated course of the primary tuberculosis complex, the severity of clinical manifestations, even in the absence of tuberculostatic therapy, decreases after 2-4 weeks: the body temperature decreases, but the subfebrile state of the wrong type persists for a long time. There is a decrease in ESR and leukocytosis, an increase in the number of lymphocytes. Symptoms of intoxication during this period are usually preserved and can even increase somewhat. The child retains pronounced anorexia, he lags in weight and height, is moody, irritable. The course of the uncomplicated primary complex and its outcome to a certain extent depend on the timely application of tuberculostatic therapy.

With the severity of the infiltration phase, the complicated course of the primary complex develops. More often you can note the acute onset of the disease, body temperature rises to febrile numbers, decreased appetite, lethargy, fast fatigue. A sick child during a period of rising body temperature can maintain a relatively satisfactory state of health, which is characteristic of a specific process. In some cases, you can note a runny nose, flushing in the throat, a small cough, which is due to the development of parallergy in tuberculosis. Complaints on coughing are rare, although in children of early age, a biton cough is possible, and in case of bronchial involvement - dry paroxysmal.

Paraspecific changes are a characteristic diagnostic sign, manifested in the form of erythema nodosum, phlyctenous keratoconjunctivitis, pseudo-rheumatism of the Ponce type. Currently, such manifestations are rare, but in some children they sometimes occur during a period of fever. When examined, the paleness of the skin is revealed, the skin turgor decreases, the body weight decreases. Peripheral lymph nodes are palpated in more than five groups, soft-elastic consistency, mobile, painless, enlarged to the size of a pea and more.

Percutary changes in the primary tuberculosis complex prevail over the auscultatory: the shortening of percussion sound or its blunting over the site of infiltration in the pulmonary tissue. The same percussion data correspond to the regional hilar lymph nodes. The size of the shortening zone of percussion sound is sometimes significant, especially in young children, they can detect such a zone within a segment or even a fraction.

When listening to the percussion sound shortening zone, weakened breathing with prolonged exhalation is determined. With fresh processes in a restricted area, damp rales of small bubbles are occasionally heard. However, in recent years, catarrhal phenomena often do not show up at all. With the resolution of perifocal phenomena and the compaction of the primary focus, blunting decreases, breathing becomes more rigid.

From the cardiovascular system can be noted diffuse changes in the myocardium, which causes the expansion of the heart, arrhythmia, tachycardia. Systolic murmur, lowering blood pressure. When examining the organs of the abdominal cavity, there is an increase in the liver and spleen, sometimes soreness in the course of the mesentery, in the region of the mesenteric nodes. A study of the patient's sensitivity to tuberculin in a Mantoux sample with 2 TE usually establishes a turn of tuberculin reactions or a period immediately after the turn. At the beginning of the disease, changes in the hemogram occur: moderate leukocytosis (up to 8-10x10 ⁹ / l) with an increase in the number of neutrophils, an increase in ESR to 25-30 mm / h. When studying protein fractions, an increase in the content of globulins is noted, mainly due to gamma fractions. Mark positive serological reactions with different fractions of MW.

Children with primary forms of tuberculosis rarely sputum. In this regard, to determine the bacterial release, it is necessary to examine the flushing waters of the bronchi, and in young children - the gastric washings.