Symptoms of the primary tuberculosis complex

Symptoms of the primary tuberculosis complex are varied and depend on the severity of morphological changes at the time of examination of the child. Clinical symptoms depend on the size of the caseous lesion, 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 a certain extent on the child's age. The tendency to extensive processes in the primary period is especially pronounced in children under 7 years of age. This circumstance is due to the fact that at this age the differentiation of the lung tissue is not yet complete, it retains wide lumens of lymphatic slits, loose connective septa, rich in lymphatic vessels, which contributes to 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 primary lesion is small, the perifocal infiltration zone is absent or poorly represented, changes in the intrathoracic lymph nodes are limited, and clinical manifestations of the primary complex are vague and asymptomatic. In some cases, the primary complex is asymptomatic and is detected already in the phase of reverse development - calcification. The evolution of the primary pulmonary lesion may be different. A small lesion with a predominance of infiltrative rather than caseous changes may completely resolve. In other cases, lime deposition occurs in the lesion, forming the so-called Ghon lesion. However, even in such cases, lime resorption and a significant reduction, and in some cases, complete disappearance of the lesion are possible.

It is customary to distinguish between smooth and complicated course of primary tuberculosis complex. In modern conditions, when clinical manifestations of tuberculosis become latent, it is not always possible to strictly classify the nature of the onset of the disease. In some cases, the primary complex may have a gradual development: over several weeks, and sometimes months, a child's well-being is impaired, he or she becomes lethargic, whiny or emotionally labile. Appetite decreases, body weight decreases, and when measuring body temperature, subfebrile temperature of the wrong type is usually detected. In some children, the primary complex may have a latent course, then it is detected as a result of a preventive X-ray examination. With an uncomplicated course of primary tuberculosis complex, the severity of clinical manifestations, even in the absence of tuberculostatic therapy, decreases after 2-4 weeks: body temperature decreases, but subfebrile temperature of the wrong type remains for a long time. A decrease in ESR and leukocytosis, an increase in the number of lymphocytes are noted. Symptoms of intoxication during this period usually persist and may even increase somewhat. The child continues to have pronounced anorexia, he lags behind in body weight and growth, is capricious, irritable. The course of uncomplicated primary complex and its outcome depend to a certain extent on the timely use of tuberculostatic therapy.

With the severity of the infiltration phase, a complicated course of the primary complex develops. Most often, one can note an acute onset of the disease, an increase in body temperature to febrile numbers, loss of appetite, lethargy, and rapid fatigue. A sick child during the period of increased body temperature can maintain a relatively satisfactory state of health, which is characteristic of a specific process. In some cases, one can note a runny nose, hyperemia in the pharynx, a slight cough, which is due to the development of paraallergy in tuberculosis. Complaints of cough are rare, although in young children, a bitonal cough is possible, and with bronchial damage - a dry paroxysmal cough.

Paraspecific changes are a characteristic diagnostic sign, manifested as erythema nodosum, phlyctenular keratoconjunctivitis, pseudorheumatism of the Poncet type. Currently, such manifestations are rare, but in some children they sometimes occur during an increase in body temperature. During examination, paleness of the skin, decreased skin turgor, and body weight are revealed. Peripheral lymph nodes are palpated in more than five groups, soft elastic consistency, mobile, painless, enlarged to the size of a pea or more.

Percussion changes in primary tuberculosis complex prevail over auscultatory ones: shortening of percussion sound or its dullness is determined above the area of infiltration in the lung tissue. The same percussion data correspond to regional intrathoracic lymph nodes. The size of the zone of shortening of percussion sound is sometimes significant, especially in young children, in them such a zone can be detected within a segment or even a lobe.

When listening over the area of shortening of the percussion sound, weakened breathing with an extended exhalation is determined. In fresh processes in a limited area, moist fine-bubble rales are occasionally heard. However, in recent years, catarrhal phenomena are often not detected at all. As the perifocal phenomena resolve and the primary focus becomes denser, the dullness decreases, and breathing becomes harsher.

From the cardiovascular system, diffuse changes in the myocardium can be noted, which causes expansion of the heart borders, arrhythmia, tachycardia. systolic murmur, decreased blood pressure. When examining the abdominal organs, an enlarged liver and spleen are found, sometimes pain along the mesentery, in the area of the mesenteric nodes. A study of the patient's sensitivity to tuberculin using the Mantoux test with 2 TE usually establishes a turn in tuberculin reactions or the period immediately following the turn. At the onset 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. Positive serological reactions with various fractions of MBT are noted.

Children with primary forms of tuberculosis rarely produce sputum. In this regard, to determine bacterial excretion, it is necessary to examine bronchial lavage waters, and in younger children - gastric lavage waters.