Disseminated pulmonary tuberculosis: a review of information

Disseminated pulmonary tuberculosis is characterized by the multiple nature of organ and tissue damage caused by the tuberculosis process.

Depending on the prevalence of the lesion, three main variants of disseminated tuberculosis are distinguished:

• generalized:
• with predominantly affecting the lungs;
• with the primary lesion of other organs.

[1], [2], [3], [4], [5], [6]

Disseminated pulmonary tuberculosis: epidemiology

Generalized disseminated tuberculosis is relatively rare. Much more often, approximately 90% of patients develop disseminated tuberculosis with predominant lung involvement.

Disseminated pulmonary tuberculosis is diagnosed in 5% of newly diagnosed tuberculosis patients. Among those registered in TB dispensaries, patients with this form of tuberculosis account for 12%. Disseminated tuberculosis causes death of 3% of patients dying from this disease.

[7], [8], [9], [10]

What causes disseminated pulmonary tuberculosis?

Disseminated tuberculosis can develop with a complicated course of primary tuberculosis as a result of increased inflammatory response and early generalization of the process. More often disseminated tuberculosis occurs several years after the clinical cure of primary tuberculosis and the formation of residual post-tuberculosis changes: the focus of the Gon and / or calcinate. In these cases, the development of disseminated tuberculosis is associated with late generalization of the tuberculosis process.

The main sources of dissemination of mycobacteria in the development of disseminated tuberculosis are the residual foci of infection in the intrathoracic lymph nodes, which are formed during the reverse development of the primary period of tuberculosis infection. Sometimes the source of dissemination of mycobacteria in the form of a calcified primary focus can be localized in the lung or other organ.

Symptoms of disseminated pulmonary tuberculosis

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

Acute disseminated pulmonary tuberculosis usually develops within 3-5 days, reaching full severity by the 7-10th day of the disease. The symptoms of intoxication appear first : weakness, increased sweating, worsening of appetite, fever, headache, and sometimes dyspepsia. The body temperature rises rapidly to 38-39 ° C; note a fever of a hectic type. Increase in intoxication and functional disorders is accompanied by loss of body weight, adynamy, increased sweating, deafness or temporary loss of consciousness, delirium, tachycardia and acrocyanosis. A characteristic clinical symptom is shortness of breath. Perhaps the appearance of a cough, often dry, sometimes with the allocation of scanty mucous sputum. In some cases, on the front surface of the chest and upper abdomen appears a delicate rosaceous rash, caused by the development of toxic-allergic thrombovasculitis.

Diagnosis of disseminated pulmonary tuberculosis

Disseminated pulmonary tuberculosis has a characteristic radiographic evidence - focal dissemination. For hematogenous and lymphogematogenic dissemination, multiple focal shadows are characteristic, which are located in both lungs relatively symmetrically. With lymphogenous dissemination, focal shadows are often identified in one lung, mainly in the middle sections. Bilateral lymphogenous dissemination is usually asymmetric.

[11], [12], [13], [14], [15], [16], [17]