Primary Tuberculosis - Symptoms

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

Intoxication syndrome is caused by metabolic and functional disorders that occur with primary tuberculosis. Early clinical signs of tuberculosis intoxication are functional disorders of the central nervous system (irritability, emotional lability), vegetative-vascular dysfunction (tachycardia, arrhythmia, hypotension, systolic murmur over the apex of the heart), impaired appetite, increased sweating. Often reduced tolerance to physical and mental stress, as well as the ability to concentrate attention. Characterized by a variable fever with short-term individual body temperature rises to subfebrile values in the afternoon. Adolescent girls due to neuroendocrine dysfunction delay the appearance of the first menstruation or they stop for the duration of the illness. With prolonged intoxication syndrome (5-6 months or more), emotional lability increases, lethargy and adynamy, lack of body mass, lag in physical development often arise. They note the pallor and dryness of the skin, a decrease in skin turgor and muscle tone.

With tuberculous intoxication as a clinical form of tuberculosis, intoxication syndrome is the predominant (sometimes the only) clinical sign of the disease. Symptoms of primary tuberculosis of local specific inflammation in patients with tuberculosis intoxication are not detected. Often, they note local nonspecific (paraspecific) changes, due to the presence in the body of mycobacteria tuberculosis. These changes are most pronounced in the peripheral lymph nodes. When palpation, you can find enlarged to 5-14 mm in diameter lymph nodes of five-nine groups, including. Supraclavicular and cubital. Lymph nodes are painless, mobile, soft-elastic consistency without signs of periadenitis and inflammation of the skin. Micropoliadenopathy is more pronounced in preschool children and to a lesser extent in adolescents and young adults. Hyperplasia of the lymphoid tissue can also be manifested by an increase in the liver and spleen.

With chronic course of tuberculous intoxication, the lymph nodes gradually decrease and become denser (sometimes to a stony density).

Symptoms of primary tuberculosis, caused by the defeat of respiratory organs, with tuberculosis of the intrathoracic lymph nodes and the primary tuberculosis complex depend on the prevalence of the process and the caseo-necrotic component of a 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. At the older age, their symptoms are often rather meager.

For 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 a bend of sensitivity to tuberculin and X-ray findings, mainly CT.

Tuberculosis of the intrathoracic lymph nodes with a large amount of lesion usually begins subacute, with a gradual increase in the symptoms of intoxication. With a pronounced exudative perinodular reaction involving the pathological process of all groups of lymph nodes of the root of the lung and mediastinum, the disease develops sharply. In this case, note febrile fever and general functional disorders. Patients may experience a characteristic dry pertussis-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 the appearance of stridor breathing.

Narrowing of the lumen of the superior vena cava with enlarged lymph nodes of the mediastinum leads to a more or less pronounced syndrome of the superior vena cava: on the anterior surface of the thorax, the network of subcutaneous veins widens from one or both sides. In the compression of the superior vena cava, 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.

Stethoacoustic symptoms of tuberculous lesions of the intrathoracic lymph nodes are caused by perifocal nonspecific inflammatory changes in the mediastinum. They detect muffling of percussion sound in the parasternal and paravertebral zones, strengthening of bronchophonia above the spinous processes of the thoracic vertebrae, venous noise of the top over the upper part of the sternum handle with a sudden tilting of the head back. Without a perifocal inflammatory reaction, it is impossible to detect an increase in the intrathoracic lymph nodes by physical methods.

Primary tuberculosis complex is often diagnosed during examination for mild symptoms of intoxication or a bend of sensitivity to tuberculin. With extensive perifocal inflammation around the primary pulmonary focus disease develops sharply, which is typical for preschool children. Observe a cough with a small amount of phlegm, febrile fever.

With a significant perifocal inflammation, when the extent of the pulmonary lesion exceeds the dimensions of the segment, it is possible to detect dullness of the percussion sound and to listen to a weakened, with exhaled breath, breathing. After coughing over the zone of defeat, unstable small bubbling rales are heard.

With all forms of primary tuberculosis in various tissues and organs, it is possible to develop toxic-allergic, paraspecific changes, which it is customary to associate with the toxic effect of the products of the life activity of mycobacteria tuberculosis. These changes can be manifested in the form of conjunctivitis, cryptic, erythema nodosum, blepharitis, allergic pleurisy, polyserositis or arthritis (rheumatoid Ponce). Occasionally, the reactive paraspecific hepatitis detected by ultrasound is noted.

Paraspecific reactions are very typical for primary tuberculosis. They are associated with a wide variety of manifestations of the disease, 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 liver, kidney, connective tissue and neuro-dystrophic disorders.

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