| ID | 96 |
|---|---|
| Name | PRIMARY PULMONARY TUBERCULOSIS |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | Investigations: 1. X-Ray chest (P/A view) usually shows unilateral enlargement of the hilar lymph nodes or opacity on the lesion. 2. Tuberculin test shows strongly positive reaction. 3. Bacteriological examination-tubercle bacilli can some-times be isolated by culture of fasting gastric washings or swab from the larynx, but sputum for A.F.B. usually negative. 4. E. S. R is usually raised, lymphocytosis may occur. |
| Management | |
| Introduction | Primary pulmonary tuberculosis refers to the events following the first infection of the lungs by tubercle bacilli. It usually occurs in childhood and in most cases is asymptomatic. History of contact with patients suffering from active pulmonary tuberculosis is often positive. Tuberculosis infection usually begins when a susceptible person inhales any droplet secretion containing viable organisms. While these reach in the lung alveoli, mycobacteria are ingested by alveolar macophages. Once, the infection is established, a small subpleural lesion (the ghon focus) develops with rapid transport of bacilli to the regional (hilar) lymph nodes leading to development of ‘primary complex’. This stage of infection is the ‘primary tuberculosis’, usually remains silent clinically and radiologically. The macrophages that have ingested the bacilli, which are nonspecifically activated, then aggregate and the lesions enlarge. After 2-4 weeks of infection two distinct T cell-mediated immune responses start. A delayed-type hypersensitivity reaction destroys nonactivated macrophages containing bacilli but also results in tissue necrosis and caseation. Cell-mediated immunity results in macrophages being activated into epithelioid cells with the formation of granulomas seen at the periphery of the caseation, which limit the multiplication and spreading of organisms. But, since the organisms are viable, they remain dormant within the granulomas for many years as ‘latent tuberculosis infection’, but cannot transmit the organisms to others. 85-90% patients of tuberculosis who develop primary complex, usually undergo spontaneous healing within 1-2 months, (but their tuberculin skin tests become positive). The other 10-15% patients may develop progressive primary tuberculosis during the course of the initial illness or after a latent interval of weeks or months if the patients immune defenses are not adequate and the organisms can escape alveolar macrophage microbicidal activity. In these patients, pulmonary and constitutional sign-symptoms develop within a few weeks or months following active infection |
| History | |
| Etiology | |
| Clinical Features | Clinical features: 1. It may produce no symptoms or signs. 2. In a few patients there may be febrile illness with anorexia, loss of weight and night sweeting. 3. It may be accompanied by other systemic features of tubercular infection. 4. Slight dry cough may be present. 5. May be accompanied by erythema nodosum- a bluish-red raised tender cutaneous lesion on the shins and on the thigh and usually associated with pyrexia and polyarthralgia. It may be the first clinical indication of tuberculous infection. 6. Mild crepitation, signs of collapse, enlarged lymph nodes may be present. 7. Symptoms and signs due to complications e.g, dry pleurisy or pleural effusion, lobar or segmental collapse, acute miliary tuberculosis, tubercular meningitis and post primary pulmonary tuberculosis may appear |
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| Treatment | |
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