Tuberculosis of the intrathoracic lymph nodes is a form of the disease that is still not fully classified. Some believe that it can be attributed to independent diseases, others believe that it should be left as part of the primary tuberculosis complex. We will talk about this ailment in our article. We will consider in detail the causes of the disease, its forms, diagnostic methods and treatment methods, as well as possible complications and preventive measures.
What it is?
Tuberculosis of the intrathoracic lymph nodes (VHL) is a disease characterized by the onset of inflammatory processes of the lymph nodes located in the area of the root of the lungs. They cause pathology of the tuberculosis microbacterium. The causative agent can be transmitted through infected animals.
Tuberculosis of HHFH most often affects children, adolescents and young people under 25 years old. Thanks to mass vaccinations, there are practically no epidemics, cases of infection are sporadic and occur only with a decrease in immunity. This pathology is characterized by a chronic course with a prolonged preservation of the activity of degenerative processes. 70% of complications of the disease occur in children under three years of age.
Method of infection
All forms of tuberculosis of the intrathoracic lymph nodes in humans are caused by the bacterium Mycobacterium tuberculosis.
Infection occurs in the following ways:
- Due to the consumption of food obtained from a sick animal (e.g., cow's milk).
- By airborne droplets from an infected person or animal.
- Through household items and products contaminated with bacteria.
- Through wounds on the skin.
- It can be transmitted from mother to child during pregnancy (through the placenta) or lactation (with milk).
The most likely infection is through the respiratory tract. A person with tuberculosis constantly exhales sputum, which contains hostile microorganisms, when coughing and talking. They are able to spread up to two meters and remain in the air for an entire hour. Then they settle to the floor and mix with dust, while their viability lasts up to a month and a half.
What increases the likelihood of infection?
The respiratory organs of a healthy person are protected from tuberculosis infection, however, smoking and bronchopulmonary diseases can reduce this immunity. In 95% of cases, the first contact with the tuberculosis bacterium does not cause infection.
Factors that increase the likelihood of infection:
- Inadequate and unbalanced nutrition.
- Prolonged contact with infected tuberculosis.
- Poor housing.
- The presence of chronic diseases.
- Great physical and mental stress.
Typically, an infected person has one of these items, or even a few, that include a medical history. Tuberculosis of the intrathoracic lymph nodes therefore affects people with bad habits who suffer from chronic fatigue, as well as children from dysfunctional families. Infection is almost impossible to notice, in addition, a healthy body immediately begins to form a natural immunity. There, where the patient was, several people can pass in a day, but only the one whose body will not be ready to defend will get infected. At risk are children and adults who have not been vaccinated, as well as patients with HIV infection and people with weak immunity.
Forms of the disease
The following forms of tuberculosis of the intrathoracic lymph nodes are:
- Tumor-like.
- Infiltrative.
- Small.
Tumor is a severe form of bronchoadenitis. Often found in young children with a strong increase in lymph nodes (their diameter can reach up to 5 cm) and massive tubification. Often, the affected nodes are soldered, forming single conglomerates.
The infiltrative form causes a slight increase in lymph nodes, with perinodular inflammation prevailing.
Small form
A small form of tuberculosis of the intrathoracic lymph nodes is difficult to detect, and mainly children suffer from it. Late diagnosis or lack of recognition leads to cicatricial changes in the mediastinum, which affects the normal functioning of capillary pulmonary blood flow. Also, pathology can cause the appearance of more serious and dangerous forms of tuberculosis.
In order to conduct a correct diagnosis and identify the disease, it is necessary to take into account the entire complex of radiological and endoscopic data, and it is also necessary to conduct a mediastinal tomography.
Diagnostic problems of small form
Even in the active phase, a small form of tuberculosis of the intrathoracic lymph nodes is characterized by damage to 1-2 lymph nodes with a slight increase (up to 1.5 cm). These signs can be seen in the x-ray.
Clinical symptoms are extremely mild. Usually they are represented only by subfebrile condition and intoxication syndrome. In adolescence, the main complaint is vegetovascular dystonia. Therefore, patients are often sent for examination to doctors of a different profile. In this case, a small form of tuberculosis is dangerous because the disease can lead to damage to other internal organs.
Symptoms
Tuberculosis of the intrathoracic lymph nodes has the following symptoms:
- Body temperature rises to 39 degrees.
- In the nighttime there is an incomprehensible sweating, that is, caused by not heat.
- Appetite is getting worse.
- A cough begins, similar to the one that appears with whooping cough.
- Strong pallor of the skin, up to a bluish tint.
However, these signs can be mild, then it will be extremely difficult to make an accurate diagnosis on them. But in the process of inspection, other signs may be revealed:
- Visuals. The peripheral venous network expands significantly in the first and second intercostal space. Between the shoulder blades, small vessels expand in the upper areas.
- Palpation. The occurrence of pain with pressure on the spinous processes of the thoracic vertebrae (from 3rd to 7th).
Important in the diagnosis of tuberculosis is an X-ray examination. It is carried out at the same time in the lateral and anteroposterior projections, because the shadow from the lymph nodes can be hidden by the mediastinal organs and the heart muscle. It is also important to perform a tomography of the tracheobronchial tree. But we will talk about this in more detail later.
Diagnostics
It is very difficult to distinguish from other similar pathologies tuberculosis of the intrathoracic lymph nodes. A differential diagnosis is necessary here as with no other disease.
So where does the diagnosis begin?
The first step is to identify the presence of mycobacterium tuberculosis in the body. Tubercle bacilli can be easily found in the gastric lavage. Most often they are found in the washings of the bronchi, sputum.
The next is a mandatory x-ray examination. With its help, you can not only determine whether a person is infected, but also understand how long he was infected. A tomography method is also good, which allows you to analyze the structure of the lymph nodes, which greatly facilitates the task for doctors when making a diagnosis.
An important diagnostic method is the Mantoux test. With a positive result, it is also called a “bend”. In this case, the reaction of the infected person to the injection will be as follows - the injection site will increase by more than 5 mm. "Turn" is diagnosed in the following cases:
- The papule (the place of compaction) becomes more than 0.5 cm.
- It is becoming significantly larger compared to previous results.
- Exceeds the norm by 17 mm without taking into account the prescription of the previous vaccination.
- After 3 years, its size remains more than 12 mm.
However, not always a positive Mantoux test indicates infection. There is a possibility that the cause of such a reaction may be an allergy or a previous illness. Also, not always a negative sample indicates the absence of infection. A false negative result can be caused by immunodeficiency or by the fact that 10 weeks have not passed since the moment of infection.
However, the “turn” is a sufficient reason to continue further examination.
Also, as part of diagnostic measures, a blood test is done. When infected with MTB, the number of leukocytes, lymphocytes, neutrophils, eosinophils will be slightly increased.
Differential diagnosis of tuberculosis of the intrathoracic lymph nodes
When diagnosed with tuberculosis, HHVD often has to be differentiated from other tuberculosis pathologies. To do this, the doctor must carefully examine the anamnesis, identify the likelihood of contact with bacillary patients, analyze tuberculin tests, consider all previous diseases that could be associated with infection.
In addition to the ability to confuse VGLU tuberculosis with another type of tuberculosis, there is still the possibility of not distinguishing it from intrathoracic lymph nodes diseases.
There is also the opportunity to confuse the pathology with metastases arising from lung damage from cancer and lymphosarcoma. However, such a probability appears only in older patients.
Treatment methods
Tuberculosis of the intrathoracic lymph nodes in children and adults is almost the same, therefore, therapy is prescribed with minimal differences.
The treatment for this type of tuberculosis is quite lengthy. On average, therapy can take from 10 months to a year and a half. In this case, the first 2-3 months, the patient should be in a TB hospital. Firstly, so as not to infect others. Secondly, for a more effective treatment.
All this time, complex therapy has been carried out, which includes drugs against tuberculosis, hepatoprotectors, vitamins, immunomodulators.
Also in the first weeks with advanced stages of the disease, chemotherapy can be performed. Together with her, various procedures for cleansing the body are usually prescribed. For example, intravenous laser irradiation of blood or plasmapheresis.
Treatment of tuberculosis of HHFH is divided into two stages. During the first, intensive treatment is carried out, which is aimed at the destruction of the office, the restoration of damaged lung tissue during diseases and the prevention of complications. Anti-tuberculosis therapy involves the combination of several drugs that can kill all types of MBT. The second stage is not so intense. The main thing here is to prevent the re-development of pathology, promote tissue healing, destroy the remaining harmful mycobacteria and strengthen the immune system.
During the entire treatment, it is recommended to follow a special diet, which will help reduce the intoxication of the body and increase resistance to infections. The diet necessarily includes foods with a high indication of protein (eggs, meat, dairy product), butter and olive oil, honey, cereals, vegetables and fruits with lots of vitamin C.
Surgical intervention
Tuberculosis of the intrathoracic lymph nodes rarely leads to the need for surgical intervention, as the disease proceeds extremely calmly, almost asymptomatically.
In total, there are two main reasons for surgery:
- The beginning of the formation of tuberculoma of the lymph nodes.
- The absence of any positive results of treatment that was started more than six months ago.
Possible complications
We list the possible complications of tuberculosis of the intrathoracic lymph nodes:
- The formation of glandular-bronchial fistula due to severe damage to the bronchi.
- Due to the complete violation of bronchial obstruction, which occurs when the bronchi are compressed by massive lymph nodes or blocked by caseous masses, a collapse of the lobe, atelectasis of the part of the lung located above the site of compression or blockage often occurs.
- Total or focal atelectasis (subsidence of a part or lobe of the lung).
Preventative measures
Tuberculosis of the intrathoracic lymph nodes, the diagnosis of which was examined in detail above, belongs, like all other types of tuberculosis, to “social diseases”. That is, its occurrence directly depends on housing conditions and the level of income. In Russia, the causes of epidemiological troubles in this pathology are considered to be a sharp deterioration in living standards, a decrease in the quality of socio-economic conditions, a rapid increase in the number of citizens without a fixed place of residence, and also an active resumption of migration processes.