Hiding under the codes A18.2, A15.4, A16.3, A18.3, adopted in ICD-10, tuberculosis of the peripheral lymph nodes is a serious disease that affects the human lymphatic system. Before you understand the features of the course of the disease and the methods of its treatment, you should understand by what principle the lymph nodes work, for which they are, in principle, necessary for a person.
Anatomy and Health
Signs and symptoms of tuberculosis of the peripheral lymph nodes indicate a violation of the integrity, adequate functioning of the lymph nodes. These elements are designed to protect the human body from harmful external factors, pathological forms of life that can penetrate here in a variety of ways. Lymph nodes detect and accumulate pathogenic microflora in themselves, remove it from the body, and are also an area of accumulation of atypical cells in oncological diseases. In fact, the nodes are an element of the immune system, and are also responsible for the generation of lymphocytes. These cellular structures are responsible for the destruction of pathogenic microbes in different parts of the body, and can spread with blood flow.
The pathogenesis of tuberculosis of the peripheral lymph nodes is infection with microflora, a specific Koch bacillus. It is known that minors and women, especially young ones, are more often prone to invasion. Nevertheless, everyone has certain dangers; neither age nor gender plays a role. Almost 70% of the lesions are localized in the neck, somewhat less often - in the axillary fossa, perineum. Perhaps the multiplication of tubercle bacillus in the intrathoracic nodes.
General information about the disease
Peripheral lymph node tuberculosis is a type of extrapulmonary form of the disease. Mycobacterium MBT can provoke pathology. The disease is on its own, but may accompany the pulmonary type. The pathological process belongs to the category of chronic, is associated with the introduction of an infectious agent into the body, which provokes the appearance of a focus of inflammation in the tissues of the lymphatic system. Infection occurs through the respiratory system. If treatment is not practiced, a rapid damage to the space between the cells of diseased tissues is possible.
Leading to the appearance of signs of tuberculosis of the peripheral lymph nodes, Koch's bacillus is able to slowly move deep into the body, looking for a suitable focus for development and spread. Microflora passes through the space between the cells, infects tissue fluids, and through the lymph flow it moves to a susceptible node. This mechanism explains why pulmonary tuberculosis in the predominant percentage of cases is accompanied by extrapulmonary infection.
Where did the trouble come from?
Tuberculosis of the peripheral lymph nodes can be sick by contact with the carrier of the disease, a sick person. Pathology is spread by the airborne method. Possible infection through sputum, discharge during sneezing, talking. The most dangerous thing is communication with a person suffering from an open form of infection with a Koch wand.
Sometimes the tuberculosis clinic of the peripheral lymph nodes is observed after contact with a sick person, as well as with objects belonging to him, used by them. Neglect of hygiene rules significantly increases the risk of infection.
You can get sick alimentarily: through the use of food infected with mycobacteria. More often microflora penetrates with meat and dairy products that have not passed the appropriate inspection and processing.
Least of all is intrauterine infection. This is possible when the pathological microflora enters the fetus during the gestation period or at the stage of passage of the birth canal.
How to notice?
Symptoms of tuberculosis of the peripheral lymph nodes depend on the stage of pathology, the presence of concomitant diseases. The first stage is associated with the proliferation process, the affected areas gradually grow, the diameter of the nodes can reach 3 cm - the cells actively divide. The area in every third case responds with painful sensations, but approximately 66% of patients have no pain, which significantly complicates the detection of pathology at the initial stage.
The second stage is caseous. In the lymph nodes, dead cells accumulate - caseous mass. Then the abscessing step begins, the cells die, the accumulated mass becomes softer, it becomes pus. Then begins the stage of formation of fistulas. In the affected area, the lymph node breaks through, the integrity of the skin is violated, purulent discharge comes out.
Features of the course
And in the absence, and in the presence of concomitant pathologies (for example, HIV), tuberculosis of the peripheral lymph nodes is most often most pronounced in the neck - this is where the nodes suffer first. In some patients, only one area increases, while there is usually no general symptomatology, the sore area does not respond with soreness. More often the disease (regardless of the scale of the lesions) is accompanied by a deterioration in appetite, constantly maintained by an elevated body temperature. The skin turns pale, sweat glands are activated, the person quickly gets tired. The disease is chronic, its manifestations become more pronounced in spring and autumn. Often, exacerbation occurs against a background of severe stress, cooling, or acute illness.
Specificity of the disease
Infection with Koch's bacillus of pulmonary tissues and root is associated with the risk of a foci of inflammation in the lymph nodes inside the sternum, which becomes the basis of bronchoadenitis. A distinctive feature of the zone is an instant reaction to inflammatory processes, since it is here that lymph is generated. In this case, a picture is observed indicating tuberculosis of the peripheral lymph nodes, the concentration of leukocytes in the circulatory system increases, and manifestations of general poisoning of the body are observed. The temperature rises to a subfebrile level and remains stable.
One clinical recommendation for peripheral lymph node tuberculosis is vaccination. The main task of introducing a specific substance is to allow the body to provoke the generation of antibodies that can fight an infectious agent.
Two formats of the course of the disease are distinguished, and transformation from one to the other is possible. With the localization of the process inside the sternum, the focus of inflammation will be strictly within the lymphatic system. An alternative is a tumor that can damage nearby tissues and disrupt structural integrity.
Diagnosis
Diagnosis of tuberculosis of the peripheral lymph nodes is aimed at identifying the disease, determining its stage and specific form. Differential refinement is aimed at eliminating other pathologies with similar symptoms. In some cases, Kaposi's sarcoma can be mistaken for lymphadenopathy. Also, differential diagnosis of tuberculosis of the peripheral lymph nodes is aimed at distinguishing between disease and lymphoma, hyperplasive processes, toxoplasmosis. Begin the study of the patient's condition by directing him to an x-ray. It is this basic study that allows localizing tuberculosis, to determine the presence of pathologies complicating the case. A TB specialist is appointed responsible for the diagnosis.
If you suspect a disease, it is reasonable to put a Mantoux test - the result should be positive. There is a danger of a false result, but its probability is less than 10%. The Mantoux test, however, will not give an idea about the form of the pathology and the area of localization - for this it is necessary to take an x-ray. The patient is prescribed CT, MRI. Additionally, a biopsy is performed (excisional or fine-needle aspiration).
What to do?
The treatment of tuberculosis of the peripheral lymph nodes is selected, focusing on the stage of the disease and the features of its manifestation, the patient's immunity and the presence of additional diseases. The pharmaceutical industry offers a wide variety of drugs to control the reproduction of mycobacteria. Most often, drugs containing streptomycin, isoniazid are used. In order for the therapeutic course to show the maximum level of effectiveness, it is necessary to take drugs with a long program under the supervision of a doctor. Interruption of treatment is fraught with the acquisition of resistance to drugs by the pathogen.
Therapy is practiced in waves. Tuberculosis of the peripheral lymph nodes requires resorting to methods of prolonged chemotherapy. With a limited form, the surgical approach may be the optimal approach. During the intervention, the doctor will remove the affected nodes, excise the area of inflammation.
Program features
At the initial stage, clinical recommendations for peripheral lymph node tuberculosis include advice on a conservative approach. A TB specialist selects antibacterial drugs and medicines designed to fight tuberculosis.
If the disease has reached the second stage of development, the nodal structures are broken, the effectiveness of the drug approach will be relatively low. It is necessary, if conditions permit, to make the patient an operation by removing the affected tissue from the body. After the intervention, it is indicated to undergo a drug program. Prescribe drugs against tuberculosis, inflammatory processes, drugs to increase immunity and alleviate the condition of the patient as a whole.
The third stage of the course of the disease is associated with the formation of a tissue bag filled with purulent discharge. The best approach is injecting the contents of the area, injecting the drug into this area. After opening the area, it is necessary to thoroughly treat the wound. Bandages are applied to the area.
What does it lead to?
Tuberculosis, which affects the peripheral areas of the lymphatic system, can trigger endobronchitis. The lymph node filled with caseous mass can become a focus of perforation, which will lead to the penetration of necrotic masses into the bronchial tree. Such processes initiate secondary infection and aggravation of the patient's condition. A strong cough may indicate endobronchitis.
After a successful therapeutic course against the background of peripheral tuberculosis infection, the appearance of secondary pathological conditions is possible. For example, ulceration sites are often formed in the stomach and intestines, obstruction of certain areas of the digestive system is possible. Against the background of the therapeutic course, the risk of ascites increases, the abdominal veins can become the area of localization of varicose veins.
Features of the course and specific classification
When detecting tuberculosis, it is first necessary to determine whether the case is limited. Otherwise, generalized tuberculosis is diagnosed. Observations showed that the clinical picture does not depend on the age of the patient, in children and adults the manifestations of the pathology are approximately the same, although some nuances are possible. When diagnosing, you need to remember: the proliferation of lymph nodes in a number of cases is the first sign of a carcinoma that metastasizes from the primary site. If the nodes are compacted, first of all, the changes are visible in the subclavian region, the patient should be checked for tumor markers - possibly the cause of the symptoms is pulmonary cancer.
As a rule, with tuberculosis, the temperature rises to subfebrile, but it is possible to maintain a normal level. Some patients have a slight fever, while others are sometimes worried about significant fever. X-ray shows an increase in lymph nodes. With palpation of the neck, you can feel the proliferation of nodes. In this area, granulomas form, cells are reborn. Sites can maintain elasticity, as they progress, they become soldered and acquire an increased density.
Present and future
If bacteriological analysis, histological examination and biopsy confirm tuberculosis, it is reasonable to proceed with treatment immediately. In most cases, the prognosis is favorable, the patient survives. If the progress of the condition has reached the formation of fistulas, as they heal, there is a risk of scarring.
Tuberculin tests can show a false negative result if a person eats too little. A similar result can lead to a decrease in immune status.
Primary disease requires standard treatment. It is often difficult to imagine the reaction of the lymphatic system to chemotherapy in advance. One in four, in particular, the nodes grow at the time of the start of the drug course, increases appear in previously healthy areas. Approximately one in five observed abscesses, fistulas. Presumably, this is due to the tuberculin hypersensitizing response due to toxins entering the circulatory and lymphatic systems during the destruction of pathological microflora - MBT. If therapy leads to this response, you should choose another, gentle course. The continuation of the program will be accompanied by a normalization of the state of the nodes. In approximately 5% of patients, after the completion of the therapeutic program, the nodes are still clearly palpable, however, complications should not be.
Tuberculous lymphadenitis
Among other lymphadenopathies, the considered form is quite common - it accounts for about 43% of all pathologies. Among extrapulmonary tuberculosis forms, localized in the peripheral lymph nodes occurs in every second patient. In approximately every third, this form accompanies other areas of localization of mycobacteria in the body.
The most common complications of pathology are fistulas, abscesses. These are observed on average in every third patient. There is a danger of generalization of the process and the occurrence of areas of bleeding. In patients undergoing inpatient treatment, complications are observed in approximately every fifth case. The probability of abscess formation is estimated at 17%, fistula - 3%. From medical statistics it is known: on average, patients seek medical help for 3-4 months from the moment of infection with Koch's bacillus.