Secondary tuberculosis: forms, causes, symptoms, diagnosis and treatment

The term "secondary pulmonary tuberculosis" refers to the pathological process that develops in adults who, in childhood or adolescence, successfully underwent a small affect, and sometimes a complete complex. According to statistics, the disease is most often diagnosed in middle-aged men. Treatment of secondary pulmonary tuberculosis directly depends on the form of the disease and its severity. In advanced cases and with the ineffectiveness of conservative treatment, surgical intervention is indicated. The outcome of the disease directly depends on the timeliness of going to the doctor.

Pathogenesis

After a person first suffered tuberculosis, the pathogen (Koch's bacillus) is disseminated to the regional lymph nodes. At the same time, pathogenic microorganisms remain there for a very long time, sometimes throughout life. As a rule, the primary lesion does not cause pronounced changes. After the disappearance of the granuloma, a scar forms. In this case, specific immunity is formed in the body.

It is important to know that absolutely all people who have previously had the disease have a risk of developing secondary tuberculosis. Under the influence of various adverse factors, the process of active life of the Koch bacillus starts. As a result, symptoms of secondary tuberculosis begin to appear. As practice shows, the disease is more severely tolerated, and surgery is much more often performed.

Koch's wand

Etiology

As mentioned above, the pathogenesis of secondary tuberculosis is based on the activation of the activity of the Koch bacillus, previously disseminated to the regional lymph nodes.

Factors contributing to the reproduction of the pathogen:

  • Living in a cold, unventilated and damp room.
  • Long stay in violation of sanitary standards.
  • Unbalanced diet.
  • The presence of other serious pathologies, the course of which is accompanied by a significant weakening of the immune system.

In addition, there is a risk of re-entry of pathogens into the body after contact with an infected person. Infection occurs by airborne droplets.

According to statistics, relapse most often occurs in middle-aged men many years after the initial infection. As a rule, both primary and secondary tuberculosis affects the airways and lungs. Much less often, the kidneys, bones, joints and skin are involved in the pathological process.

Lung affection

Clinical manifestations

The second time the disease is more severely tolerated than the first. In extremely rare cases, pathology can be asymptomatic.

Symptoms of secondary pulmonary tuberculosis:

  • A sharp decrease in body weight.
  • Impaired appetite (up to its absence).
  • Persistent cough. Initially, it is dry, after a while sputum begins to separate.
  • Dyspnea.
  • Constant jumps in body temperature. In the morning it is often low or within normal limits, in the evening and at night it is elevated.
  • Excessive sweating.
  • Constant fatigue for no apparent reason.
  • Disturbance of the digestive process.

In advanced cases, the oral cavity and larynx are affected. This is due to the constant ingestion of sputum on the mucous membranes during coughing. Gradually granulomas begin to form.

With regards to what is the difference between primary and secondary tuberculosis. When Koch's stick penetrates the body, the process of its reproduction starts. Symptoms during primary infection develops acutely. With timely access to a doctor, the prognosis is usually favorable. More patients are recovering.

Secondary tuberculosis is characterized by an unstable course. In other words, the periods of exacerbation and remission are constantly changing. The general well-being of the patient is much worse than with the initial infection. But in rare cases, the pathology is asymptomatic.

Clinical manifestations

Forms of secondary tuberculosis

The disease is characterized by a wave-like course. He quickly moves from one form to another. That is why any delay can threaten the development of dangerous complications.

There are 8 forms of secondary tuberculosis. They are described in the table below.

The morphological form of tuberculosisChanges in the body
Acute focalAt the initial stage of development, signs of endo-, meso- and panbronchitis appear. After some time, bronchopneumonia occurs. During diagnostic measures, one can detect Langhans cells. Foci of pathology are few, usually 1-2. Most often they are localized in the I and II segments of the right lung. The foci have the form of seals, their diameter does not exceed 3 cm. As the recovery progresses, encapsulated petrificates are formed.
Fibrous focalIt develops on the site of healing foci. New lesions can trigger caseous pneumonia. As a rule, foci of pathology are localized in several segments of one lung. Thus, this form of secondary tuberculosis is characterized by the simultaneous course of exacerbation and healing processes.
InfiltrativeAs the pathology progresses, cases of caseous necrosis are formed. Around them, an infiltrate or exudate is formed. It is at this stage during the X-ray examination that you can already make an accurate diagnosis.
TuberculomaIt is characterized by the formation of an encapsulated focus of necrosis. The diameter of the affected area can be up to 5 cm. At the same time, perifocal inflammation is stopped. The encapsulated focus is most often localized in the I and II segment of the right lung.
Caseous pneumoniaThe extent of the lesion in this case may be different. Sometimes the entire lung is involved in the pathological process. It becomes dense and increases in size.
Acute cavernousCavities form in the cavalous zones. Their walls are covered with a layer whose consistency resembles cottage cheese. Behind it are the epithelial and Langhans cells.
Fibrous cavernousAnother name is pulmonary consumption. The disease is rapidly progressing: sclerosis develops (both focal and diffuse), petrificates and foci of caseous pneumonia appear. The second lung is involved in the pathological process.
CirrhoticThe final form. It is accompanied by the formation of scar tissue. The affected lung is deformed, compacted, becomes inactive. For this stage, the formation of adhesions and bronchiectasis is characteristic.

Thus, the acute focal form is an early stage of the development of the disease. Secondary secondary tuberculosis is practically incurable. Patients can be saved only in isolated cases.

Coughing

Diagnostics

If you have any warning signs, you should contact your therapist. The doctor will conduct an examination, collect medical history data and, if a pathology is suspected, will refer him to a TB specialist for treatment.

Diagnosis of secondary tuberculosis involves the following measures:

  • Conversation with the patient. The TB specialist listens to complaints, clarifies whether there was a primary infection with tuberculosis. In addition, the specialist assesses the likelihood of contact of the patient with carriers of the pathogen.
  • Inspection The following indicators are clinically significant: cough, appetite, body temperature, sweating, size of lymph nodes, body weight (more precisely, its recent fluctuations).
  • Sputum analysis.
  • X-ray examination.
  • A blood test to detect antibodies to Koch's bacillus.

Based on the diagnostic results, the doctor makes the most effective treatment regimen. All events are held in a hospital.

The focus of the pathology in the picture

Conservative treatment

Drugs are selected exclusively by the doctor, taking into account the individual characteristics of the body and diagnostic results.

Treatment of secondary tuberculosis is aimed at the destruction of the pathogen and the relief of symptoms. All drugs are divided into 3 groups: A, B and C.

The first medication includes the following:

  • "Rifampicin."
  • "Streptomycin".
  • "Pyrazinamide."
  • Ethambutol.
  • Isoniazid.

Group A drugs are considered the main ones. In other words, they are most often prescribed to patients. If a person has HIV, Rifampicin is replaced with Rifabutin.

If the pathogen is resistant to the action of the active components of the drugs, patients are shown taking group B drugs. These include:

  • Ethionamide.
  • Amikacin.
  • "Cycloserine."
  • "Capreomycin."

In many cases, doctors prescribe medications of group C. They relate to fluoroquinolones. Examples of funds: Levofloxacin, Ofloxacin.

In severe cases, bacteriostatic drugs are indicated. As a rule, doctors prescribe Terizidone and Ethionamide. Sometimes drugs with unproven activity are also included in the treatment regimen. These include: Linezolid, Clarithromycin, Amoxiclav.

Regarding treatment regimens. The first 5 months, patients are prescribed 2 or 3 drugs from the main group. In the presence of resistance of the Koch stick, all daily dosages are indicated for drinking at 1 dose. So you can achieve the maximum concentration of active components in the blood. The same treatment regimen is prescribed for patients who, for any reason, interrupted therapy earlier.

There are combined anti-TB drugs. In practice, the following medications are used: “Rifinag”, “Rimkur”, “Phthisoetam”, “Protiocomb”. These products contain from 4 to 5 active substances. The main disadvantage of combination drugs is an impressive list of side effects.

Hospital treatment

Surgical treatment

As practice shows, conservative therapy often does not lead to pronounced positive dynamics. In the presence of secondary tuberculosis, surgery is prescribed more often than with primary infection.

Indications for surgical intervention:

  • Koch stick resistance to the active substances of the prescribed drugs.
  • Joining a secondary infection.
  • The development of irreversible morphological changes.
  • The occurrence of complications that pose a threat not only to health, but also to the life of the patient.

There are several surgical procedures:

  • Lobectomy During the operation, the affected lobe of the lung is removed. Intervention is carried out using an open or minimally invasive technique.
  • Pneumoectomy It involves the removal of the entire lung. An operation is performed if irreversible changes have affected most of the organ.
  • Thoracoplasty. During the operation, the doctor removes the ribs from the affected side. This allows you to reduce the volume of the chest and reduce the elasticity and tension of the lung.

If respiratory function is impaired, surgery is not performed. In addition, diseases of the kidneys, liver and cardiovascular system are contraindications. This is due to the high risk of complications and the onset of death.

Forecast

The outcome of the disease directly depends on the timeliness of going to the doctor. Subject to all the recommendations of a specialist, the prognosis is usually favorable. In addition, all patients diagnosed with secondary tuberculosis are registered and undergo a comprehensive examination annually. This allows you to timely detect even the smallest changes in the body.

If the treatment is carried out incorrectly or if it was completely absent, the prognosis is poor. The probability of death is about 60%. This percentage is higher in people suffering from diabetes and AIDS.

Surgical intervention

Prevention

It can be primary and secondary. But at the same time, all measures are aimed at preventing the development of pathology among the population. Primary prevention includes vaccination. Parents should not neglect it, it is important to ensure that the child is given BCG in a timely manner.

Secondary tuberculosis prevention is carried out in carriers of Koch's bacillus. It consists in conducting annual examinations and explaining to the patient that it is extremely important to maintain a healthy lifestyle.

Finally

The term "secondary tuberculosis" refers to a disease that occurs, as a rule, in adulthood, but at the same time, the person already suffered a pathology several years ago. When the Koch's wand (the causative agent of the disease) enters the body, it remains in it forever, even after the formation of specific immunity. The pathogen can remain in a dormant state all its life and at the same time not cause harm to health. However, under the influence of various adverse factors, the process of its active life starts again. Treatment of secondary tuberculosis is longer, in addition, the pathology is more difficult for patients to tolerate. Therapy involves taking medication. However, in some cases, this does not lead to positive dynamics. In this situation, surgical intervention is indicated.


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