4.1.1 Early and chronic tubercular intoxication


Primary are named those forms of tuberculosis, which develop after first MBT infection of an organism, i.e. at primary penetration of mycobacterium tuberculosis in organism, being sterile before tubercular infection.

With primary tuberculosis are getting sick mainly children and teenagers and much less often adults.

From the moment of penetration of tubercular infection before display of tuberculosis as illness there passes the period of so-called latent (cryptic) infection. The period of a primary infection has characteristic features:

  1. high sensibillization of the host;
  2. predisposition to lymphohematogenous infection generalization;
  3. involving in process lymphatic system;
  4. predisposition to caseous degeneration of lymphatic nodes;
  5. ability to spontaneous healing.

With primary tuberculosis infection is connected damage of peripheral lymphatic nodes, serous membranes (pleurisy, peritonitis, pericarditis), bone-joint system, eye and other organs. Range of clinical signs of primary tuberculosis is extended with paraspecific changes of the body:

  1. keratocnjuctivitis;
  2. knotty erythema (erythema nodosum);
  3. rheumatoid Ponce;
  4. acute diffused nephritis.

These forms must be referred to primary tuberculosis, if it is testified that the fallen ill persons shortly before disease had negative tuberculin test.
In clinical picture of child tuberculosis several forms of primary tuberculosis are distinguished. First of all it is the early period of a primary infection, transiting in case of absence of treatment into chronic tubercular intoxication.
Tubercular intoxication as the independent disease characterizes the period of illness without clear localization of tuberculosis. Its clinical symptoms — are symptoms of various systems functional frustration.

Early and chronic intoxication among children and teenagers.

The symptoms of early tubercular intoxication become apparent first of all by misbalance of nervous system, expressed in change of behavior of the child: his irritability, downturn of attention and excitability. Quite often in this period it is possible to observe the poor appetite, pallor of skin covers, mild fever and malaise develop, swelling of lymphatic nodes. Among under feed children it is easy to palpate the enlarged liver and spleen. There can be an infringement of digestion, week intestine activity, and constipation. In 4-6 weeks after primary infection children could have positive tuberculin test (tuberculin test conversion).

Quite often erythema nodosum found out. Its occurrence is preceded with high temperature, several days after, mainly on forward surfaces of knees occur dense infiltrations, hot to the touch, very painful, red color with cyanotic collar. More often erythema nodosum arises among preschool and young schoolchildren, being allergic paraspecific reaction, instead of tubercular inflammation of the skin. It is accompanied a primary tuberculosis or flare and it is considered as display of a high allergy of a beginning of primary tuberculosis.

The most important differential diagnostic sign of early tubercular intoxication is coincidence of these functional frustration and morphological changes with positive reactions on tuberculin tests. If this period is not taken into consideration of parents and doctor of the child, clinical signs of tubercular process could develop with involving regional lymphatic nodes or damage of other organs.
If the patient will receive rational therapy in time, all phenomena rather quickly abate, and then disappear. Tuberculin testing usually reveal only moderate positive reactions. In this period it is necessary for the child to ensure a sanatorium-hygienic mode regime at home or in medical establishment — hospital, sanatorium children’s facility, forest school. On the background of the correctly adjusted feeding, rich with all complexes of vitamins, depending on weight of intoxication it is necessary to organize antibacterial therapy. The treatment should be long and proceed after ceasing of the signs of intoxication.

Chronic tubercular intoxication.

Chronic tubercular intoxication is characterized by signs of the child retarded development, pallor, micropoliadenia (palpated 6-9 groups enlarged lymphatic nodes of elastic consistence up to “small stones”). The following fact is important, that in 1 or more year after appearance of the positive tuberculin reaction, these reactions are kept positive or grow. At chronic tubercular intoxication morphological changes of tubercular character could be found out in one or simultaneously in several organs: in bone marrow, in lymphatic nodes and sometimes in parenchymatous organs. As to distinct early tubercular intoxication, from chronic one all symptoms expressed more brightly and keep more steadfastly.

Chronic conjunctivitis, flictens could be revealed, which repeatedly occur, then disappear. Appetite sharply lowered, dyspepsia or constipation are taking place. Depending on duration of chronic tubercular intoxication it is possible to find out in a child backlog of his growth and especially of his weight. As a rule, the turgor of all tissues and subcutaneous tissues is weakened. Weak periodic increase of temperature with fluctuation from 37 up to 37,5 C. Positive tuberculin reactions are prominent in different degree. The reaction of a sick child sharply changes on noisy games, favorite pastime, and relations with other children. As a rule, children quickly get tired, aspire to retire and, that is not peculiar to children’s age, quite often are early stacked to sleep. The schoolchildren have lack of attention.

In the lungs it fails to reveal obvious pathological changes neither clinically, nor roentgenologicaly. At “older age children “, which are carriers of long chronic tubercular intoxication, are possible to found out healed primary complex: the Gohn focus and scar changes of the lung root with calcifications in it.

It is possible to prevent chronic tubercular intoxication applying appropriate correct and prolong treatment. The treatment of already developed chronic tubercular intoxication represents big difficulties. It is due to formation around of tuberculosis focus of fibrotic capsule and of a zone poorly supplied with vessels. Because of it, antituberculosis drugs do not fully penetrate to the tubercular focus, and MBT contained in it, do not lose vitality. The diagnosis of tubercular intoxication establish on the basis of tuberculin test (positive, amplifying hyperallergic reactions, during repeated tests), clinical signs of the disease at absence of local damage determined by rentgenological and other methods of examinations.

The specificity of the described functional infringements should be confirmed by careful examinations of the child (teenager) for exception of not specific diseases. At examinations it is necessary to use modern X-ray methods of diagnostics, including, at availability, computer tomography, bronchoscopy, comprehensive tuberculin testing and bacteriological research for MBT .

The diagnosis tubercular intoxication is confirmed only after observation in specialized anti-tuberculosis establishment.

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