Acute progressive tuberculosis. Tuberculosis

Tuberculosis

1. Acute progressive
tuberculosis.

Caseous pneumonia.
Pathogenesis, clinical picture,
treatment.

LENZ 5

2. a’

Acute progressive pulmonary tuberculosis is a
concept that combines various clinical forms of
respiratory tuberculosis, characterized by an
acute onset ofthe disease and a severe
progressive course with a pronounced

intoxication syndrome, a predominance of
exudative-caseous tissue reaction, extensive
lesions and rapid formation of destructions due
to massive reproduction of mycobacteria and
immunodeficiency.

3. ACUTE PROGRESSIVE DESTRUCTIVE FORMS OF
PULMONARY TUBERCULOSIS COMBINE several forms of
tuberculosis N2

Caseous pneumonia

Acute progressive infiltrative TB
35% among the
newly identified
Acute progressive fibrous- patients with
cavernous TB pulmonary
tuberculosis

Acute progressive disseminated TB

Acute pyopneumothorax

Chronic specific pleural empyema I sig
is more often associated with a
multiple drug resistance of the ay

4. Modern pathomorphosis

TB pathomorphosis has done several phases

B pathomorphism p

1, Phase of positive dynam )-70 years

bilization phase- 70-80 years.
3. Negative phase - 90 years till now

Signs of the negative phase of TB pathomorphism:

1. The growth of epidemiological indicators.

2. «Rejuvenation of TB».

3. Growth acutely progressive, generalized and extrapulmonary

4. Polyresistent forms.

5. The predominance of exudative-necrotic reactions over productive.
6. Increased number of specific complications.

7. TB in AIDS patients.

a characteristic feature of the pathomorphosis of tuberculosis in recent years can be

| considered the return of acute progressive forms of pulmonary tuberculosis. Within the

_ framework of ute progressive process, the leading type of caseous inflammation is with the
lung tissue and the formation of destructions. Thi

5. PATHOGENESIS OF CASEOUS PNEUMONIA N°5

The pathogenesis of caseous pneumonia is based on the formation of
acute progression: 1. Massive multiplication of MBT.2. Deep endotoxicosis . 3.
Severe immunodeficiency . 4. Microcirculation disorder. 5. Increase in the zone of
caseous necrosis.

&

Increase in the zone of caseous necrosis.

Massive Severe
multiplication of immunodeficiency
MBT
Deep Microcirculation

endotoxicosis disorder

6. Caseous pneumonia N3 *

Caseous pneumonia is one of the most

Caseous pneumonia

severe forms of pulmonary tuberculosis.

It is characterized by a pronounced acute TB
caseous-necrotic component of om with the
q lecay
tubercular inflammation, rapid
ee me 4 predominance
progression and the formation of and severe

multiple cavities of decay. It can arise as progressive
course

in independent disease in a previously
healthy person or as a complication of
another form of pulmonary tuberculosis.
There are two clinical forms of caseous
»neumonia; lobar and lobular. Lobar
caseous pneumonia usually develops as
an independent clinical-anatomical form
of tuberculosis, and lobular complicates
other forms of pulmonary tuberculosis

more often

7. Pathogenesis and pathological anatomy of caseous pneumonia N°4

Pathogenesis and pathological anatomy of caseous
8 F 8
pneumonia.

caseous
passes into the next
fc nd foci are

Zing with each othe

onchi, lymphatic and

eous change

y. Morphological

8. Without treatment, caseous pneumonia often
leads to death, The cause of death is pulmonary-
cardiac insufficiency, which develops against the
background of destruction of the lung tissue and
pronounced intoxication.

With the timely begun complex treatment, rapid
progression of the process can be stopped.
Gradual organization of fibrinous mas
determines the appearance of areas of
carnification: the cavity is transformed into
fibrous cavities, caseous necrotic foci are
encapsulated. So caseous pneumonia, in which
changes in the lungs are largely irreversible, is
transformed into fibro-cavernous tuberculosis of
the Jungs

9. MORPHOLOGICAL PICTURE OF ACUTE PROGRESSIVE FORMS

Macropreparation of the lung. Caseous pneumonia

of destruction

Total caseous pneumonia with acute foci

10. | Symptoms of caseous pneumonia No7
A typical caseous pneumonia develops sharply. In the
initial stage, when caseous necrotic masses are formed
in the affected area, an intoxication syndrome (fever,
chills, weakness, severe sweating, a sharp deterioration
in appetite) is expressed, dyspnea, cough, mostly dry,
sometimes with a small amount of difficultly separated
sputum. |
After the melting of the caseous necrotic masses and the
formation in the lung of multiple cavities of decay, the
severity of bronchopulmonary-pleural syndrome sharply
increases. The cough becomes wet, with more sputum.
Patients are concerned about chest pain. An impurity of
blood may appear in the sputum. Dyspnea increases,
acrocyanosis develops. Mark a hectic fever of the wrong
type, often the development of cachexia.
In the physical examination of the affected lungs, the
shortening of the percussion sound is detected, the
weakened bronchial breathing, wet, finely bubbling rales
are heard. After the formation of cavities of decay, rales
become sonorous, numerous, medium- and large-bubbly.
- They note the appearance of tachycardia and an accent
tone || over the pulmonary artery, Often observed
increase in the liver.

11. 1. Mantoux test: negative energy
2. Bacteriological examination: effective from the 2nd week (after the
formation of decay cavities, there is practically no sputum before that);
MBTs often have multi-resistance.

3. X-ray diagnostics:

1. lobar pneumonia: darkening of the entire or most part of the lobe, at
first homogeneous, then with areas of illumination of a bay-shaped
shape with indistinct contours; in the future, cavities are visible.

2. lobular pneumonia: large focal shadows and small foci (up to 1.5 cm)
of irregular shape, medium or high intensity, with fuzzy contours; often
arranged symmetricallyd).

Laboratory data: UAC (with the progression of leukopenia with a
predominance of rod-shaped, lymphopenia, sharply increased ESR),
OAM (white blood cells, leached red blood cells, hyaline cylinders).

12. Radiographic picture of caseous pneumonia 8a
>

Caseous pneumonia lesions occupy at least two lobes ofthe lungs, but

bilateral lesions often noted. Caseous pneumonia radiographically looks like
irregular and often diffuse blackout large areas without significant changes in its
volume at the beginning. It is possible to detect some more dense foci,
projections of bronchi, areas enlightenment arising out of rapid decay of cheesy
masses in some places. Complete homogeneous blackout due particularly the
associated atelectasis. X-ray may also detect disseminated and confluent large
solitary infiltrates, often with irregular, blurred contours in which in the future,
with the rapid dilution of cheesy masses formed a giant cavities or a large
number of small cavities .

13. Radiographic picture of caseous pneumonia
Ne9
organs
patients with
fallo
ned, initially
reas of
iment of irreg ıy-shaped form with

contours appear. On CT ("ai

yronchography”) in the condensed lobe of the

lung, the lumens of the enlarged medium and
ronchi ¢ € liscernible
e caseous mass is rejected, the
1e characterist sofa
idually forming w the
nt segments and in the other foci of
dropout are often se > affected

yortion of the lung decreases as a

lobular caseous pneumonia, large focal
mall foci with a diameter of about
m the ntgenog
ojection. The shadows ha egular

im or high intensity, fuzzy contours

14. A

Caseous pneumonia differential
diagnosis.

- pneumonia of different nature: lobar,
Frydlender's, staphylococcal, virus,
mycoplasmal, legionellas and other,
- gangrene of the lungs,

lung'ssyphilis,

malignant tumors: pneumonia-like
form of lung cancer,

fungi lesions: aspergillosis pneumonia,
actinomycosis, candidiasis,

- histoplasmosis, cryptococcosis
coccidia-mycosis of lungs,

- vascular lesions: pulmonary infarction,
- atelectasisof different etiology.

15. Complications: bleeding;
pyopneumothorax with
the development of
pleural empyema,
cardiopulmonary and
respiratory insufficiency.
Outcome: healing is
impossible, as the lung
tissue melts;

In case of an unfavorable
outcome - a fatal outcome;
A relatively favorable
outcome is the
development of fibrous-
cavernous tuberculosis,
cirrhotic Tb

16. Disseminated tuberculosis (DT),
according to some authors, is from
16 to 34.5% of the acutely
progressive forms of tuberculosis.

Acute progressive forms of tuberculosis include
generalized tuberculosis (acute miliary tuberculosis,
acute tuberculous sepsis) as a result of hematogenic
dissemination of the process.The disease is
characterized by gradual development over 1-3
months, and then an acute outbreak of the disease
appears. Generalized tuberculosis occurs with
extrapulmonary manifestations, sometimes multiple.
Moreover, extrapulmonary symptoms of the lesion
lead to errors in the diagnosis of tuberculosis.

17. Infiltrative-alternative radiological picture.
Severe intoxication with the development
of multiple organ failure. Pronounced
bronchopulmonary syndrome. Massive
bacterial release. Deep immunodeficiency
and endotoxicosis.

18. ; x 10 sign

e 4 ofan +
o À alterative®s

== lesion

19. SS) Gl SZ SE DEZ

10.

High intensity and heterogeneous pricing structure.

Hypoventilation in the blackout zone.

Visualization of segmental bronchi - "air bronchogram“.

Fuzzy internal contours of cavities.

Fuzzy outer contours of cavities.

The presence of sequestration in the cavities.

Large- and medium-focal dissemination with high intensity in the
center of the foci, blurred outer contours, with a tendency to merge.
Inhomogeneous structure of dissemination foci with clearings in the
center and decay cavities.

The contact path of the spread of the process with the defeat of
nearby segments and pleura.

A high rate of progression of the process with an increase in changes
within 3-20 days is a pathognomonic sign of acute progressive forms
of tuberculosis.

21. ¿e

+

Visualization of segmental bronchi - "air
bronchogram".
A

tal

à Overview X-ray and tomogram of the apex of the left lung
(section 9 cm) of a patient with caseous pneumonia.

Against the
background of
intense
heterogeneous
darkening of the
upper lobe of the
left lung, lobular
and segmental
bronchi are traced
on the mediastinal
tomogram.

23. Overview X-ray, tomogram of the apex of the left lung (section 6 cm),
section of a computed tomogram, a patient with acute progressive
infiltrative tuberculosis.

24. Large- and medium-focal dissemination with high
intensity in the center of the foci, blurred outer
contours, with a tendency to merge.

Inhomogeneous structure of dissemination foci with
clearings in the center and decay cavities.

25. RADIOLOGICAL SIGNS OF ALTERATIVE LUNG LESIONS N:20 Sg

1. Intense inhomogeneous
shadowing of the upper
lobe of the right lung. of the
upper lobe of the right lung.

2. S6 contact lesion of the
right lung — intense
heterogeneous shadowing
associated with the upper
lobe.er lobe.

3. 3. Intense homogeneous
darkening along the costal
part in the affected area
indicates the involvement
of the pleura in the
process.

26. CASEOUS PNEUMONIA N021

An example of an X-ray picture of caseous pneumonia of the upper lobe of
the right lung.6 signs of alterative inflammation are visible, reflecting a
caseous-destructive lesion of the upper lobe of the right lung:1. Intense
inhomogeneous shadowing. 2. Hypovent n in the affected area. 3.
Visualization of segmental bronchi. 4. Fuzzy external contours of cavities. 5.
Fuzzy internal contours of cavities. 6. Contact lesion of the pleura.

27. X-RAY PICTURE OF INDIVIDUAL ACUTE PROGRESSIVE FORMS N22

DISSEMINATED TUBERCULOSIS

4 signs of alterative lesion:

1. Multiple areas of intense
heterogeneous darkening, consisting of
large, merging infiltrative-alterative foci.

2. Visualization of segmental bronchi. 3.
Fuzzy external contours of cavities. 4.
Fuzzy internal contours of cavities.

28. X-RAY PICTURE OF INDIVIDUAL ACUTE PROGRESSIVE F

FIBROU AVERNOUS
TUBERCULOSIS.