What is secondary tuberculosis? Why secondary tuberculosis requires increased attention Is it possible to get pulmonary tuberculosis again

Secondary tuberculosis develops as a result of reinfection or reactivation of an endogenous infection that is latent in the pulmonary system. The disease is found mainly in adults who previously had primary tuberculosis. The signs inherent in this form of tuberculosis were described by Robert Koch, who torn off the causative agent of the disease.

The most common form of pathology in the practice of phthisiology. It develops against the background of already formed anti-tuberculosis immunity. Therefore, the doctor detects secondary tuberculosis, as a rule, in persons who have previously been exposed to the bacterium.

Important! The disease affects people aged 30-50 years who have previously suffered a full-fledged primary tuberculosis complex or have developed a focus that later healed safely.

In medicine, there is no specific opinion about the initial catalyst of the disease. There are two main causes: reactivation and reinfection. In the first case, the old foci in the body are reactivated.

They get to the place of development in childhood or adolescence, but at the same time clinically the disease is completely cured. There is an assumption that in children with tuberculosis of the lymph nodes, pathogens may remain in a latent form.

After the fall of the protective functions of the body (hypothermia, acute respiratory infections,) with a current of lymph, mycobacterium enters the upper sections of the lungs.

In the second case, we are talking about the re-entry of pathogens into the body. The penetration of superinfection is so massive that the body cannot cope with the influx, and the disease enters the active phase.

The causative agent enters the lungs of a person who has already had primary tuberculosis or earlier, which was in a latent state. At the time of penetration of a large dose of the pathogen, the infected person has a good reactivity of the body, and the disease develops in a limited way.

Most experts adhere to the second option, as it is confirmed by a genetic study of a strain of mycobacterium.

How the disease develops and its symptoms

After contact with the pathogen, the disease is not clinically manifested. The sick person does not seek help from a doctor, and the lesion develops progressively, without being affected by drug treatment.

Further progression of tuberculosis leads to central necrosis that accompanies caseosis. That is, necrotic tissues appear similar to cheesy masses, which subsequently liquefy.

The pathological process can spread to a segment or lobe of the lung. being exposed negative influence mycobacteria, the lung loses its natural structure and its functionality deteriorates.

Symptoms of secondary tuberculosis:

cough is the main symptom of the disease;
- discharge scanty and without pus;
hemoptysis - manifested by small blood clots in the sputum;
bleeding in the lungs - develop with constant progression of the disease.

Features of the development of pathology:

there is no infection of the lymph nodes;
the segments of the upper lobe and the upper segments of the lower lobe of the lungs are affected;
promotion of infection occurs by contact;
the clinical forms of the pathological process are replaced in a certain order, and the phase of the disease can be traced from them.

At the beginning of the disease during the examination, the patient will not reveal serious clinical indicators. You can suspect the development of the disease with the help. Subtle signs appear, as a rule, with an extensive lesion.

There may be wheezing in the upper lobes of the lung. The formation of large caverns, when listening, is manifested by amphoric breathing. The progression of the disease can be manifested by quite pronounced symptoms, symptoms of intoxication are characteristic.

Forms

There are 8 forms of secondary tuberculosis. The transition from one to the other represents a further development of the previous phase.

Clinical forms of the disease have the following sequence and symptomatic manifestation:

Forms of tuberculosis	How do they manifest
Acute focal	It is the initial manifestation of secondary TB, with mild symptoms that can last for years. There are wheezing, cough, night sweats, headache, subfebrile temperature.
Fibrofocal	The lesion affects several segments of one lung. This form is characterized by a change in periods of exacerbation and healing.
Infiltrative tuberculosis	Continuation of the focal form. The temperature before going to bed rises to 38-39, cough, sputum, chest pain, weakness, night sweats.
Tuberculoma	Evolution of the previous form, foci of necrosis up to 5 cm in size appear. Signs of intoxication, moist rales, sometimes cough and fever.
Caseous pneumonia	Significantly increased caseous necrosis, further disintegrates and is rejected. The patient needs outside help, cough, purulent sputum, bleeding.
Acute cavernous	In the tops of the lung, caverns 2-7 cm in size are formed, the walls of which are covered with curdled masses. Slight fever, weakness, sputum production, chest pain.
Fibrous-cavernous	Continuation of the acute form, has a chronic course, possibly the formation of respiratory and heart failure. Characterized by pallor of the skin, cough, shortness of breath, loss of appetite.
cirrhotic	Final form. There is a deformation of the lung, it is compacted and weakly moves. Often troublesome dry cough, mucus streaked with purulence, sometimes purely purulent.

The difference between the initial focal form and the final cirrhotic one is global. In the first case, the patient may not suspect the presence of pathology for several years, only fluorography (pictured) will reveal the pathology.

Important! In the cirrhotic form, the instruction suggests palliative treatment. High probability of death.

The video in this article will acquaint readers with the main clinical complications of tuberculosis.

Complications and prognosis

Clinical complications can cover the following areas of the body:

bronchi;
trachea;
larynx;
oral cavity;
intestines.

The entry of mycobacteria into the upper respiratory tract and oral cavity leads to the appearance of hemoptysis. Such a symptom acts as a marker of an open form of the disease, the patient should be isolated from society.

The cavities formed in the lungs can cause severe functional deformation and cause the following syndromes:

anemia;
pneumothorax;
pleurisy;
tuberculous empyema;
fistula.

With a prolonged course of the disease, the development of secondary amyloidosis is likely. Against this background, renal failure occurs, and the patient may die.

With secondary tuberculosis, the prognosis depends on the timeliness of the initiated exposure. Despite the previously formed immunity to the disease, in the absence of the necessary treatment, the patient has a risk of death.

The average life expectancy of patients who do not receive adequate treatment is 2-2.5 years. It must be taken into account that the pathology has a sufficient duration, and the active phase is characterized by periods of exacerbation, which can be replaced by remission.

Just 100 years ago, tuberculosis was listed as incurable. They called him a consumptive. Now there are effective methods of treating tuberculosis, both medical and surgical. Many doctors claim that it is completely incurable, since Mycobacterium tuberculosis has a strong protective property.

If a person has undergone a course of treatment and feels well, he is still under medical supervision for at least 10 years, because he can get secondary tuberculosis.

What is secondary tuberculosis

Secondary tuberculosis is determined in people who have already had tuberculosis. They have developed immunity from this disease, but the infection is dormant in the human body and persists for a very long time. A person can simply be a carrier of mycobacteria all his life. Under certain conditions, the infection begins its activity. But this is not the main cause of secondary tuberculosis. Professionals believe that basically the disease comes again from the external environment and the person becomes infected with external mycobacteria.

In cases of a sharp decrease in immunity, with a negative impact of the external environment on a person, mycobacteria are excited, and secondary tuberculosis occurs. This disease is mainly localized in the apex of the right lung. The disease recurs in most cases in middle-aged men who abuse alcohol and drugs. Women are less likely to get sick with this disease, because basically after the illness they lead a healthy lifestyle, follow the recommendations of the doctor.

Robert Koch discovered the bacillus of the causative agent of the disease and it was called Koch's wand. Mycobacterium tuberculosis is ubiquitous and can withstand many disinfectants. There are types of mycobacteria that develop and exist only in humans, but only in birds and animals.

There are 2 forms of the disease - open and closed. Others can become infected with tuberculosis if the carrier has an open form of the disease. In other cases, the wand is not contagious.

Signs of the disease

Tuberculosis doctors in most cases diagnose pulmonary tuberculosis, and other types of tuberculosis are less common. The symptoms of pulmonary tuberculosis are as follows:

Weight is lost sharply, pale skin color appears, appearance worsens.
Weakness, fatigue, greatly reduced ability to work.
Dry cough at night and in the morning.
The cough goes from dry to wet with phlegm.
The average body temperature is 38 degrees and slightly higher.
With pulmonary tuberculosis, the presence of blood in the sputum.

The most common signs of secondary tuberculosis:

The lymph nodes are enlarged.
Pain in the solar plexus and behind the chest.
Painful urination.
Headache.
Hematuria.
The voice is changing.
Labored breathing.
The liver is enlarged.
Inadequate consciousness.
The heart rate rises.

Diagnosis of secondary tuberculosis

Important! All those who have been ill with this serious illness at the first signs similar to tuberculosis must undergo an examination. The onset of the disease can be mistaken for a cold, so you need to be extremely careful! The Mantoux test in the diagnosis of this disease will not give real results.

Secondary tuberculosis is diagnosed by more effective methods. In the study appoint:

Epidermal tuberculin test.
X-ray.
Sputum analysis.
Bronchoscopy.
Computed tomography.
Biopsy.

Forms of secondary tuberculosis

Secondary tuberculosis appears gradually. It begins without showing any signs, the patient may not be aware of a relapse.

With repeated tuberculosis, infectious bacilli can affect the entire body, and if it is not treated, then a person can live no more than 2.5 years. Experts have identified several forms of development of tuberculosis in its recurrence.

Focal

Up to 80% of sick people fall ill with this form in secondary tuberculosis. Signs can be different manifestations, but in many cases the disease does not manifest itself. Only during an X-ray examination can seals be detected on the lungs of different sizes. The first signs of the disease appear within a few years in the form of hoarseness, coughing, increased work of the sweat glands at night, migraine headaches, constant temperature fluctuations.

disseminated

This form often affects children, adolescents, and the elderly. They have:

The body temperature rises.
There are foci of inflammation in the lungs.
Chills.
Headache.
Cyanosis.
Complete lack of appetite.
There is sweating.
Interruptions in the work of the heart.
Dryness in the throat and the same cough.

The disease in a disseminated form is difficult, because there is strong change in the lung tissues, persistent nausea due to a large number toxins entering the body, which can lead to death.

infiltrative

In the lungs, many foci are formed connected to each other. This form is characterized by:

Inflammation of the lungs.
Strong expansion of the bronchi.
Mild discomfort.
Weakness.
Decreased appetite.
Drowsiness.
A short-term increase in body temperature.

Diagnosis in this form is not easy to make. Phthisiologists diagnose pathology only after receiving the results of the examination, which helps to detect thin-walled isolated cavities in a small amount, the lung tissue hardly changes. Although the symptoms of the disease are not complicated, but repeated tuberculosis can bring serious problems to the patient's health.

Fibrous-cavernous

This form differs from others in that caverns with thick walls are formed in the lungs, which are formed by fibrous tissue. The disease lasts for a long time without any special signs and gradually the lungs can be transformed into fibrous tissue.

cirrhotic

Last form. The lung is deformed, becomes dense, its movements are weak. This stage is distinguished by a dry cough, mucous sputum with pus.

Treatment of pathology

The disease is treated with antibiotics using special individual schemes compiled by a phthisiatrician for each patient, depending on the form of the disease. Together with antibiotics, experts prescribe glucocorticosteroids, probiotics, vitamins. During the course of treatment, the doctor may, if necessary, prescribe symptomatic medicines and medicines to strengthen the immune system. Tuberculosis doctors prescribe drugs such as Ethambunol, Pyrazinamide, Isoniazid, Rimfapicin at the beginning of treatment. The dosage is selected individually for each patient.

The doctor prescribes at least 2 drugs, but in practice it has been proven that it is easier to achieve a positive result by prescribing all 4 drugs at once. Paracetamol and alcohol, when used simultaneously with anti-tuberculosis drugs, can lead to a deterioration in the patient's health, because the liver suffers. The patient stays in the hospital for at least 6 months, then the patient undergoes 6 months of chemotherapy.

In addition to drug treatment, patients are prescribed a diet that includes foods high in calories, protein and fat. For patients, they make a special daily regimen, send them for treatment to a sanatorium, carry out physiotherapy exercises, physiotherapy, occupational therapy.

With complications of the disease, surgery is performed. Surgery rarely used in treatment, but its admissibility in secondary pathology is high.

The operation is performed if the doctors find in the patient:

Pulmonary bleeding.
Open cavities of the lungs.
Foci containing calcium, interfering with breathing.
Bronchial scars.
Oncological disease.
Secondary tuberculous meningitis.
Tuberculosis of the pericardium.
Skeletal tuberculosis.

Causes of a secondary disease

AIDS disease.
Strong medicines and drugs.
Prolonged stay of the ill person near the source of infection.
Inflammation of old foci of the disease.
Non-compliance with the treatment regimen for primary tuberculosis.
Have you had chemotherapy?
A person who has been ill for a long time is in dampness, cold, without fresh air.
Living in unsanitary conditions and in cramped quarters without complying with housing standards.
Infertility and malnutrition.
Another serious disease that reduces the protective function of the body.

Mechanisms of development of secondary tuberculosis

Having cured, for the first time from tuberculosis, a person develops immunity to Koch's sticks. It arises due to the fact that defenders, T-lymphocytes, are present in all organs and tissues. Getting the second time in the body of mycobacteria, they are destroyed by immune cells. But for a number of reasons, secondary tuberculosis can develop.

The first mechanism of infection with Koch's bacillus is superinfection

Through the respiratory organs, infectious bacilli penetrate the lungs, and the inflammatory process begins. Since the lymphatic system is well protected by immune cells, of which there are many, bacilli cannot enter it.

Immune cells also protect the blood and other organs from infection. The recurrence of the disease affects only lung tissue. Without appropriate drug treatment, mycobacteria spread to a segment or lobe of the lung. The natural structure of the lung is destroyed and its functionality is reduced.

The second mechanism of infection is reactivation

A person who has been ill with tuberculosis has primary foci that healed after recovery, in which the infection remains in a latent state. When immune cells partially or completely disappear, "sleeping" bacilli are activated in Gon's foci - secondary foci in which the division and reproduction of Koch's sticks begins. A new round of disease is coming.

At-risk groups

Patients with diabetes.
Suffering from diseases of the endocrine system.
Do not consume protein foods for a long time.
WITH clear signs exhaustion.
Suffering from a high degree of obesity.
Working as medical experts, pathologists, laboratory assistants.
Prison workers, social workers, prisoners.
AIDS patients.
Alcoholics.

Disease prognosis

Timely referral to a specialist with a recurrent disease and its immediate treatment, the prognosis is always positive. But it all depends on the form of the disease. It has been established that patients with focal tuberculosis recover faster than with other forms of tuberculosis.

In chronic tuberculosis, the patient remains able to work for a long time, which does not allow timely diagnosis of a relapse. For a long period without treatment, connective tissue forms in the lungs, so phthisiatricians do not undertake to treat the disease with medicines. Doctors in this case carry out surgical treatment. The prognosis in such cases is unfavorable.

Ways to restore the body

Attention! The main thing during the fight against the disease and prevention of relapse is the support of immunity in a normal form.

To improve immunity after inpatient treatment, doctors prescribe rehabilitation.
Ways to strengthen immunity:

The use of vitamins.
Enhanced nutrition.
Stop smoking, drinking alcohol.
Normal sleep.

Important! In order to avoid a recurrence of the disease, doctors recommend maintaining a healthy lifestyle, constantly monitoring the condition of the lungs, taking x-rays at least once a year, and trying not to come into contact with the source of infection. During the recovery period, it is necessary to follow the recommendations of the phthisiatrician, who will monitor the treatment, and make the necessary appointments during the recovery process.

If a repeated diagnosis is established - tuberculosis, one should not panic and despair, but continue to fight the disease with all possible methods. This disease is curable and there are many examples of this. Work in scientific medical institutes and perhaps tomorrow they will find even more effective methods and drugs to fight this disease!

Secondary tuberculosis, otherwise called re-infectious, is formed in the body of a person who has previously encountered a primary infection. It provided him with a certain immunity and protection of the body, but did not protect him from the likelihood of recurrence. pathological condition. About the causes of this phenomenon, symptoms and how prevention is carried out further.

Secondary tuberculosis is associated with the least obvious developmental factors. In a small number of people, after a relatively long period of time, a secondary tuberculosis form develops. This can occur independently of the primary infection and whether cellular immunity has been restored.

Most often it is observed in adults from 30-40 years old. This is due to the fact that immunity and metabolism are weakened by the following factors:

chronic diseases;
potent medicinal components (immunosuppressants and others);
bad habits: from alcohol to drug addiction.

Secondary varieties of tuberculosis associated with extrapulmonary manifestations are formed much more often than primary ones. This is despite the fact that lung infections remain a common form of secondary TB that will take at least 6 months to prevent. About how the secondary form of the disease manifests itself further.

Condition symptoms

Secondary pulmonary tuberculosis provokes symptoms similar to those of the primary type of pathology. In this case, they may be more pronounced.

Characteristic manifestations in the presented pathology are cough urges within 2 or more weeks, getting rid of accumulated sputum, which can be replaced by hemoptysis.

Symptoms may be accompanied by fever, a decrease in body index and a total lack of appetite. Patients who have previously encountered tuberculosis quickly identify the symptoms presented and turn to a pulmonologist. As a result, prevention and therapy is facilitated by 2-3 times.

If we talk about the extrapulmonary form of tuberculosis, then depending on the organ affected by the disease, different symptoms can be observed. We can talk about an increase in lymph nodes, pain in the peritoneum or sternum. There may be pain during urination or the appearance of blood in the urea.

Feelings can be joined by a headache, problems with the integrity of consciousness and the perception of what is happening. If the prevention of previous pathological conditions and primary tuberculosis was carried out incorrectly, symptoms such as:

an increase in the size of the liver;
change in the timbre of the voice, the appearance of hoarseness and other objective processes;
frequent shortness of breath;
rapid heart rate.

Diagnostic measures

Secondary forms of tuberculosis imply a detailed diagnostic examination. If tuberculosis has been previously identified in a patient, there is no need to perform a Mantoux test, because the secondary tuberculosis form is obvious. Otherwise, the diagnostic examination begins with an epidermal tuberculin test. The presented pathological condition associated with a deviation in the activity of the lungs is identified using radiography. An additional measure of examination is the analysis of the ratio of sputum.

The pulmonologist may need bronchoscopy, CT, or MRI to identify the forms of the pathological condition of the extrapulmonary type. In the most problematic cases, we can talk about a biopsy and urinalysis. It should be noted that it is recommended not to be limited to conducting a survey only on initial stage illness. The best option It turns out to do this every 6-7 months. In order for prevention to be 100% effective, it is necessary to know about the methods of treating the disease.

Ways to restore the body

The presented form of the disease is treated medicines. We are talking about rifampicin, ethambutol, pyrazinamide and others medicines. Pulmonologists note that the recovery course will be effective with the synchronous use of two medicines. A significant result is achieved by the use and correct combination of four means.

As part of therapy for tuberculosis, it is recommended to abandon the use of alcoholic beverages and medicinal components. We are talking about paracetamol and other drugs that heavily burden the liver. To identify the presented drugs, it is necessary to undergo a consultation with a pulmonologist and an additional examination.

In some cases, an operation is prescribed. This may be required in the following situations:

forced pulmonary bleeding;
secondary tuberculous meningitis;
pathological processes in the pericardium, the prevention of which is problematic.

The skeletal type of tuberculosis should be distinguished, which affects the joints and can even provoke forced damage. In these situations, the prompt intervention of the surgeon is necessary. About what complications and consequences may turn out to be if prevention is carried out incorrectly, further.

Complications and consequences

Given the weakness of the body and the seriousness of the problems associated with tuberculosis, one can expect serious critical processes. These include complications from the following systems: pulmonary, bronchial, cardiac. Blood circulation, the functioning of the liver and other internal organs may be aggravated.

The secondary type of tuberculosis can affect the integrity and general condition of the skeleton, bone composition. It can adversely affect the activity of the gastrointestinal tract, aggravating digestion. Special attention should be given to restoring the state. Diagnostics should remain no less correct and thorough.

Preventive measures

Vaccination is the main method that prevents the development of a pathological condition. Additionally, chemoprophylaxis may be needed, which at each stage of implementation should be adjusted in accordance with the recommendations of the pulmonologist and phthisiatrician.

According to the experts presented earlier, each of the designated forms of prevention will be ineffective without changing social conditions. This complex, which includes prevention, consists in eliminating bad habits, proper nutrition and adherence to physical activity.

It is mandatory to exclude contact with the source of infection and other aggressive components.

The secondary form of tuberculosis is an extremely serious form of the disease. This is due to progressive negative symptoms and the rapid possibility of complications and critical consequences. Correct treatment allows you to get out of this state with minimal losses and save 100% of your life.

07.04.2010, 13:54

Good day! I have had tuberculosis twice. The first time was 4 years ago, and 2 months ago I completed a 9-month course of treatment after a relapse. I will say right away that the conditions in our city are such that I was treated at home, I did not take any tests during treatment, only at the very beginning I passed sputum 1 time. They said there was no bacteria. Every 2 months, an extensive x-ray took place, the pictures clearly showed that the spots were disappearing. The treatment regimen was as follows - 4 rifampicin, 2 isoniazid, 4 pyrazinamide, 3 ethambutol. And this is all 9 months. I don't know if I was cured, or rather, if only an X-ray can serve as an answer to this question. Anyway - in 4 months I plan pregnancy. By the way, after long attempts to get pregnant, I still succeeded once, in the same month as I started treatment ...... the pregnancy had to be terminated. In 4 months it will be half a year since I do not take pills, then I will undergo a control fluorography, and if there are no changes for the worse, can I get pregnant and most importantly, can tuberculosis return during pregnancy ???? how to prevent? what to do before pregnancy? Can I take a prophylactic course of pills? Please, please, my husband and I want a child so much, but this illness made me so desperate (((((

07.04.2010, 18:05

You can, of course, plan a pregnancy if everything is in order during the examination.
The risk of recurrence during pregnancy is no higher than outside pregnancy. There is no point in taking pills.
It is impossible to completely prevent a relapse - but if you are less nervous, do not smoke and eat well, then the risk is less.

07.04.2010, 20:43

13.04.2010, 07:27

Hello doctor! Please tell me who I can contact with the results of a blood test, indirect bilirubin - 19, total bilirubin - 21.4, total protein - 54.9.

13.04.2010, 14:41

First of all, you need to contact an eye doctor.

29.06.2010, 08:06

Hello! It has been 4 months since I finished treatment (8 months). I had an x-ray a week ago and they said everything was fine. It worries me that I periodically feel like a pulsating whining (weak) just below the collarbone on the right, there I had spots on the x-ray, it does not last long, but it happens a couple of times a day, and it happens that not even once during the day whines. Tell me is it okay? Is tuberculosis coming back? And another question: I'm planning a pregnancy - I have problems in a feminine way, so it's not a fact that I quickly get pregnant, but isn't it scary if the pregnancy occurs 5-6 months after the cure? and how to give birth? I understand caesarean? Many thanks in advance for your replies!

29.06.2010, 08:32

Why do you start new topics every time?
Your pain may be pleural, this is normal. If there is no increase in foci in the pictures, it's okay.
It is too early to get pregnant 5-6 months after the end of treatment, it is better to wait a year so that there is no early relapse. However, you already asked about pregnancy. You don't have to be smart Elsa - you are not even pregnant yet, but you are already thinking about how to give birth. This is unpredictable even in perfectly healthy women, and is determined not by the presence of tuberculosis, but by obstetric indications.

29.06.2010, 10:15

I’m thinking about how to give birth because I’ve heard that during natural childbirth after tubes, there is too much stress on the body and CS will be safer. And I didn’t want to seem smart Elsa at all, I just want to clarify the points that interest me. Thank you for the answer about the pain, reassured.

29.06.2010, 13:42

Indications for caesarean section are determined ONLY by the obstetric situation. With CS, on the contrary, a very large load on the lungs and heart occurs after the extraction of the fetus. Therefore, there is no need to collect information about experienced people; there are no such recommendations anywhere in the world literature.

19.07.2011, 10:20

Hello! [Only registered and activated users can see links] - a year ago I created a topic where I asked about tube recurrence, as well as behavior in case of pregnancy. So, I finally got pregnant. Now I am 14 weeks. The last x-ray took place a year ago (more on this in the topic at the link), everything was fine. Before pregnancy, I wanted to undergo an x-ray, but I didn’t have time, and now I’m worried if everything is fine. I feel good, I don’t sweat at night, I don’t seem to have a TT, but during pregnancy I heard TT 37 and a little higher - this is normal, there is no cough. Do I need to have a sputum or blood test for TB? If the process has begun, but I don’t know, and I give birth against the background of an illness, will the child become infected and will it be possible for him to put BCG? Thanks a lot in advance!! I worry a lot, because the child is very long-awaited!!

Secondary pulmonary tuberculosis occurs in adults who have formed and successfully healed in childhood at least a small tuberculous primary affect, and often a complete primary complex.

Secondary tuberculosis occurs either due to re-infection of the lungs ( reinfection), or when the pathogen is reactivated in old foci (20-30 years after the initial infection), which may not give clinical symptoms.

Features of secondary tuberculosis

predominant lesion of the lungs (synonymous with pulmonary tuberculosis) without involvement of the lymph nodes in the process; damage to the apical, posterior apical segments of the upper lobe and the upper segment of the lower lobe (I, II and VI segments); contact or canalicular spread; change of clinical morphological forms, which represent the phases of the tuberculous process in the lung.

It is customary to distinguish 8 morphological forms secondary tuberculosis

Acute focal tuberculosis. The initial manifestations of secondary tuberculosis are represented by specific endobronchitis, mesobronchitis and panbronchitis of the intralobular bronchus. In the future, acinous or lobular caseous bronchopneumonia develops. Along the periphery of necrotic foci are layers of epithelioid cells, then lymphocytes. There are Langhans cells. One or two foci occur in the apex, i.e. in I and II segments of the right (rarely left) lung in the form of compaction foci with a diameter of less than 3 cm. Sometimes there is a bilateral and symmetrical lesion of the apexes with even smaller foci. When the lesions heal (after treatment or spontaneously), encapsulated petrificates occur (ossification does not occur).
Fibrofocal tuberculosis develops on the basis of healing, i.e. encapsulated and even petrified foci. Such newly “revived” foci can give rise to new acinous or lobular foci of caseous pneumonia. The lesion is limited to several segments of one lung. Microscopic examination can pay attention to the presence of foci of caseous necrosis and granulomas, as well as encapsulated petrificates and foci of pneumosclerosis. The combination of healing and exacerbation processes characterizes this form of tuberculosis.
Infiltrative tuberculosis represents a further stage of the progression of the acute focal form or exacerbation of the fibro-focal form. The foci of caseous necrosis are small, around them on a large area there is a perifocal cellular infiltrate and serous exudate, which can sometimes cover an entire lobe ( lobit). Specific features - epithelioid and giant Langhans cells - are not always clearly expressed in the infiltrate. It is at this stage that X-ray examination most often reveals secondary tuberculosis (rounded or cloudy infiltrate).
Tuberculoma - an encapsulated focus of cheesy necrosis up to 5 cm in diameter, a peculiar form of the evolution of infiltrative tuberculosis, when perifocal inflammation disappears. It is located in the I or II segment of the upper lobe, more often on the right.
Caseous pneumonia most often it is a continuation of the infiltrative form. The scale of the lesion is from acinous to lobar. It is characterized by massive caseous necrosis with its subsequent disintegration and rejection. The lung is enlarged, dense, on a cut of yellow color with fibrinous overlays on the pleura. May occur in the terminal period of any form of tuberculosis in debilitated patients.
Acute cavernous tuberculosis develops as a result of the rapid formation of a cavity in the caseous masses. A cavity with a diameter of 2-7 cm is usually located in the region of the apex of the lung and often communicates with the lumen of the segmental bronchus, through which caseous masses containing mycobacteria are removed along with sputum when coughing. This creates a great danger of bronchogenic seeding of the lungs. The walls of the cavity from the inside (inner layer) are covered with cheesy masses, behind which are layers of epithelioid cells with scattered Langhans cells.
Fibrous-cavernous tuberculosis (pulmonary consumption) has a chronic course and is a continuation of the previous form. At the apex, more often than not, of the right lung there is a cavity with a thick dense wall, the inner surface of the cavity is uneven, the cavity is crossed by sclerosed vessels and bronchi. On microscopic examination, the inner layer of the cavity is represented by caseous masses, in the middle layer there are many epithelioid cells, multinucleated giant Langhans cells and lymphocytes, the outer layer is formed by a fibrous capsule. The process spreads in the apico-caudal direction. With this form (especially during the period of exacerbation), the “number of storeys” of changes is characteristic: under the cavity, one can see focal lesions, older in the upper and middle, and more recent in the lower parts of the lung. There are focal and diffuse sclerosis, petrifications, foci of caseous pneumonia. Through the bronchi with sputum, the process passes to the second lung. In the second lung there are also foci of caseous pneumonia, foci of decay with the formation of caverns, pneumosclerosis. Constant or recurrent bacilli isolation of multiresistant strains of M. tuberculosis is characteristic. Patients with fibrous-cavernous pulmonary tuberculosis pose the greatest threat to the healthy population, requiring isolation and long-term chemotherapy. At autopsy, this form of secondary tuberculosis is the most common.
Cirrhotic tuberculosis - the final form of secondary tuberculosis, characterized by a powerful development of scar tissue. In place of the healed cavity, a linear scar is formed, focal and diffuse pneumosclerosis is expressed. The lung is deformed, dense, inactive, interpleural adhesions appear, as well as numerous bronchiectasis. It is almost impossible to cure such patients.

With secondary tuberculosis, due to the spread of infection canalicular or contact, the bronchi, trachea, larynx, oral cavity, intestines are affected.

Hematogenous spread of infection in secondary tuberculosis is rare, but it is considered possible in the terminal period of the disease with a decrease in the body's defenses.

Complications of secondary tuberculosis

associated mainly with caverns. Bleeding from damaged large vessels, especially repeated ones, can end in death from posthemorrhagic anemia. The rupture of the cavity and the penetration of its contents into the pleural cavity lead to pneumothorax, pleurisy, tuberculous empyema and bronchopleural fistula.

With a long-term undulating course of secondary pulmonary tuberculosis (and with chronic destructive extrapulmonary tuberculosis), secondary amyloidosis may develop. Chronic inflammation in the lungs with the development of pneumosclerosis and emphysema can lead to the formation of chronic cor pulmonale and death from chronic pulmonary heart failure.