Tuberculosis of the intrathoracic lymph nodes is a form of the disease that is still not fully classified. Some believe that it can be attributed to independent diseases, others believe that it should be left as part of the primary tuberculosis complex. We will talk about this disease in our article. Let's take a closer look at the causes of the disease, its forms, diagnostic methods and methods of treatment, as well as possible complications and preventive measures.
What is this?
Tuberculosis of the intrathoracic lymph nodes (ITLN) is a disease characterized by the onset of inflammatory processes in the lymph nodes located in the root of the lungs. Cause the pathology of microbacterium tuberculosis. The pathogen can be transmitted through infected animals.
Children, adolescents and young people under 25 years of age most often suffer from VLLU TB. Thanks to mass vaccinations, there are practically no epidemics, casesinfections are rare and occur only with a decrease in immunity. This pathology is characterized by a chronic course with a long-term preservation of the activity of degenerative processes. 70% of the complications of the disease occur in children under three years of age.
Method of infection
All forms of tuberculosis of the intrathoracic lymph nodes in humans are caused by the bacterium Mycobacterium tuberculosis.
Infection occurs in the following ways:
- Due to the consumption of food obtained from a sick animal (for example, cow's milk).
- Airborne droplets from an infected person or animal.
- Through household items and products contaminated with bacteria.
- Through skin wounds.
- Can be passed from mother to child during pregnancy (via the placenta) or lactation (through milk).
The most likely infection is through the respiratory tract. A person with tuberculosis constantly exhales sputum into the air when coughing and talking, which contains hostile microorganisms. They are able to spread over a distance of up to two meters and remain in the air for an entire hour. Then they settle on the floor and mix with dust, while their viability lasts up to a month and a half.
What increases the chance of infection?
The respiratory organs of a he althy person are protected from tuberculosis infection, but smoking and bronchopulmonary diseases can reduce this immunity. In 95% of cases, upon first contact withtuberculosis bacterium does not infect.
Factors that increase the likelihood of infection:
- Inadequate and unbalanced nutrition.
- Prolonged contact with infected TB.
- Bad living conditions.
- Presence of chronic diseases.
- Great physical and mental stress.
Usually, an infected person has one of these items, or even several, includes a medical history. Tuberculosis of the intrathoracic lymph nodes therefore affects people with bad habits who suffer from chronic fatigue, as well as children from dysfunctional families. Infection is almost impossible to notice, moreover, a he althy body immediately begins to form natural immunity. Where the patient was, several people can pass in a day, but only the one whose body is not ready to defend itself will become infected. At risk are children and adults who have not been vaccinated, as well as those with HIV infection and people with weak immunity.
Disease forms
There are the following forms of tuberculosis of the intrathoracic lymph nodes:
- Tumor.
- Infiltrative.
- Small.
Tumor is a severe type of bronchoadenitis. It often occurs in young children with a strong increase in lymph nodes (their diameter can reach up to 5 cm) and massive tubinfection. Often the affected nodes are soldered together, forming single conglomerates.
The infiltrative form causes a slight enlargement of the lymph nodes, with perinodular inflammation predominating.
Small form
Small form of tuberculosis of the intrathoracic lymph nodes is difficult to detect, and affects mainly children. Late diagnosis or lack of recognition leads to cicatricial changes in the mediastinum, which affects the normal functioning of the capillary pulmonary blood flow. Also, pathology can cause more serious and dangerous forms of tuberculosis.
In order to make a correct diagnosis and identify the disease, it is necessary to take into account the entire complex of radiological and endoscopic data, it is also necessary to conduct a tomography of the mediastinum.
Problems of small form diagnostics
Even in the active phase, a small form of tuberculosis of the intrathoracic lymph nodes is characterized by damage to 1-2 lymph nodes with a slight increase (up to 1.5 cm). These signs can be seen on an x-ray.
Clinical symptoms are extremely mild. They are usually presented only by subfebrile condition and intoxication syndrome. In adolescence, the main complaint is vegetovascular dystonia. Therefore, patients are often sent for examination to doctors of a different profile. At the same time, a small form of tuberculosis is dangerous because the disease can lead to damage to other internal organs.
Symptoms
Tuberculosis of the intrathoracic lymph nodes has the following symptoms:
- Body temperature rises to 39 degrees.
- At night time arisesincomprehensible sweating, that is, not caused by heat.
- Appetite is deteriorating.
- Cough starts, similar to whooping cough.
- Severe pallor of the skin, up to a bluish tint.
However, these signs can be mild, then it will be extremely difficult to make an accurate diagnosis on them. But during the inspection, other signs may be revealed:
- Visual. The peripheral venous network expands significantly in the first and second intercostal space. Between the shoulder blades, small vessels dilate in the upper areas.
- Palpatory. The occurrence of pain with pressure on the spinous processes of the thoracic vertebrae (from the 3rd to the 7th).
X-ray examination is important in the diagnosis of tuberculosis. At the same time, it is carried out in lateral and anteroposterior projections, since the shadow from the lymph nodes may be hidden by the mediastinal organs and the heart muscle. It is also important to conduct a tomography of the tracheobronchial tree. But we will talk about this in more detail later.
Diagnosis
It is very difficult to distinguish tuberculosis of the intrathoracic lymph nodes from other similar pathologies. Differential diagnosis is needed here more than in any other disease.
So where does the diagnosis begin?
The first step is to identify the presence of Mycobacterium tuberculosis in the body. Tuberculosis bacilli can be easily found in the washings of the stomach. Most oftenthey are found in bronchial washings, sputum.
The next is the obligatory X-ray examination. With it, you can not only determine whether a person is infected, but also understand how long ago he was infected. The tomography method is also good, which allows you to analyze the structure of the lymph nodes, which greatly simplifies the task for doctors in making a diagnosis.
An important diagnostic method is the Mantoux test. With a positive result, it is also called a "turn". In this case, the reaction of the infected person to the injection will be as follows - the injection site will increase by more than 5 mm. "Bend" is diagnosed in the following cases:
- Papule (place of compaction) becomes larger than 0.5 cm.
- Becomes significantly larger compared to previous results.
- Exceeds the norm by 17 mm, excluding the prescription of the previous vaccination.
- After 3 years, its size remains more than 12 mm.
However, not always a positive Mantoux test indicates infection. There is a possibility that the cause of such a reaction may be allergies or previous diseases. Also, a negative test does not always indicate the absence of infection. A false-negative result may be due to immunodeficiency or the fact that 10 weeks have not passed since the infection.
However, the "turn" is sufficient reason to continue further investigation.
Also, as part of diagnostic measures, a blood test is done. Atinfected with MTB, the number of leukocytes, lymphocytes, neutrophils, eosinophils will be slightly increased.
Differential diagnosis of tuberculosis of intrathoracic lymph nodes
When making a diagnosis of tuberculosis, VLLU often has to be differentiated from other tuberculosis pathologies. To do this, the doctor must carefully study the history, identify the likelihood of contacts with bacillary patients, analyze tuberculin samples, and consider all previous diseases that could be associated with infection.
In addition to the possibility of confusing VLLU tuberculosis with another type of tuberculosis, there is still a chance of not distinguishing it from diseases of the intrathoracic lymph nodes.
It is also possible to confuse the pathology with metastases caused by lung cancer and lymphosarcoma. However, this possibility appears only in older patients.
Treatment methods
Tuberculosis of the intrathoracic lymph nodes in children and adults proceeds almost the same way, therefore, therapy is prescribed with minimal differences.
Treatment of this type of tuberculosis is long enough. On average, therapy can take from 10 months to one and a half years. In this case, the first 2-3 months the patient should be in an anti-tuberculosis hospital. First, so as not to infect others. Second, for more effective treatment.
All this time, complex therapy has been carried out, which includes drugs against tuberculosis, hepatoprotectors, vitamins, immunomodulators.
Also in the first weeks when runningstages of the disease, chemotherapy may be given. Together with it, various procedures for cleansing the body are usually prescribed. For example, intravenous laser blood irradiation or plasmapheresis.
Treatment of VLLU tuberculosis is divided into two stages. During the first, intensive treatment is carried out, which is aimed at destroying the office, restoring lung tissues damaged during diseases and preventing complications. Therapy against tuberculosis involves the combination of several drugs that can destroy all types of MBT. The second stage is not so intense. The main thing here is to prevent the re-development of pathology, promote tissue healing, destroy the remaining harmful mycobacteria and strengthen the immune system.
During the entire treatment, it is recommended to follow a special diet that will help reduce body toxicity and increase resistance to infections. The diet necessarily includes foods with a high protein reading (eggs, meat, dairy products), butter and olive oils, honey, cereals, vegetables and fruits with a lot of vitamin C.
Surgery
Tuberculosis of the intrathoracic lymph nodes rarely leads to the need for surgical intervention, as the disease is extremely calm, almost asymptomatic.
There are two main reasons for surgery:
- The beginning of the formation of tuberculoma of the lymph nodes.
- No positive resultstreatment that was started more than six months ago.
Possible Complications
Let's list the possible complications of tuberculosis of the intrathoracic lymph nodes:
- Formation of glandular-bronchial fistulas due to severe bronchial damage.
- Due to the complete violation of bronchial patency, which occurs when the bronchi are compressed by massive lymph nodes or blocked by their caseous masses, often there is a collapse of the lobe, atelectasis of the part of the lung located above the focus of compression or blockage.
- Total or focal atelectasis (collapse of part or lobe of the lung).
Preventive measures
Tuberculosis of the intrathoracic lymph nodes, the diagnosis of which was discussed in detail by us above, belongs, like all other types of tuberculosis, to "social diseases". That is, its occurrence directly depends on housing conditions and the level of prosperity. In Russia, the causes of epidemiological trouble for this pathology are considered to be a sharp deterioration in living standards, a decrease in the quality of socio-economic conditions, a rapid increase in the number of citizens without a fixed place of residence, as well as an active resumption of migration processes.
