The term "secondary pulmonary tuberculosis" refers to a pathological process that develops in adults who successfully endured a small affect, and sometimes a full complex, in childhood or adolescence. 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, surgery is indicated. The outcome of the disease directly depends on the timeliness of the visit to the doctor.
Pathogenesis
After a person has had tuberculosis for the first time, dissemination of the pathogen (Koch's sticks) occurs in 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 of expressedcauses no changes. After the disappearance of the granuloma, scar formation occurs. At the same time, specific immunity is formed in the body.
It is important to know that absolutely all people who have previously had the disease are at risk of developing secondary tuberculosis. Under the influence of various adverse factors, the process of active life of Koch's wand starts. As a result, symptoms of secondary tuberculosis begin to appear. As practice shows, the disease is more difficult to tolerate, surgery is performed much more often.
Etiology
As mentioned above, the pathogenesis of secondary tuberculosis is based on the activation of the vital activity of the Koch bacillus, previously disseminated to regional lymph nodes.
Factors contributing to the reproduction of the pathogen:
- Live in a cold, unventilated and damp room.
- Long stay in conditions of violation of sanitary standards.
- Unbalanced diet.
- The presence of other severe 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 respiratory tract and lungs. Much less often in pathologic althe process involves the kidneys, bones, joints and skin.
Clinical manifestations
The second time the disease is more difficult than the first. In extremely rare cases, the pathology may be asymptomatic.
Symptoms of secondary pulmonary tuberculosis:
- Dramatic weight loss.
- Disturbance of appetite (up to its absence).
- Persistent cough. Initially, it is dry, after a while sputum begins to separate.
- Shortness of breath.
- Constant jumps in body temperature. In the morning it is often low or within the normal range, in the evening and at night it is increased.
- Excessive sweating.
- Persistent fatigue for no apparent reason.
- Disruption 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 also begin to form.
Regarding what is the difference between primary and secondary tuberculosis. When Koch's wand enters the body, the process of its reproduction starts. Symptoms during the initial infection develop acutely. With timely treatment to the doctor, the prognosis is usually favorable. More patients are recovering.
Secondary tuberculosis is characterized by an unstable course. In other words, there is a constant change of periods of exacerbation and remission. The general state of he alth of the patient is much worse than during the initial infection. But in rare cases, the pathology proceedsasymptomatic.
Forms of secondary tuberculosis
The disease is characterized by an undulating course. It changes quite quickly 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.
| Morphological form of tuberculosis | Changes in the body |
| Acute focal | At the initial stage of development, signs of endo-, meso- and panbronchitis appear. After some time, bronchopneumonia occurs. In the course of diagnostic measures, Langhans cells can be detected. There are few foci of pathology, as a rule, 1-2. Most often they are localized in 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, the formation of encapsulated petrificates occurs. |
| Fibrofocal | Develops in place of healing lesions. New lesions can provoke the occurrence of 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 occurrence of exacerbation and healing processes. |
| Infiltrative | As the pathology progresses, areas of caseous necrosis are formed. Around them, an infiltrate or exudate is formed. It is at this stage during the X-ray examinationit is already possible to make an accurate diagnosis. |
| Tuberculoma | 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 segments I and II of the right lung. |
| Caseous pneumonia | The scale of the defeat in this case may be different. Sometimes the entire lung is involved in the pathological process. It becomes dense and increases in size. |
| Acute cavernous | Cavities are formed in the caveous zones. Their walls are covered with a layer, the consistency of which resembles cottage cheese. Behind it are epithelial and Langhans cells. |
| Fibrous-cavernous | Another name is pulmonary consumption. The disease progresses rapidly: sclerosis develops (both focal and diffuse), petrificates and foci of caseous pneumonia appear. The second lung is involved in the pathological process. |
| Cirrotic | Final form. Accompanied by the formation of scar tissue. The affected lung is deformed, compacted, becomes inactive. This stage is characterized by the formation of adhesions and bronchiectasis. |
Thus, the acute focal form is an early stage in the development of the disease. Secondary tuberculosis of the last degree is practically incurable. It is possible to save patients' lives only in isolated cases.
Diagnosis
WhenIf you have any warning signs, you should contact your physician. The doctor will conduct an examination, collect anamnesis data and, if a pathology is suspected, will refer you to a phthisiatrician for treatment.
Diagnosis of secondary tuberculosis involves the following activities:
- Conversation with a patient. The phthisiatrician listens to complaints, clarifies whether there was a primary infection with tuberculosis. In addition, the specialist assesses the likelihood of the patient coming into contact 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 fluctuations in recent times).
- Sputum analysis.
- X-ray examination.
- A blood test to detect antibodies to Koch's wand.
Based on the results of the diagnosis, the doctor makes the most effective treatment regimen. All activities are carried out in a hospital.
Conservative treatment
Drugs are selected exclusively by a doctor, taking into account the individual characteristics of the body and the results of the diagnosis.
Treatment of secondary tuberculosis is aimed at the destruction of the pathogen and relief of symptoms. All drugs are divided into 3 groups: A, B and C.
The first includes the following medicines:
- Rifampicin.
- "Streptomycin".
- "Pyrazinamide".
- Ethambutol.
- Isoniazid.
Group A drugs are considered essential. OtherIn 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".
- "Amicacin".
- Cycloserine.
- "Capreomycin".
In many cases, doctors prescribe group C medications. They are 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 the treatment regimen. For the first 5 months, patients are prescribed 2 or 3 drugs from the main group. In the presence of Koch's bacillus resistance, all daily dosages are shown to be drunk in 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 also combined anti-tuberculosis drugs. In practice, the following medicines are used: "Rifinag", "Rimkur", "Ftizoetam", "Protiocomb". These funds contain from 4 to 5 active substances. The main disadvantage of combined drugs is the impressive list of side effects.
Surgical treatment
As practice shows, conservative therapy often does notleads to a pronounced positive trend. In the presence of secondary tuberculosis, surgery is prescribed more often than in case of primary infection.
Indications for surgery:
- Resistance of Koch's sticks to the active substances of prescribed drugs.
- Accession of a secondary infection.
- Development of irreversible morphological changes.
- The occurrence of complications that pose a threat not only to he alth, but also to the life of the patient.
There are several methods of surgical intervention:
- Lobectomy. During the operation, the affected lobe of the lung is removed. The intervention is carried out using an open or minimally invasive technique.
- Pneumoectomy. It involves the removal of the entire lung. The 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.
In case of violations of the respiratory function, the operation is not performed. In addition, contraindications are diseases of the kidneys, liver and cardiovascular system. This is due to the high risk of complications and death.
Forecast
The outcome of the disease directly depends on the timeliness of the visit to the doctor. Subject to all the recommendations of a specialist, the prognosis is usually favorable. In addition, all patients diagnosed with secondary tuberculosisare registered and annually undergo a comprehensive examination. This allows you to timely detect even the slightest changes in the body.
If the treatment was not carried out correctly or it was completely absent, the prognosis is unfavorable. The chance of death is about 60%. This percentage is higher in people suffering from diabetes and AIDS.
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 is vaccination. Parents should not neglect it, it is important to ensure that the child is given BCG in a timely manner.
Secondary prevention of tuberculosis is carried out in carriers of Koch's bacillus. It consists of conducting annual examinations and explaining to the patient that it is extremely important to lead a he althy lifestyle.
In conclusion
The term "secondary tuberculosis" refers to a disease that occurs, as a rule, in adulthood, but at the same time a person has already suffered a pathology several years ago. When Koch's wand (the causative agent of the disease) enters the body, it remains in it forever even after the formation of specific immunity occurs. The pathogen can be in a dormant state for a lifetime and still not harm he alth. However, under the influence of various unfavorable factors, the process of its active life activity is restarted. The treatment of secondary tuberculosis is longer, in addition, the pathology is more difficult to toleratepatients. Therapy involves taking medication. However, in some cases this does not lead to positive dynamics. In this situation, surgery is indicated.
