Pulmonary primary tuberculous syndrome
Introduction
Introduction to pulmonary tuberculosis recurrence Primary pulmonary tuberculosis recurrence is also called primary syndrome: primary pulmonary tuberculosis, primary lung lesions, lymphangitis and hilar lymph node tuberculosis are called primary syndrome, X-ray is dumbbell-shaped shadow, clinical The symptoms and signs are not obvious. basic knowledge Sickness ratio: 0.05% Susceptible people: no specific population Mode of infection: respiratory transmission Complications: pneumothorax, bronchiectasis
Cause
Primary pulmonary tuberculosis recurrence
For the initial infection of tuberculosis, the human body inhales dust or droplets containing tuberculosis from the air and causes disease. It occurs mostly in children or young people, especially in infants under 3 years old. Primary syndrome includes primary lesions and peri-inflammatory lesions, lymphangitis, and lymphadenitis, sometimes with additional local pleural changes.
Prevention
Primary pulmonary tuberculosis relapse prevention
1. Vaccination with BCG
BCG should be vaccinated in uninfected persons such as neonates, recruits and new trainees with negative serotonin test, young workers in new TB medical units, and adolescents undergoing kidney transplantation.
2. Chemoprevention: Selective chemoprevention of infected persons is as follows:
(1) Close contacts of patients with bacteriucin, such as children with positive serotonin test (no BCG), strong positive adolescents.
(2) The children and adolescents were tested positively, and the adult sputum test was strongly positive.
(3) Inactive tuberculosis is one of the following: 1 long-term large amount of glucocorticoids, immunosuppressive agents, cytotoxic drugs. 2 radiation therapy. 3 before and after gastrectomy. 4 recruits, new students, strong test positive. 5 tuberculosis and HIV double infection, AIDS patients with positive test. 6 Kidney transplant recipients have tuberculosis, or have inactive tuberculosis. 7 diabetes combined with inactive tuberculosis. 8 patients with silicosis (silicosis) who were positive for the test.
For chemoprevention, the isoniazid adult is 0.3g/d, the child is 6-8mg/(ks·d), and the treatment lasts for 6 months.
3. Eliminate the source of infection
Sputum smear positive (smear positive) tuberculosis is the main source of infection, eliminating the source of infection is the fundamental countermeasure to control tuberculosis. The initial treatment of smear-positive pulmonary tuberculosis and re-treatment of smear-positive pulmonary tuberculosis is the main target of chemotherapy.
Complication
Primary pulmonary tuberculosis recurrence complications Complications
1, pneumothorax
When the lung cavity and cheese-like lesions are close to the pleural area, it can cause tuberculous pus. Miliary tuberculosis can cause bilateral spontaneous pneumothorax.
Second
Repeated progression and fibrosis of tuberculosis lesions, resulting in the destruction of the normal structure of the bronchus in the lungs, can cause secondary bronchiectasis, often repeated hemoptysis. Often located in the upper lobe, called dry branch expansion. Can cause fatal hemoptysis.
Symptom
Primary pulmonary tuberculosis recurrence symptoms common symptoms high fever cough, anger, night sweats, weight loss
Fever, cough, shortness of breath, night sweats and weight loss are the main clinical symptoms. Some cases can be found without any symptoms and due to physical examination. Mycobacterium tuberculosis can be found in the sputum examination.
Examine
Primary pulmonary tuberculosis reexamination
Imaging performance
1. The upper part of the upper lobe or the lower part of the lower lobe is flaky or circularly blurred, and may also be a lung segment or a shadow of the lung lobe.
2, ipsilateral hilar lymph node enlargement.
3. There is a cord-like shadow between the primary lesion in the lung and the enlarged hilar lymph node, ie tuberculous lymphangitis.
The above three are dumbbell-shaped, also known as bipolar period, which is typical of primary syndrome, but this sign is rare. If the scope of the primary lesion is large, tuberculous lymphangitis and lymphadenitis can often be masked.
Diagnosis
Diagnosis and differential diagnosis of primary pulmonary tuberculosis
diagnosis
Diagnosis can be performed based on clinical performance and laboratory tests.
Differential diagnosis
Primary tuberculosis cavity and acute lung abscess cavity identification, the latter density is more uniform, there is often a clear liquid level in the cavity.
