CLINICAL PICTURE OF MILIARY

TUBERCULOSIS:

1.Develops within 3 to 5 days.

2.Symptoms of intoxication:

•weakness;

•increased sweating → increased sweating;

•worsening of appetite;

•increase in body temperature to 38 - 39ºC;

•hectic fever is noted;

•headache;

•occasional dyspeptic disorders;

•weight loss;

•adynamia;

•stunned or temporary loss of consciousness, delirium;

•tachycardia;

•acrocyanosis;

•dyspnea (more often of the asphyxial type);

•cough, usually dry, sometimes with scanty mucous sputum;

•Occasionally, a delicate rosaceous rash (toxic- allergic thrombovasculitis) appears on the anterior surface of the chest and upper abdomen);

•over the entire pulmonary surface - tympanic percussion sound, weakened or harsh breathing, a small number of dry or small bubbling rales are heard;

•enlargement of liver and spleen, sometimes moderate bloating of abdomen;

•examination of the fundus: the fundus shows a rash of grayish-white or yellowish, rounded or elongated tubercles;

•the hemogram is characterized by a shift of neutrophils to the left - increased number of stab neutrophils, appearance of juvenile forms and myelocytes in peripheral blood with normal number of leukocytes and lymphocytes;

•differential diagnosis with typhoid fever

X-ray characteristics of miliary tuberculosis:

1.The first 7-10 days of the disease are characterized by diffuse decreased transparency of the lung fields, indistinct (blurred) lung pattern, appearance of a peculiar small net.

2.Day 10-14 of the disease - multiple small (no more than 2 mm in diameter) single-type foci, which are located from the apices to the basal parts of the lung (total small-focal dissemination); focal shadows have rounded shape, low intensity and indistinct contours.

3.In young children, focal shadows are larger (2 to 5 mm) than in adults.

X-RAY DIAGNOSTICS

1.Multiple focal shadows.

2.The foci were 2 - 3 mm in diameter.

3.Localization of foci - in both lungs, symmetrically, from vertex to diaphragm.

4.Intensity of foci is low.

5.Contours of the shadows were clear.

6.Pulmonary pattern is not traced.

7.Presence of emphysema.

dissemination with thin- walled caverns, predominantly affecting the upper posterior

SUBACUTE DISSEMINATED

PULMONARY TUBERCULOSIS

Develops with less severe immune disorders and less massive bacteremia. Foci forming around the venules and arterioles.

Dissemination often spreads to the visceral leaflet of the pleura, upper respiratory tract. Inflammatory reaction in the foci gradually becomes productive. Productive obliterating vasculitis and lymphangitis develop in alveolar walls and interalveolar septa, pulmonary tissue around foci shows signs of emphysema.

SUBACUTE DISSEMINATED TUBERCULOSIS IS CHARACTERIZED BY SUBACUTE DISSEMINATION SYNDROME:

1.Multiple focal shadows 5 to 10 mm in diameter, in some places merging into foci due to perifocal inflammation.

2.The foci are located in both lungs in the upper lobes (at least three segments on each side) or throughout the lungs.

3.Intensity of shadows is low to medium.

4.The contours of the shadows are blurred.

5.Pulmonary pattern is not clear enough.

CLINICAL PICTURE OF SUBACUTE DISSEMINATED PULMONARY

TUBERCULOSIS :

1.It develops gradually over a few weeks and has no obvious manifestations.

2.There is a typical mismatch between the low severity of clinical manifestations and multiple characteristic lung lesions.

3.Severe autonomic-vascular dystonia, psycho- emotional lability, peculiar euphoria (biased in the assessment of their condition).

4.General weakness, increased fatigue, decreased ability to work, irritability, sweating, poor appetite, gradual weight loss, subfebrile fever, mild shortness of breath, recurrent productive cough.

5.May be complicated by pleurisy (pain in the side) and/ or tuberculosis of the larynx (farting and pain in the throat when swallowing, hoarseness of the voice).

6.Persistent red dermographism, relatively symmetrical shortening of the percussion sound and persistent dry rales in the interscapular space, sometimes moist small bubbling rales, and medium bubbling rales when cavities of decay are formed.