Tuberculosis Study Guide - M.M. Savula 2002

Secondary forms of pulmonary tuberculosis
Cirrhotic pulmonary tuberculosis

Cirrhotic Pulmonary Tuberculosis is characterized by massive proliferation of scar tissue in the Lungs and Pleura, within which active tuberculous foci persist.

Pathogenesis. It results from the involution of fibrocavernous, chronic disseminated, or widespread Infiltrative pulmonary tuberculosis, as well as specific pleural lesions.

Cirrhotic tuberculosis is an active form of pulmonary tuberculosis in which areas of tuberculous inflammation and caseation persist among cicatricial formations, causing periodic exacerbations of the disease. Brief, scanty bacterial shedding may occur. Cirrhotic tuberculosis must be distinguished from pulmonary cirrhosis, which represents cicatricial post-tuberculous changes without signs of activity. According to the Classification, these are categorized as residual changes after cured tuberculosis.

Cirrhotic tuberculosis can involve a segment or a lobe, and can be unilateral or bilateral. Bronchial deformity in the cirrhotic zone leads to The formation of Bronchiectasis, while compensatory emphysema develops in the unaffected areas of the lungs. All of this gives rise to the corresponding clinical symptoms.

Clinical presentation. The medical history often reveals that the patient has previously suffered from and been treated for tuberculosis. The severity of symptoms varies depending on the extent of the cirrhotic changes. The most common Complaints are shortness of breath and a cough with mucopurulent or purulent sputum (due to bronchiectasis). Hemoptysis and even Pulmonary Hemorrhage may occur. During exacerbations of tuberculosis or a non-specific inflammatory process in the bronchiectasis, signs of systemic intoxication appear: general weakness, sweating, and fever. Gradually, Chronic Cor Pulmonale, cardiopulmonary insufficiency, and sometimes Renal Amyloidosis develop.

Physical examination reveals cyanosis of the Lips and sometimes chest deformity, such as narrowing of one hemithorax, its lagging during Respiration, and retraction of the supraclavicular and infraclavicular fossae.

Over the areas of cirrhosis, Percussion reveals dullness, and breath sounds are diminished, harsh, or even bronchial. Numerous moist crackles of various sizes and dry wheezes can be heard. Cardiac Auscultation often reveals accentuation of the second Heart sound over the pulmonary artery. When circulatory failure develops, an enlarged Liver can be palpated, and leg edema occurs.

During the remission phase, the hemogram is within normal limits. During an exacerbation of the tuberculous or suppurative process, leukocytosis and an elevated ESR occur. Activation of tuberculosis is indicated by the detection of MTB in the sputum, which rapidly disappears under METABOLISM/18.html">The Influence of Chemotherapy.

The chest radiograph shows distortion of the lung hilum and pulmonary markings, sometimes narrowing of one lung field, and deviation of the Trachea and cardiovascular shadow toward the affected side (Fig. 9). Cirrhotic areas appear as opacities, while the lower lung fields show increased translucency due to emphysema.

Cirrhotic pulmonary tuberculosis must be differentiated from pulmonary cirrhosis resulting from non-specific inflammatory and suppurative processes, congenital lung anomalies, or Pneumoconiosis.

Treatment during exacerbations of a non-specific inflammatory process consists of prescribing Antibiotics and expectorants. To prevent exacerbations of tuberculosis (as well as during an active flare-up), a TB specialist prescribes antituberculosis drugs.

In case of hemoptysis or chronic cor pulmonale, appropriate treatment is prescribed.