Study Guide on Tuberculosis - M.M. Savula 2002

Secondary forms of pulmonary tuberculosis
Respiratory tuberculosis combined with occupational dust lung diseases (coniotuberculosis)

Pathogenesis. Tuberculosis associated with occupational dust-induced lung diseases occurs in individuals of certain occupations working in highly dusty environments: stone quarries, coal mines, ore mines, porcelain manufacturing, cement plants, etc. Tuberculosis is usually a secondary disease complicating Pneumoconiosis. Most commonly, tuberculosis develops as a complication of silicosis—a pneumoconiosis caused by silica dust. Silica dust has been proven to be a highly active factor triggering the reactivation of latent tuberculosis in previously infected individuals. Fresh infection with Mycobacterium tuberculosis is also possible. In stage III silicosis, The rate of tuberculosis complication reaches 80%. Any form of Pulmonary Tuberculosis can develop against the Background of pneumoconiosis.

Clinical presentation. In uncomplicated pneumoconiosis, patients are well-nourished and show no signs of intoxication. As the disease progresses, dust-induced Bronchitis, emphysema, and respiratory failure slowly develop. The primary Complaints are shortness of breath, a dry cough, or a cough productive of mucoid or mucopurulent sputum. There are no Changes in the Percussion sound; on Auscultation, scattered dry wheezes are heard in some patients against the background of harsh (bronchitis) or diminished (emphysema) breath sounds.

Blood counts are normal; at the stage of advanced respiratory failure, a compensatory increase in THE RED BLOOD Cell count and Hemoglobin content is observed.

The onset of tuberculosis can be suspected if, In addition to these symptoms, signs of intoxication appear: loss of appetite, general weakness, sweating, and elevated body Temperature. Localized moist crackles, predominantly over the upper lung fields, and changes in the hemogram (moderate leukocytosis, a left shift in the WHITE BLOOD CELL differential, lymphopenia, and elevated ESR) also raise suspicion of developing pulmonary tuberculosis.

Radiologically, uncomplicated pneumoconiosis shows linear opacities and well-defined nodular shadows, predominantly in the middle and outer lung fields. When tuberculosis supervenes, additional groups of nodules of various sizes and densities, infiltrates, or ring-like shadows (cavities) appear, mostly in the upper lung zones.

The Diagnosis is confirmed by the detection of MTB in the sputum, which must be searched for repeatedly.

Treatment of patients with silicotuberculosis must be more intensive and prolonged than for uncomplicated pulmonary tuberculosis, because healing processes are significantly slowed down against the background of silicotic changes.

Questions

1. Name the Clinical forms of secondary pulmonary tuberculosis. Which of them is the most common?

2. What is the primary method for detecting Focal pulmonary tuberculosis? Why?

3. How can the disease onset manifest in Infiltrative pulmonary tuberculosis?

4. What other diseases can infiltrative pulmonary tuberculosis mimic?

5. What is Pulmonary Tuberculoma?

6. What are the Main Features of Fibrocavitary pulmonary tuberculosis? What are the causes of its development?

7. List the complications that can occur in a patient with fibrocavitary pulmonary tuberculosis.

8. What complaints in a patient with silicosis should raise suspicion of complicating pulmonary tuberculosis?

9. Which diagnostic Methods most reliably confirm the diagnosis of pulmonary tuberculosis?