Tuberculosis Study Guide - M.M. Savula 2002

Extrapulmonary tuberculosis
Ocular tuberculosis

There are two distinct forms of ocular tuberculosis: hematogenous-disseminated and allergic. Ocular tuberculosis occurs predominantly in young adults.

The most common form of ocular tuberculosis is hematogenous-disseminated involvement of the uveal tract - uveitis. In these cases, MBT enter the eye hematogenously from other Organs. Typical tuberculous tubercles form in the uvea and retina, and the course of the disease depends on their subsequent evolution. In 70-80 % of patients, Tuberculosis of the posterior uvea - choroiditis - is observed. Focal Changes in the uveal tract lead to retinal detachment, sometimes to Hemorrhage into the retina and vitreous body. Vitreous opacity and decreased Vision may occur. The disease runs a prolonged, indolent course without acute inflammatory manifestations. Patients complain of decreased visual acuity, occasionally headache, “fog”, “a spot”, or “floaters” before the eyes. Under METABOLISM/18.html">The Influence of Treatment, the foci resolve or leave scars.

Tuberculous-allergic involvement develops mainly in children aged 3-12 years as one of the paraspecific reactions to primary tuberculous infection. It mostly affects the conjunctiva and Cytology/practical/76.html">Cornea of the eye in the form of phlyctenular keratoconjunctivitis. Grayish nodules, redness, and edema of the conjunctiva appear around the limbus and on the cornea. Morphologically, the nodules do not have The Structure of a true tuberculous tubercle, and MBT are not found in them. A few days after onset, an ulcer forms in the center of the nodule, which heals slowly and can cause opacity and decreased vision. The disease has an acute course, accompanied by photophobia, lacrimation, a “sensation of sand in the eye”, and blepharospasm (spasmodic closure of the eyelid).

Diagnosis of ocular tuberculosis is often difficult. An ophthalmic and general examination of the patient is required. Detecting tuberculosis in another organ facilitates the diagnosis.

The Mantoux test with 2 TO is positive, sometimes strongly positive. The eye affected by tuberculosis is highly sensitive to tuberculin; sometimes, even an intradermal Mantoux test triggers a focal reaction — symptoms of disease exacerbation. Therefore, if a subcutaneous Koch test is required, the dose of tuberculin is selected with caution.

The main method of treating ocular tuberculosis is standard Chemotherapy. In addition, patients with hematogenous forms receive local administration of anti-tuberculosis drugs - subconjunctivally or via Electrophoresis.

In tuberculous-allergic lesions, along with anti-tuberculosis drugs, desensitizing therapy, including corticosteroids, is of great importance.

Questions

1. What are the most common sites of Extrapulmonary Tuberculosis?

2. Which Bones and joints are most commonly affected by tuberculosis, and at what age are these lesions predominantly detected?

3. What investigations should be performed in patients with suspected tuberculosis of the spine or joints?

4. What are the complications and consequences of spinal tuberculosis?

5. Which treatment Methods, other than chemotherapy, are of great importance in the management of Bone and joint Tuberculosis?

6. What does Aleksandrov's sign consist of?

7. What are the possible changes in a complete urinalysis in Renal tuberculosis?

8. What tests are performed on a patient with suspected renal tuberculosis to confirm the diagnosis?

9. Describe the Procedure for collecting urine for MBT testing.

10. What is the most common site of Male Genital Tuberculosis?

11. What is the most common site of female genital tuberculosis, and what are its potential consequences?

12. What are the MAIN CLINICAL MANIFESTATIONS of tuberculous Peritonitis?

13. Which diagnostic method is the most reliable for confirming the diagnosis of Peripheral Lymph Node tuberculosis?

14. What are the main forms of ocular tuberculosis?

15. What is the most important treatment method for extrapulmonary tuberculosis?

Case Study

- Two patients presented with enlargement of the peripheral Lymph Nodes.

Patient A, 32 years old. In the right submandibular region, There is a 2 cm lymph node, highly tender on Palpation, with erythematous overlying Skin. Body Temperature is 38.8 °C. Complete Blood count: leukocytes - 14.5-10/l, ESR - 29 mm/h.

Patient B, 12 years old. On the right, along the posterior border of the sternocleidomastoid Muscle, there are two lymph nodes, 1.5 and 2 cm in diameter, which were noticed accidentally and are slightly tender. The boy is pale, reports sweating, and his body temperature is normal. Complete blood count: leukocytes - 8.7-10/l, ESR - 18 mm/h.

1. In which of these patients is peripheral lymph node tuberculosis more likely to be suspected?

2. What investigations should be performed to confirm the diagnosis?