Under certain conditions, with weakened general immunity of the organism, as a result of frequent exposure to droplet or foodborne infection, tuberculous bacilli usually settle in the lungs. Then a specific (ie characteristic for a given trigger) inflammatory disease process begins; a primary focus is formed. In the primary focus, the tuberculous bacilli multiply. As in any inflammatory process, there is an inflammatory tuberculous infiltrate with a characteristic, i.e. specific, microscopic structure (hence the name specific inflammation) with an inflammatory reaction in the adjacent lymph node. The group of these changes is called the primary syndrome.
Primary tuberculosis – symptoms
Primary tuberculosis usually begins with flu-like symptoms:
- cough
- low-grade fever,
- general weakness
- pale skin,
- sweating.
So these are non-specific symptoms. Nevertheless, such symptoms – especially those that are protracted and occur in children or adults who are in social (or home) contact with people suffering from tuberculosis – should prompt a medical consultation. Early diagnosis and implementation of appropriate treatment of this initial stage of the disease is the most effective and leaves no traces or consequences.
The organism in which the tuberculous inflammation has appeared is trying to defend itself. The focus of infection is eliminated and surrounded by phagocytic and giant cells. Together, such activities are aimed at destroying and absorbing mycobacteria, and until their elimination, at least to limit and prevent their spread in the body.
This type of specific, focal inflammation with infiltration of cells and phagocytic blood cells, giant epithelial cells and fibrous tissue is referred to as tuberculosis. It is from its shape and name that tuberculosis takes its name.
Thanks to defense mechanisms or medical help, the inflammatory exudate is absorbed, and the place where it takes place disappears or becomes fibrous and calcified. Calcification or fibrosis of the primary lesion is often regarded as a cure. The only symptom of this type of pulmonary tuberculosis is residual tuberculin allergy.
At the stage of formation of the primary syndrome, the organism’s reaction to mycobacteria and their transformation products changes, which have antigenic effects and cause specific, allergic retuning of the organism. The measure of this allergy is considered positive tuberculin skin reaction.
In the case of the unfavorable course of the first contact with tuberculosis, which may occur after the penetration of a large number of virulent tuberculosis mycobacteria, or in the case of weakened immunity, the primary tuberculosis infiltration may be prolonged, and tissue necrosis (resembling serous necrosis) may form in its central part. In its vicinity, tuberculosis mycobacteria multiply and form a fibrous envelope on the perimeter, which separates them from the rest of healthy tissue.
It happens that the primary infiltration is extended. If the decay of tissue necrosis comes into contact with the bronchus and the center begins to clear itself of decayed masses, a tuberculous cavity will be detected radiographically. Then the patient begins to expectorate mucopurulent sputum, sometimes with some admixture of blood; sputum contains large amounts of mycobacteria.
In the period of coughing, spitting and coughing up the cheesy masses of decaying tissue, the patient is the most dangerous to the environment as a potential source of tuberculous infection. Moreover, during this period it is required to intensify specialist treatment, which should be systematic and long-lasting. Cleansing the inflammatory focus from the tuberculous masses of cheese, despite the apparent improvement in well-being (the toxic effect of mycobacterial venoms on the body has decreased), can only be regarded as an apparent cure. An encapsulated focus may still contain live tuberculous bacilli and may be a possible source of infection for the environment and relapse for a long time.
Location of primary tuberculosis
Primary tuberculosis – especially after droplet infection – usually develops in the lungs or paratracheal or paravalvular lymph nodes. However, it may also develop in other organs (e.g. kidney, vertebrae, other bones of the skeleton, brain) or lymph nodes elsewhere in the body, causing different symptoms and impaired function of these organs.
Surviving the primary infection causes a specific defensive reaction of the body and a kind of immunization in the patient. Hence, repeated superinfection with mycobacteria – especially shortly after the original, when there are still effective forces and immune mechanisms – is not so dangerous. With time, however, especially in old age or in people who are malnourished and after debilitating diseases, etc., the natural immunity disappears and post-primary tuberculosis develops.
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