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Tuberculosis is a tuberculous disease that occurs several months or many years after primary tuberculosis. Usually it is a consequence of repeated superinfection of the organism from the outside, but also very often an expression of superinfection from one’s own, encysted or calcified, currently activated primary focus.
A few words about post-primary tuberculosis
Tuberculosis is a condition that appears months or years after primary tuberculosis. The cause of this disease is usually secondary infection of the organism from outside or superinfection from its own (once active) primary area of the disease. Tuberculosis may be activated with a decrease in immunity, inadequate hygiene of life or as a result of excessive alcohol consumption.
Primary tuberculosis – causes of formation
The site of primary tuberculosis may be the result of the type of route of infection and its spread through lymph vessels, bronchi, through the blood, or through direct contact.. Primary tuberculosis usually arises because of:
- a significant decrease in immunity,
- significant weakening of the body’s overall biological strength,
- unhygienic lifestyle,
- chronic malnutrition,
- consuming a lot of alcohol,
- suffering from various types of debilitating ailments,
- chronic work overload in unfavorable conditions.
It includes all forms of tuberculosis not directly related to the primary infection. Such persons show a positive allergic reaction to tuberculin. The nature of the lesions that arise can be very different.
Primary tuberculosis – types
1. Tuberculous lymphadenitis – it is an ailment that can be treated as the development of post-primary tuberculosis, but also the location of the primary tuberculosis lesion. In people with reduced immunity, tuberculosis mycobacteria enter the lymph nodes and lead to a cycle of changes in them. Tuberculous lesions cause the lymph nodes (neck, nape) to begin to enlarge, become soft, and then rupture and exit the necrotic (seropurulent) content, which contains small visible mycobacteria. Only after the purulent content has come out, the nodes return to their original form – they become smaller. A star-shaped scab is formed at the site of the puncture.
Other lymph nodes that undergo a similar cycle of changes can also become infected. This process may take many months or years, but due to the availability of effective anti-tuberculosis preparations, this variety is relatively rare. The treatment includes drugs aimed at stopping the multiplication of tuberculosis bacilli.
2. Primary pulmonary tuberculosis – it is the most common form of tuberculosis. Infection usually occurs via droplets. Then, single or multiple disease lesions are formed, which are usually located in the apical and sub-peak region of one or both lungs. In patients with primary pulmonary tuberculosis, the following may be observed:
- low-grade fever,
- excessive sweating (especially in the morning),
- cough,
- progressive weakness,
- sputum discharge (sometimes blood or purulent).
Lesions are completely healed by their subsequent fibrosis, calcification and “suction”. However, there are situations in which a cheese-like necrosis is formed in the area of the infiltrate. Then, the emerging disease lesions give the image of cavernous tuberculosis. Yet another time, the cheese lesions spread, giving expression to cheesy pneumonia. Patients with such lesions are usually an epidemiological source of infection.
Diagnostics and assessment of the type and degree of advancement of the changes occurring require numerous medical, bacteriological (sputum) and radiological examinations.
3. Tuberculosis of the urinary system – usually it does not give any characteristic symptoms and its development is discreet. The underlying cause of infection is usually the hematogenous sowing of tuberculous bacilli, which gives rise to lesions first in one kidney, and then in both.
4. Miliary tuberculosis – it arises as a result of the spread of tuberculosis mycobacteria through the blood; may indicate an acute or subacute infection. Thus, miliary tuberculosis occurs when primary or secondary mycobacteria enter the bloodstream and are seeded in the meninges of the brain, lungs, bones, or other organs.
The name of the disease comes from a disease that resembles millet grain. The symptoms of miliary tuberculosis located in the lungs include:
- cough,
- shortness of breath
- septic, serious condition of the patient,
- rapid breathing,
- shortness of breath,
- blueberry
- apathy.
Hospitalization is necessary during the treatment of miliary tuberculosis. In the past, this kind of ailment was much more common and ended fatally. Currently, it is much less common, and the treatment methods are more effective.
5. Tuberculosis of the bladder – usually occurs as a secondary process and descends from the kidney through the urinary tract. By excreting mycobacterium tuberculosis with urine for a long time, they become deposited in the bladder mucosa, which gives rise to the tuberculous process. The most troublesome and most frequently mentioned symptom of the disease are ailments that resemble recurrent cystitis.
In order to diagnose bladder tuberculosis, it is necessary to perform medical and laboratory-bacteriological examinations. In turn, the treatment of the disease is long-term and combined (the patient is given 2-3 anti-tuberculosis preparations at the same time).
6. Renal tuberculosis – the symptoms of this disease are repeated low-grade fever and general weakness of the patient. At first, specific urinary symptoms are absent. It is only after some time that symptoms begin to join, in the form of painful and scanty urination, hematuria, and sometimes pain in the lumbar region.
In patients with suspected renal tuberculosis, specialist urine bacteriological tests are performed together with culture and biological tests. Treatment of the disease is long-term and should be carried out systematically, both in terms of taking medications and medical supervision. In patients with advanced renal tuberculosis who have destroyed the parenchyma of the kidney, surgery may be necessary.
7. Tuberculosis of the digestive system – it usually occurs as a result of infection through the digestive tract (joint use of cutlery with the infected patient, swallowing of the patient’s own saliva). Lesions are usually located in the large intestine or at the end of the small intestine. They take the form of a lumpy inflammatory infiltrate or ulcerative enteritis.
Symptoms that patients complain of include:
- prolonged diarrhea,
- abdominal pain (chronic and severe),
- weakness,
- low-grade fever,
- anemia.
Sometimes the surrounding lymph nodes are also enlarged.
It is not an easy task to make an appropriate diagnosis and, as a rule, hospitalization of the patient is necessary. The patient’s general condition is assessed and, in addition, histopathological and bacteriological examinations are performed on the specimen from the affected organs.
Treatment is long-term and includes the consumption of high-protein foods to replenish the deficiencies. In the event of complications such as a bowel obstruction or a bowel perforation, surgery is required. The prognosis of the disease is much better than before, thanks to earlier diagnosis of the disease and the introduction of new drugs.
8. Tuberculosis of bones and joints – it arises as a result of infection with tuberculosis bacilli, which cause serous-necrotic changes in the skeleton. Most often, tuberculosis bacilli are located in the vertebrae of the spine and the articular long bones. This type of tuberculosis does not cause any characteristic symptoms at first, so it may develop asymptomatically. Only after some time does the pain in the bones gradually increase. In addition, swelling begins to form and sometimes bone fractures also occur. Tuberculous lesions located in the body of the spine may present symptoms in the form of: sciatica, intercostal neuralgia or lumbago.
The diagnostics involves a radiological examination, which shows more or less extensive infiltrates and defects in bone structures.
Tuberculous arthritis can affect a single joint (e.g. the knee). It usually appears as a result of the spread of the inflammatory process into the soft tissues of the joints. Tuberculous arthritis is accompanied by:
- swelling
- effusion into the joint cavity,
- reddening of the skin.
The diagnosis is made on the basis of bacteriological examination of the joint exudate fluid and on the basis of a histopathological examination, it is removed from the lesion site. The treatment includes preparations and it is recommended to stay in a health resort specializing in the treatment of osteoarticular tuberculosis (in Poland, such centers are located in Czerwona Góra and Otwock). The earlier tuberculosis is detected, the better the prognosis.
9. Tuberculous meningitis – tuberculosis develops in the central nervous system, usually in the meninges. This type of tuberculosis (apart from miliary tuberculosis) is considered the most dangerous and severe. Tuberculosis, which spreads through the bloodstream, causes tuberculosis nodules to form in the meninges and brain tissue. At the beginning of the disease, mild feverish states occur. Over time, join:
- unbearable headaches,
- vomiting,
- general poor condition of the patient,
- darkness,
- loss of consciousness.
The diagnosis of the disease should be carried out only in the hospital, during the patient’s hospitalization. For diagnosis, cytological, biochemical and bacteriological tests of the cerebrospinal fluid are used. Treatment of the disease is long-term and its results depend on the severity of tuberculous lesions and the stage of the disease. Therefore, the visit to the doctor should not be postponed, especially if the patient with tuberculosis has persistent headaches, nausea and low-grade fever.
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