Tuberculosis Course for

English-speaking students

Chapter 3. Clinical forms of tuberculosis

3.1. Tubercular intoxication
 3.2.1. TUBERCULOSIS INTOXICATION
AMONG CHILDREN AND ADOLESCENTS

Primary tuberculous forms develop after МВТ

infection when tubercle bacillus enters the
healthy body for the first time.
Mainly children and teenagers have primary
tuberculosis while rare adults.
The period from the moment of infection till the
manifestation of the disease is known as the
latent infection period.
 Primary infection period has typical
signs:

• hyper sensibilized organism;

• predisposition to generalized process
through lymphatic and hematologic route;
• lymphatic system involvement;
• predisposition to caseous degeneration of
lymph nodes;
• ability for spontaneous healing.
 Tuberculous intoxication, as a separate
disease characterizes period without clear
tuberculosis localization.

It is impossible to reveal the localization of

tuberculous lesions, due to its small size, by
X-ray and other methods of investigation.

The diagnosis of tubercular intoxication is

confirmed only after examination at a
specialized tuberculosis institution.
 The variety of clinical signs in primary
tuberculosis extends due to the paraspecific
changes in the body:

• keratoconjunctivitis;
• erythema nodosum;
• rheumatoid Poncet;
• acute diffused nephritis.
 Keratoconjunctivitis

http://www.atlasophthalmology.com/atlas/photo.jsf;jsessionid=767F7AFA9CDB1E73303DAADD3ED26C82?node=5992&locale=en
 Histology of conjunctival TB

• Tubercular granuloma
with necrosis (black
arrow) and Langhans'
giant cells.

(AFIP, Washington DC)

 Lupus vulgaris (tuberculosis). Nicht verkäsendes epitheloidzelliges
Granulom in der oberflächlichen Dermis.

http://alf3.urz.unibas.ch/pathopic/e/getpic-fra.cfm?id=003952
http://alf3.urz.unibas.ch/pathopic/e/getpic-fra.cfm?id=003953
Erythema nodosum picture

www.dokkyomed.ac.jp/.../vas-images/vas-02.jpg
 Poncet's disease: reactive arthritis
accompanying tuberculosis.
• The occurrence of polyarthritis in patients with
active tuberculosis was first reported by Antonin
Poncet in 1897.
• In contrast to the usual tuberculous arthritis
which is monoarticular, infectious and
destructive, tuberculous rheumatism (Poncet’s
disease) is a non-destructive para-infective
polyarthritis occurring in patients
• with active tuberculosis, which resolves
completely on anti-tuberculosis therapy.
 Differential diagnostic sign of early
tuberculous intoxication

The most important differential diagnostic sign of early

TB intoxication is:
- coincidence of these functional disorders and
morphological changes with conversion of tuberculin tests.

Complication. If this period is not noticed by the parents

and the doctor of the child, TB process in lungs and
regional lymph nodes or affection of other organs can
develop.

•
Treatment of early TB intoxication among
children and teenagers

If the patient gets rational anti-tubercular

treatment in time, all manifestations quickly
cease and then disappear only moderate
positive reactions on tuberculin retain.
Chronic tubercular intoxication among children
and teenagers

Typical signs are:

child's developmental delay, palleness, micropoliadenia (6-9
groups of enlarged lymph nodes can be palpated; they differ from
elastic consistency to «small stones»).

For suspicion of chronic tuberculous intoxication it is important that

a year passed after conversion of tuberculin tests, these tests
remain positive or even increase in.

Unlike early tuberculous intoxication, chronic intoxication

symptoms are better expressed and last more steadfastly.

In patients, chronic conjunctivitis, flictena can appear and

disappear repeatedly.
 It is possible to prevent chronic tuberculous
intoxication by appropriate and long treatment.

Treatment of developed chronic tuberculous

intoxication is very difficult.

Tuberculostatic drugs poorly penetrate into

tubercular focus.

МВТ being inside of such focus do not lose

vitality.