The main clinical forms of tuberculosis in infants and young children
1. The tendency to generalize and disseminate the process in infants and young children is expressed primarily in the fact that miliary tuberculosis and tuberculous meningitis reach a maximum frequency at this age.
2. The forms of the disease occurring under the guise of chronic pulmonary tuberculosis are essentially also often generalized forms, since along with pulmonary lesion, which is more easily accounted for by a clinical and radiological examination, such a patient at an early age has a latent localization in the lymph nodes(bronchial, mesenteric), dissemination in the parenchymal organs, intestines. The younger the child, the more one has to think about the possibility of such a hidden generalization and hidden localization of the lesion, especially in the lymph glands.
3. In cases with a benign course, the tendency for a small child to develop metastasis of the process is manifested in the multiplicity of the localization of the process, the simultaneous damage to the skin, peripheral lymph nodes, bones, lungs, etc.
This multiplicity of localization of the process, predominantly extrapulmonary,the impression of a favorable course of the disease, which affects the more rare development of severe pulmonary tuberculosis in these children, still does not exclude an unfavorable outcomedisease and the "unexpected" development of tuberculous meningitis.
4. A peculiarity of tuberculosis at an early age is also a pronounced tropism of the tubercle bacillus to the lymphatic system, a tendency to a widespread lesion of the lymph nodes and primarily of the intrathoracic bronchial nodules. The most pronounced and severe forms of bronchodenitis - tumor-like with compression phenomena( noisy breathing, expiratory stridor, bitonal cough) - are most often observed in infants and young children.
5. The most frequent manifestation of pulmonary tuberculosis at an early age can be considered as an infiltrative-pneumonic form developing in the area of the primary complex. For this form of pulmonary tuberculosis, as in older children, a tendency to reverse development is associated with the prevalence of the nonspecific morphological substrate of perifocal exudative inflammation or pulmonary atelectasis.
Significantly more often than in older children, however, the adverse course and outcome of this form of pulmonary tuberculosis is noted due to the tendency to growth and destruction of the primary focus, curdled necrosis and the development of lymphohematogenous bronchogenic metastases in the adjacent areas of infiltration, as well astransition to the primary phthisis. Along with the development of primary phthisis in an early child, a secondary caseous-cavernous process that is not associated with the primary focus, by merging secondary predominantly lymphohematogenic focal lesions, is less likely, as a result of breakthrough into the lumen of the bronchus of the caseous foci or caseous gland with subsequent bronchogenic spreading. This picture of a more severe course of tuberculosis in young children compared with what we see in older children is largely due to the biological characteristics of the child's organism at an early age. However, these features are not the only factor determining the form and severity of the disease, as well as at an early age there are favorable forms of the disease.
At present, it can be considered established that, despite pronounced inclination to growth and destruction of the primary focus, the generalization of the process and, as a result, the greater lethality and mortality from tuberculosis, the prevalent contingent of tuberculosis-infected infants( with a positive tuberculin reaction)to this group seriously ill.
Prior to the widespread introduction of tuberculin samples into practice, when the entire mass of infected children were not taken into account and only serious cases were recognized, it was believed that infecting an infants certainly leads to a severe and almost always fatal disease. With the introduction of tuberculin samples into practice and the improvement in the recognition of tuberculosis in connection with this, the range of tuberculosis children detected by us has significantly expanded and it was found that at an early age among infected children, the contingent of children with the so-called small and clinical expression of localizationdefeat. This can be said not so much about the children of the first year of life, as about children aged 2 and 3 years. We meet, therefore, and at an early age, a state where, with a positive tuberculin reaction, there are no obvious signs of the disease or they are not expressed clearly - a condition that is characterized by the generally accepted nomenclature as a status allergicus, or chronic tuberculous intoxication.
In the X-ray examination, the pulmonary fields in such children are clean;if there are changes, only in the form of enlargement of the shadows of the roots of the lungs, strengthening their pattern, etc.
With more pronounced changes from the roots of the lungs in young children, there are all grounds to suspect the evolutionary process in the bronchial lymph nodes, since pronouncedtuberculosis of the bronchial lymph nodes does not always give characteristic shadows in the form of large outlined arches during X-ray examination. In each such case careful monitoring of the child( temperature, weight) and re-examination of blood are necessary, since the blood picture( sudden acceleration of erythrocyte sedimentation, shift of the leukocyte formula to the left) can unexpectedly give an indication of a serious illness. In the absence of severe fever and significant changes in the morphological picture of blood, such tuberculosis-infected children without obvious signs of the evolutionary process develop in the vast majority of cases in the nursery and children's homes quite satisfactorily, and, provided they organize an improved regime, do not need to be placed in a special institution. Thus, and at an early age, there are a wide variety of forms of the disease - from small-symptomatic with barely expressed clinical manifestations( always available, although not widespread anatomical localization of the process) to a pronounced disease with multiple localization of the process - forms of generalized tuberculosis.
This variety of forms and severity of the disease in young children is predetermined by a number of factors: individual resistance of the organism to tuberculosis infection, conditions and duration of communication with the source of infection, superinfection, nutrition, environmental conditions, diseases, etc. All this complex complex of influenceswith the leading role of the age factor determines the variety of forms, different severity, features of the course and the outcome of tuberculosis in the infant and young child.
Currently, with significant success in the fight against tuberculosis, there has been a marked reduction in morbidity and mortality from tuberculosis, including in young children.
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