2. What is Infiltrative pulmonary
tuberculosis
• Infiltrative tuberculosis is regarded as a phase in the
progression of focal tuberculosis of the lungs in which
infiltration, perifocal inflammation are the leading. In
this form of tuberculosis is extremely diverse
proliferative, tissue reaction in the lungs.
The mechanism and the causes of various downstream
infiltrates complex. Usually infiltrative-pneumonic
process develops in the hyperergic reaction of the
organism, hypersensibility lung tissue, greater lability
of the neuro-vegetative and endocrine systems
3. What triggers / Causes of Infiltrative
pulmonary tuberculosis:
• The causative agents of tuberculosis are Mycobacterium - acid
bacteria of the genus Mycobacterium. Only 74 known species of
such bacteria. They are widely distributed in soil, water, among
humans and animals. However, tuberculosis in humans causes
conditionally allocated complex M. tuberculosis,
including Mycobacterium tuberculosis (the human species),
Mycobacterium bovis (bovine species), Mycobacterium africanum,
Mycobacterium bovis BCG (BCG strain), Mycobacterium microti,
Mycobacterium canetti. Recently attributed to him, Mycobacterium
pinnipedii, Mycobacterium caprae, phylogenetically related to
Mycobacterium microti, and Mycobacterium bovis. The main
species symptom of Mycobacterium tuberculosis (MBT) -
pathogenicity, which manifests itself in virulence. Virulence can vary
significantly depending on environmental factors and different ways
to manifest itself, depending on the state of the microorganism,
which is subject to bacterial aggression.
4. Pathogenesis (what is happening) at
the time of Infiltrative
• Primary infection with Mycobacterium tuberculosis and hidden course of
tuberculosis infection.
Primary human infection office usually occurs by airborne. Other pathways
- alimentary, contact and transplacental - are much rarer.
The respiratory system is protected against the penetration of
mycobacteria mucociliary clearance (the secretion of the goblet cells of
the respiratory tract mucus, which adheres received mycobacteria, and
further elimination of mycobacteria by using wavelike oscillations of
ciliated epithelium). Violation of mucociliary clearance in acute and
chronic inflammation of the upper respiratory tract, trachea and major
bronchi, and also under the influence of toxic substances makes possible
the penetration of mycobacteria in the bronchioles and alveoli, then the
probability of infection and tuberculosis disease significantly increases.
The possibility of infection through the alimentary due to the condition of
the intestinal wall and its suction function.
5. Pathogenesis
• TB agents do not emit any exotoxin, which could stimulate phagocytosis. The possibility
of phagocytosis of mycobacteria at this stage is limited, therefore, the presence in the
tissues of a small amount of the pathogen is not immediate. Mycobacteria are outside
the cells and reproduce slowly, and fabric for some time retain normal structure. This
condition is called "latent microbism". Regardless of the initial localization of they
lymph current fall in regional lymph nodes, then lymphogenous spread throughout the
body - is the primary (obligate) mycobacteremia. Mycobacterium linger in the organs
with the most developed microcirculatory bed (lungs, lymph nodes, cortical layer of the
kidneys, epiphyses and metaphyses of the tubular bones, ampullaria-pimpinellae
departments of the fallopian tubes, uveal tract of the eye). Since the pathogen
continues to multiply, and immunity is not yet formed, the pathogen population is
significantly increased.
However, in places where a large number of mycobacteria phagocytosis begins. First
pathogens begin to phagocytose and destroy polynuclear leukocytes, but to no avail -
they all die, or come in contact with the office, due to weak bactericidal capacity.
Then to phagocytosis office connect macrophages. However, MBT synthesize ATP-
positive protons, sulfate and virulence factors (cord factor), resulting in disturbed
function of the lysosomes of macrophages. Education phagolysosome becomes
impossible, therefore, lysosomal enzymes of macrophages does not affect the absorbed
Mycobacterium. The office is located intracellular, continue to grow, multiply and more
and more damage the host cell. The macrophage gradually dies, and mycobacteria re-
enter into the intercellular space. This process is called "incomplete phagocytosis".
7. The symptoms of Infiltrative
pulmonary tuberculosis:
• The symptoms of Infiltrative pulmonary
tuberculosis:
• There are the following clinical and radiological
types of infiltrates:
1) bangaloresony infiltration-
2) rounded infiltration-
3) obliquity infiltration-
4) caseous pneumonia.
5) lobit-
6) peristian
8. •
Bangaloresony infiltration is the focus, located in cortical sections I or II of the
segments of the upper lobe of the lung, incorrectly rounded, with indistinct
contours, with a diameter of 1-3 cm for the CT it consists of 2-3 or more fused
fresh foci. Asymptomatic, with no functional change and bacilli.
Rounded infiltrate is magic blackout round or oval shape, slightly contoured, with
a diameter of 1.5-2 cm, often located in the I-II or VI segments of the lungs. From
them to the root of the lung is inflammatory "track" against the background of
which is determined by the projection of the bronchus.
When rentgenotomograficheskie the study identified the inclusion of more dense
or calcified lesions, the presence of small cavities, pleural changes, scar
formations. With the progression of the round infiltrates to increase the zone of
perifocal inflammation, the signs of the collapse of the caseous center with the
formation of cavities. In the cavity contains sequesters and a small amount of
liquid - pneumovagina cavern.
As a result of bronchogenic dissemination in the healthy parts of the lungs appear
lesions of varying size.
Obliquity infiltrate radiographically is an uneven shading, contours vague shadow
of which, it applies to one or more segments of the upper lobe of the lung.
Tuberculous infiltration picture reminds nonspecific pneumonia, but differs from it
in the x-ray resistance changes, the tendency to decay and formation of cavities.
9. • Lobit - tuberculous inflammatory process extending to the whole portion
of the lung. Lobit different structural forms (multiple caseous lesions) and
severe clinical picture. As the progression of the process affects the entire
lung lobe, which is delineated clear the interlobar fissure. Monitoring
trends showed that Lobito often precedes the development of small
infiltrative focus.
Peristiani, or regional infiltrationis obliquity infiltrate located at the
interlobar sulcus. The apex of the triangle pointed to the root of the lung,
the base outwards. Upper boundaries are vague and moving without
sharp outlines slightly changed in lung tissue. The lower bound
corresponds to the interlobar pleura, and therefore clear.
Caseous pneumonia. Some patients with insufficient immune infiltration
resistance assumes the character of caseous pneumonia. Caseous
pneumonia is characterized by the development in the lung tissue
inflammatory response with a predominance of necrosis and caseous-
pneumonic lesions comprise everything easy and even.
