Focal pulmonary tuberculosis refers to minor forms of tuberculosis, which in most cases are benign. This form of tuberculosis is currently the most common both among newly identified patients and among those registered. Among newly identified patients with pulmonary tuberculosis focal tuberculosis observed in 60%, and among those registered in anti-tuberculosis dispensaries - in 50%.

The relative frequency of focal tuberculosis among tuberculosis patients is determined by the organization of the entire system of preventive anti-tuberculosis measures and in recent years has increased even more only thanks to timely detection And effective treatment tuberculosis.

Focal tuberculosis includes processes of various origins and duration, of limited extent, with a focal size of no more than 1 cm in diameter. As can be seen from this definition, focal tuberculosis is a collective concept, therefore, two main forms of focal tuberculosis are distinguished: soft-focal and fibrous-focal tuberculosis. The need to distinguish these forms is due to their different genesis, different pathomorphological picture and potential activity, unequal tendency to reverse development.

Soft focal tuberculosis is the beginning of secondary tuberculosis, which determines the significance of this most important form process for development following forms.

In the pathogenesis of the development of focal tuberculosis, it is important to correctly understand the role of exo- and endogenous infection. A. I. Abrikosov attached decisive importance in the development of secondary tuberculosis to the repeated entry into the lungs of mycobacterium tuberculosis from environment. The importance of exogenous infection is confirmed by the more frequent incidence of tuberculosis in persons who have had contact with tuberculosis patients. Although the incidence of “contacts” (persons in contact with patients with active tuberculosis) has now significantly decreased, it is still 3-4 times higher than the general incidence of the population.

The endogenous development of tuberculosis is also of undoubted importance, which is confirmed by the almost constant detection in the zone of fresh tuberculosis foci of older ones, which were apparently the source of exacerbation of the process. Old encapsulated and calcified lesions in the lungs and lymph nodes are detected in 80% of patients with focal tuberculosis. The importance of endogenous infection is also indicated by the more frequent disease of active tuberculosis in previously infected individuals, especially X-ray positive, i.e., those with lung traces previous tuberculosis infection.

The tendency to exacerbation of old lesions depends on the nature and duration of residual changes and the state of reactivity of the body. Live, virulent Mycobacterium tuberculosis can persist for a long time in the body (directly in the foci and in the lymph nodes). Mycobacterium tuberculosis is usually not found in scar tissue.

Currently, TB specialists recognize the importance of both endogenous and exogenous infection. Exogenous superinfection sensitizes the body and can contribute to the exacerbation of endogenous infection. The entire system of anti-tuberculosis measures is built on a correct understanding of the role of endogenous and exogenous infection: vaccination, early diagnosis and treatment of primary and secondary tuberculosis, as well as tuberculosis prevention.

In the pathogenesis of focal tuberculosis, as well as other clinical forms process, unfavorable factors that reduce the body’s resistance are also important: concomitant diseases, industrial hazards, unfavorable climatic and living conditions, excessive sun exposure, mental trauma, etc.

Thus, the pathogenesis of focal tuberculosis of the secondary period is different. Focal tuberculosis can develop as a result of exogenous superinfection or endogenous spread of Mycobacterium tuberculosis from latent tuberculosis foci in the lymph nodes, bones, kidneys, and more often from aggravated old encapsulated or calcified foci in the lungs. According to their origin, these pathological changes or belong to the period primary infection, or are residual changes after infiltrative processes, hematogenous disseminations or small cavities.

The initial pathological changes in secondary tuberculosis consist of the development of endoperibronchitis of the intralobular apical bronchus [Abrikosov A. I., 1904]. This is followed by cheesy necrosis of the inflammatory walls of the bronchus. Panbronchitis develops, sometimes with blockage of the bronchial lumen by caseous masses, then a specific process spreads to the adjacent pulmonary alveoli. This is how a focus of specific caseous bronchopneumonia arises - the Abrikosov focus. The combination of such foci with a diameter of up to 1 cm creates a pathomorphological picture of soft-focal tuberculosis.

For tuberculous inflammation exudative stage gradually gives way to proliferative. Fresh lesions are therefore often replaced by connective tissue and turn into scars. A capsule is formed around the caseous foci. Such lesions are called Aschoff-Bullet lesions. Morphologically, alterative and proliferative foci are distinguished, but their combination is more often observed. Based on size, lesions are divided into small - up to 3 mm, medium - up to 6 mm and large - 10 mm in diameter.

It has been established that certain physicochemical changes are observed in the lung during the formation of foci. In the area where Mycobacterium tuberculosis settles, the pH of the environment shifts to the acidic side, which stimulates the activity of the connective tissue involved in delimiting the inflammatory area of ​​the lung.

The formation of limited focal changes in a person with tuberculosis, and not an extensive infiltrative-pneumonic process, is possible only under conditions of a certain state of organism reactivity, which is characterized by the absence hypersensitivity the body to tuberculin and maintaining, although somewhat reduced, relative immunity. This is evidenced by the normergic reactions to tuberculin detected in patients with focal tuberculosis and the data of biochemical studies. Patients with focal tuberculosis do not have such a sharp increase in the level of histamine in the blood as with infiltrative-pneumonic tuberculosis, when pronounced sensitization of the body is observed.

The clinical picture of soft-focal tuberculosis is characterized by low symptoms for a certain period. However, for soft-focal tuberculosis the predominance of general mildly expressed functional disorders from some internal organs and systems.

Some patients experience low-grade fever, excessive sweating, sleep and appetite disturbances, decreased ability to work.

The appearance of patients with focal tuberculosis does not allow one to suspect an incipient tuberculosis process: they look healthy. However, when objective research of the chest organs, symptoms of reflex sparing of the affected areas are clearly identified: a lag in the act of breathing on the affected side of the chest, tension and soreness of the muscles over the affected area, weakening of inspiration. There may be a shortening of the percussion tone and, during auscultation, increased exhalation over the affected segment, the degree of which depends on the number of foci, their fusion and involvement of the pleura in the process.

The leukocyte form and ESR remain normal in a significant proportion of patients with focal tuberculosis. In a number of patients, minimal changes are detected in the form of a slight shift in the leukocyte count to the left, moderate increase ESR. Lymphocytic leukocytosis or its combination with monocytic leukocytosis is often observed. An increase in the absolute content of monocytes and lymphocytes in the peripheral blood indicates functional stress on the part of the hematopoietic system involved in anti-tuberculosis immunity, and more often this accompanies the benign course of the disease.

The detectability of Mycobacterium tuberculosis depends on the phase of the process and the research methodology. In focal tuberculosis, Mycobacterium tuberculosis is found mainly in the phase of decay of lung tissue.

It is necessary to use the entire complex microbiological research: bacterioscopy (using enrichment methods, in particular flotation), fluorescent microscopy, cultural and biological methods. It is the latter two methods for focal tuberculosis that often allow the detection of Mycobacterium tuberculosis. To determine Mycobacterium tuberculosis, bronchial or gastric lavage water is usually examined, since patients produce a small amount of sputum.

Repeated cultures almost double the detection rate of Mycobacterium tuberculosis in the focal form.

The integrated use of laboratory methods not only increases the reliability of determining the frequency of isolation of mycobacterium tuberculosis, but also makes it possible to judge the nature of bacilli isolation: viability, virulence and drug sensitivity of microbacteria tuberculosis, their type, which is of great importance for chemotherapy.

The X-ray picture of focal tuberculosis depends on the phase, genesis and duration of the process. Newly emerging in intact lung fresh the lesions on the radiograph are visible as rounded spotty shadow formations of low intensity with vague contours, usually located in groups, often in a limited area.

The nature of radiological changes is better revealed by tomography. The greatest role of X-ray tomography is in the diagnosis of destruction, since in this form small decay cavities are observed (up to 1 cm in diameter), which can rarely be detected during survey or even targeted radiography. Up to 80% of such decay cavities in focal pulmonary tuberculosis are detected only using a tomographic research method, therefore, for all newly diagnosed patients with focal pulmonary tuberculosis, X-ray tomography is mandatory. Otherwise, most small decay cavities remain undiagnosed, treatment is ineffective and the process progresses.

Patients with focal tuberculosis are identified mainly during mass fluorographic examinations, as well as during examination of persons visiting the clinic for catarrh of the upper respiratory tract, asthenic conditions, vegetative neurosis and other diseases, under the “masks” of which focal tuberculosis can occur.

Differential diagnosis of focal tuberculosis should be carried out with its “masks”: influenza condition, thyrotoxicosis, vegetoneurosis and diseases in which focal-like shadows are detected radiographically in the lungs - focal eosinophilic pneumonia, limited pneumosclerosis.

At differential diagnosis It is necessary to conduct a timely X-ray examination, which will confirm or exclude the presence of focal changes in the lungs. In addition, it is necessary to take into account the history and characteristics of the clinical course of the disease.

For eosinophilic focal pneumonia an increase in the number of eosinophils in the peripheral blood is detected, eosinophils are also found in the sputum. Noteworthy is the rapid disappearance of clinical and radiological signs of eosinophilic focal pneumonia. Eosinophilic foci of pneumonia often develop with ascariasis, since ascaris larvae undergo a development cycle in the lungs and sensitize the lung tissue.

When diagnosing focal tuberculosis, it is important not only to establish the origin of the lesions, but also to determine the degree of their activity.

If, when using the entire complex of clinical and radiological research methods, it is difficult to resolve the issue of the degree of activity of focal tuberculosis in a newly diagnosed or long-term treated patient, subcutaneous injection of tuberculin (Koch test) and sometimes diagnostic therapy are used.

The response to subcutaneous injection of tuberculin is assessed by the size of the infiltrate. A reaction with an infiltrate diameter of at least 10 mm is considered positive. About general reaction judged by changes in the patient’s well-being (the appearance of symptoms of intoxication) - an increase in body temperature, changes in the leukocyte formula and ESR, biochemical changes in the blood serum. In case of a focal reaction, which is very rarely detected radiologically, catarrhal phenomena may occur in the lung and Mycobacterium tuberculosis may be detected in the sputum or lavage waters of the stomach and bronchi.

To carry out the above tests, the temperature is measured every 3 hours for 3 days before using the Koch test (excluding night time), the test is carried out the day before general analysis blood. On the day of the test, the blood serum is examined for the content of hyaluronidase, histamine, and protein fractions. This analysis is repeated after 48 hours, a general blood test - after 24 and 48 hours. At the same time, sputum or washings of the stomach and bronchi are examined for Mycobacterium tuberculosis by culture.

An active process is characterized by an increase in the number of leukocytes, the appearance of a shift in leukocyte formula to the left, an increase in the number of lymphocytes, monocytes in the peripheral blood and a decrease in the number of eosinophils, and sometimes lymphocytes. In the blood serum there is a shift towards coarse protein fractions - a- and y-globulins. Particularly characteristic is the increase with active process levels of hyaluronidase, histamine, serotonin and catecholamines.

In the absence of reliable data indicating the activity of the tuberculosis process, the issue is resolved negatively. In case of doubtful data, a 3-month diagnostic course of treatment with three main tuberculostatic drugs is advisable. In 90-95% of patients, this period is sufficient to resolve the issue of the activity of the tuberculosis process.

The course of focal tuberculosis is determined by the potential activity of the process and the method of treating patients. Soft focal tuberculosis is characterized by pronounced activity, which requires great attention to the treatment of patients suffering from this form.

Treatment of patients with active focal pulmonary tuberculosis must begin in a hospital setting with three main tuberculostatic drugs against the background of a rational general hygienic regimen, as well as diet therapy. All this is carried out until there is significant clinical and radiological improvement. In the future, treatment in sanatoriums and outpatient setting when using two drugs. The duration of treatment should be at least 12 months, during which intermittent chemotherapy can be performed.

In case of protracted course of focal tuberculosis, pathogenetic agents can be recommended: pyrogenal, tuberculin. With the exudative nature of inflammation, a pronounced infiltration phase, with allergic symptoms caused by anti-tuberculosis drugs, with concomitant diseases of an allergic nature, the use of corticosteroid hormones is indicated.

The outcomes of focal tuberculosis depend on the nature of changes in the lungs at the start of treatment and the method of treating patients. When used in combination modern methods therapy, cure occurs in 95-98% of patients. Complete resorption is observed only with fresh lesions (in 3-5% of patients). In most patients, in parallel with resorption, delimitation of foci occurs with the formation of local pneumosclerosis. This is due to the body’s sufficient resistance to tuberculosis infection and the predominance of the intermediate phase of inflammation from the very first days of the development of the disease.

In 2-7% of patients with focal tuberculosis, with the confluence of a number of unfavorable factors, the disease may progress with the development of the following forms of secondary tuberculosis: infiltrates, tuberculosis, limited fibrous-cavernous pulmonary tuberculosis. In these cases, there may be indications for surgical treatment - economical lung resection.

The pathogenesis of fibrous-focal tuberculosis is in connection with the reverse development of all forms of pulmonary tuberculosis: primary tuberculosis complex, disseminated tuberculosis, soft-focal tuberculosis, infiltrative, tuberculoma, cavernous tuberculosis.

Pathomorphologically and clinically, fibrous focal tuberculosis is characterized by great polymorphism, depending on the prevalence and duration of the forms of the previous tuberculosis process.

Patients with fibrous focal tuberculosis may complain of weakness, increased fatigue and other functional disorders.

Complaints of cough with sputum, sometimes hemoptysis, pain in chest can be explained by specific pneumosclerosis in the affected area.

An objective examination above the affected area reveals a shortening of the percussion tone, and upon auscultation, dry rales are heard.

Changes in blood and sputum depend on the degree of activity of both specific and nonspecific inflammatory processes in the focal area. During the compaction phase in the blood, lymphocytic leukocytosis is possible. Mycobacterium tuberculosis is found very rarely in sputum.

X-ray examination of fibrous-focal tuberculosis clearly reveals the intensity, clarity of boundaries and polymorphism of the foci, pronounced fibrosis and pleural changes (Fig. 28).

In the diagnosis of fibrous-focal tuberculosis, the greatest difficulties are in determining the degree of activity of the process, as well as the reasons for the exacerbation of the inflammatory process in the area of ​​tuberculous pneumosclerosis. To answer this question it is necessary comprehensive examination sick. There may be indications for diagnostic chemotherapy.

The course of fibrous focal tuberculosis depends on the number and condition of the lesions, the method of previous therapy, as well as the living and working conditions of the patient.

Indications for specific therapy for patients with fibrous focal tuberculosis are determined by the phase of the process. Persons with fibrous focal tuberculosis in the thickening phase do not require specific antibacterial therapy. Preventative treatment GINK drugs. and PASK is indicated for them under complicating circumstances: when changing climatic conditions, after intercurrent illnesses or surgical interventions.

Patients with fibrous-focal tuberculosis in the infiltration phase need treatment with chemotherapy, first in a hospital or sanatorium, and then on an outpatient basis.

For newly diagnosed fibrous focal tuberculosis of questionable activity, it is necessary to carry out therapy with three main drugs for 3-4 months, and if it is effective, continue therapy on an outpatient basis.

The criterion for clinical cure of focal tuberculosis is the absence of clinical, functional and radiological data on lung disease, observed within 2 years after the end effective course treatment.

Focal pulmonary tuberculosis is most often found in patients who have already had this disease at one time, and it proceeds with almost no symptoms. You need to know under what conditions and what places focal pulmonary tuberculosis affects.

There is a possibility that a person who has had tuberculosis for a long time and has successfully gotten rid of it may become infected with this type of disease again. The patient may not even realize that he has it and may not observe any signs of it. The presence of the disease can be detected only through fluorography.

Watch the video in which there is a conversation about focal formations in the human lungs.

This disease in any of its forms is, first of all, social. The task of every person is to protect himself as much as possible from contracting the disease, at least without falling into risk groups. In addition, in 90% of cases, a timely detected disease is cured without significant time and emotional costs on the part of the patient.

Important! Detection of focal pulmonary tuberculosis is statistically 10-15% in first-time cases of tuberculosis. And in people who have already had tuberculosis, this form appears in 24-25% of cases.

What are the features of this form of tuberculosis?

Focal pulmonary tuberculosis, compared with others, has the following features:

• Productive inflammation occurs in several small foci (1 or 2);
• as mentioned earlier, occurs without symptoms or with a small number of them;
• is a secondary form of the disease, so most patients are adults;
• there are two forms of the disease: fresh (mild focal) and chronic (fibro-focal), which differ in the duration or duration of the disease;
• the course of the disease goes through three stages: infiltration, decay and compaction;
• Varieties of small (up to 3 mm in diameter), medium (up to 6 mm) and large (up to 10 mm) lesions are possible.

Only 1/3 of all patients with this form of the disease experience one or two symptoms; the remaining 2/3 do not experience any symptoms at all.

What are the differences between fibrous-focal and soft-focal forms of the disease?

In addition to duration and duration, these phases also differ in other features, for example:

• In fibrous-focal disease, tissue compactions (hardening) and scars appear in the complete absence of the inflammatory process, and calcium salts are also deposited;
• in mild focal cases, the inflammatory process is present, and tuberculosis itself disintegrates into cavities.

What are the possible symptoms of the disease?

Despite the fact that the course of focal pulmonary tuberculosis is almost asymptomatic, patients, nevertheless, note the presence of the following signs:

• 90% of all patients with this disease report sharp decline weight not caused by physical activity or diets;
• increased sweating, heat in the upper extremities and cheeks;
• the appearance of an infrequent dry cough, sometimes with sputum;
• pain in any side, and also possibly in the thoracic region;
• the appearance of shortness of breath during light physical exertion or normal daily activities, as well as during uncomfortable body positions;
• general decrease in the body's performance, drowsiness, fatigue, depressed mood, etc.

Where can foci of this form of tuberculosis appear?

Depending on the form of the disease - fresh or chronic - lesions may appear in different places. In the case of the mildly focal form, most often the lesions appear in the bronchi of the first and/or second segments of the upper lobe of the lungs and do not exceed one centimeter in diameter.

Lesion on a computed tomography image.

In the case of the fibrous-focal form of the disease, about 90% of cases of lesions also occur in the upper lobes of the right or left lung. This disease may appear in case of exacerbation of existing lesions. Newly appearing lesions are surrounded by a fibrous capsule, and fibrous tissue can grow into these lesions.

Most often, focal tuberculosis appears in upper parts one of the lungs, perhaps because this place is inactive compared to the rest. Some scientists believe that this arrangement of foci is due to favorable environment for their appearance. Moreover, in most cases, it is the right lung, its upper lobe, that is affected. Only sometimes the defeat can be synchronous.

Carefully! It is possible for focal tuberculosis of the upper lobe of the right lung to transition, as well as the left, into, i.e. the disease will progress, and the number of affected areas will increase.

What are the consequences of the disease?

Doctors consider three possible options for the consequences of focal pulmonary tuberculosis:

1. The disease has favorable outcome, because all traces of the disease are destroyed thanks to timely and correct treatment.
2. There is a partially favorable outcome, i.e. the pathology is cured, but remains of fibrosis and calcite are observed.
3. In severe cases of the disease, if the patient is not treated in a timely manner, there is a risk of death.

Is it possible to become infected with this form of the disease?

The most important question is: is focal tuberculosis contagious or not? If the patient has available open form illness, and at the same time he is on, i.e. moves freely, is in society, then in this case, he is a spreader of infection.

Any healthy person who comes into contact with sick people can become infected. The open form of focal tuberculosis is transmitted in the same way as the open form typical disease. Very often this is an airborne and contact method.

Attention! Be vigilant and careful when in public places; people with tuberculosis may refuse hospital treatment and go to inpatient treatment. Another option is possible when a sick person does not suspect that he has a disease and spreads it without knowing it.

What treatments are there for this form of the disease?

In the case of correctly selected treatment for focal pulmonary tuberculosis and the patient’s fulfillment of all doctor’s prescriptions full recovery may occur approximately 12 months after onset. The therapy process has a standard scheme, which includes the following steps:

1. Taking medications, medicines, in particular antibacterial, immunomodulating drugs, hepatoprotectors, glucocorticoids, vitamins. Treatment involves prescribing four or more simultaneously medications multidirectional spectrum.
2. Organization of a balanced diet that would ensure that a sufficient amount of protein enters the human body. Food has a very important role in getting rid of the disease.
3. Sanitary-resort treatment that allows you to improve general condition body, improve immunity.

Focal tuberculosis is a secondary form of damage, in which specific foci of inflammation are formed, not exceeding 1 cm in diameter. The clinical picture does not differ in pronounced signs.

Only some patients experience mild malaise, dry cough and pain on the affected side. As diagnostic measures It makes sense to carry out x-rays, as well as sputum examination. Treatment is selected individually, depending on the stage of the disease.

General characteristics of the disease

Focal pulmonary tuberculosis is characterized by limited damage to small tissues. Most often, productive inflammation is local in nature, that is, it is recorded in only one or two segments.

The occurrence of a focal form of tuberculosis is regarded as a relapse that occurs several years after treatment of the primary form of the disease or against the background of incorrectly selected therapy.

Therefore, the risk group primarily includes patients who have already had tuberculosis. This explains age category sick. Most often, focal tuberculosis in the infiltration phase is diagnosed in adult patients. Moreover, in total number Clinical and morphological forms of the disease, the focal form occupies one fifth.

In turn, this form of the disease has its own characteristic differences:

• limited affected area;
• inflammation is not destructive;
• hidden development.

It is the absence of obvious signs that often becomes the reason for late seeking help.

Classification of the disease

Like all other forms of tuberculosis, focal tuberculosis develops in stages.

It is the duration of infection that is reflected in the stage and neglect of the disease:

1. On initial stage in the secondary process, a patient who was previously infected with mycobacteria and has already suffered primary forms of infection is diagnosed with fresh or mildly focal tuberculosis. IN clinical picture in such patients, endobronchitis or peribronchitis may occur, affecting the segmental bronchi. As the process develops, lobular bronchopneumonia may occur.
2. In the absence of adequate treatment, the disease becomes chronic or fibrous-focal. This outcome may be associated with the resorption of a fresh disease or be a logical development of other types of pulmonary tuberculosis, including infiltrative, cavernous, and disseminated. In such cases, foci of inflammation are compacted or calcified spots.

With relapses of chronic pulmonary tuberculosis, the boundaries of the lesion may increase, which leads to the degeneration of focal tuberculosis into other more dangerous forms.

If we consider the gradual development of the disease, then it goes through three main stages: infiltration, decay and compaction. The lesions in this form of tuberculosis can be very small up to 3 mm, medium - from 3 to 6 mm and large up to 10 mm.

Causes of development of focal tuberculosis

Tuberculosis in focal form does not occur in practice as a primary disease. Most often, the disease develops as a secondary process against the background of a person’s lack of anti-tuberculosis immunity.

The main reasons for the development of this form of the disease are associated with:

• activation of old lesions;
• re-entry of infection into the body.

In any case, relapse occurs with weakened immunity.

Most often, relapses or reinfection happening in the background:

• abuse of alcohol, smoking, drugs;
• antisocial lifestyle;
• heavy chronic diseases such as diabetes mellitus, oncological pathologies, chronic pneumonia, peptic ulcer stomach.

Infection is possible as a result of prolonged contact with carriers of mycobacteria.

How does focal tuberculosis manifest?

With focal tuberculosis, periods of exacerbation and attenuation alternate in waves. Moreover, such alternation can continue for quite a long time. In this case, the person complains of general malaise and causeless weakness. He may have a dry or unproductive cough, as well as heavy sweating, especially at night. However, such symptoms do not suggest a relapse of tuberculosis. Therefore, the disease is most often detected during routine photographic examination.

The disease itself goes through several stages, each characterized by its own symptoms:

1. At the infiltration stage, when MBT activation occurs, with increased emissions toxins into the lymphatic and circulatory system, signs of intoxication predominate. The patient's general condition worsens, loss of appetite and weight loss. There is a slight increase in temperature and a persistent cough. Some patients complain of pain in the side on the affected side. As the temperature rises, heat is felt in the cheeks and palms.
2. At the stage of decay and compaction, the presence of more characteristic symptoms tuberculosis. The patient's breathing becomes harsh. When listening, fine wheezing appears, percussion sounds become dull. A complication of lung problems can be increased heartbeat, as well as profuse sweating.

With focal tuberculosis of the chronic type, hemoptysis may be observed. Traces of blood in the sputum appear during an exacerbation. It is the presence of such symptoms that gives a clear answer to the question of whether it is focal or not. Since the disease occurs in active open phase, being near an infected person at such moments is dangerous.

What are the possible complications?

In the focal form of the disease, patients often write off nonspecific symptoms for signs of respiratory inflammatory diseases. And few people take into account that at this stage tuberculosis is completely curable. With an unreasonable delay in therapy or improper treatment, the disease progresses and acquires a fibrous-focal form, in which dangerous complications may develop.

Development is possible:

1. , at which inflammatory reaction becomes exudative in nature with the formation of caseous foci of decay.
2. Tuberculoma with foci exceeding 1 cm in diameter in the form of caveous capsules. Most often, surgery is required to remove tuberculoma.
3. Tricky tuberculosis, in which persistent cavities are formed in the form of caverns with complete collapse of lung tissue. With this form, a huge amount of mycobacteria is released with sputum, which makes the infected person dangerous.

Lack of treatment for the focal form of tuberculosis leads to the degeneration of the disease into incurable forms. In such cases even intensive care is not able to completely cope with the infection, and the disease itself simply heals.

Video

PULMONARY TUBERCULOSIS. Why is it dangerous? How do they get infected? Symptoms and mortality!

How is the treatment carried out?

For focal pulmonary tuberculosis, treatment with initial stages for two to three months it is carried out in a hospital with complete isolation of the infected person. Subsequently, the patient is transferred to outpatient treatment. In total, the course of taking anti-tuberculosis drugs can last up to a year.

Typically, standard treatment regimens are used, which include the prescription of several groups of drugs:

1. Antibiotics. In the hospital, in the initial stages, a combination of several drugs is used. Tablets or injections of Ethambutol, Pyrazinamide, Rifampicin, Isoniazid may be prescribed. The fixing course involves the use of Isoniazid and Rifampicin or Ethambutol for 4–5 months.
2. Immunomodulators. Drugs in this group are extremely important in the treatment of any form of tuberculosis, since the body needs to fight the infection, but its own defenses are not enough for this.
3. Hepatoprotectors. Prescribed for the purpose of restoring liver cells after long-term use of anti-tuberculosis drugs, which are considered toxic. Chemotherapy inevitably destroys the liver, so it has to be supported with special drugs.
4. Vitamins. They can be prescribed in tablets or injections to support the immune system and eliminate the consequences of taking harmful chemotherapy drugs.

A special place in the treatment regimen for tuberculosis occupies dietary food. The patient is prescribed a moderate diet with increased content proteins. Tuberculosis patients are recommended to increase the proportion of dairy products, eggs, lean veal, rabbit and chicken in the menu. Preference is given to boiled and stewed food.

At the same time, easily digestible fats must be present in sufficient quantities, first of all, fish oil and vegetable oil. There are no special restrictions regarding the consumption of carbohydrates, as well as vegetables and fruits. However, you should exclude sweets that contain large number oil creams. It is necessary to regularly eat fresh fruits and vegetables with high content ascorbic acid. Therefore, peppers and onions, currants and strawberries, lemons and rose hips should always be present on the table.

Secondary prevention

For focal tuberculosis, as for any other form of the disease, secondary prevention is important.

Since the disease is secondary in nature, patients cured of primary tuberculosis need to:

• avoid prolonged contact with infected people;
• undergo regular medical examinations;
• take care of your immunity, including nutrition, daily routine, availability of sufficient physical activity and walks in the fresh air;
• giving up smoking, taking drugs, stimulants is a categorical requirement.

If any signs of relapse appear, it is better to play it safe and undergo an emergency examination, which will help detect and stop the disease in the initial stages.

If you find an error, please highlight a piece of text and click Ctrl+Enter. We will correct the mistake, and you will receive + to karma :)

Focal pulmonary tuberculosis is a secondary manifestation of tuberculosis. This species is characterized by the fact that after illnesses respiratory system lesions are found in the lungs. And not only after tuberculosis. It would seem that they should not exist, since in most cases the treatment was carried out, but alas. This situation is especially complicated after suffering from tuberculosis.

is an infectious disease caused by Mycobacterium tuberculosis (Koch bacillus). All countries Eastern Europe on at the moment are endemic for this disease. The pulmonary form is the most common among all forms of tuberculosis. In most cases, focal pulmonary tuberculosis is recorded.

Focal inflammation is a specific inflammation in which changes in the lungs, according to radiography, do not exceed 1 cm. Moreover, they are larger than miliary affects, whose diameter is 2-3 mm. With focal tuberculosis, there may be several affects, but they do not tend to merge and no other changes are detected in the lungs.

Most often, focal tuberculosis affects the upper lobes of the lungs. The fact is that Koch's bacillus is an aerobe; it needs oxygen to grow and reproduce. The upper lobes of the lungs are better ventilated than the lower ones and have a worse blood supply, which means they always have a lot of oxygen.

The focus of infection often occurs here, but mycobacteria can live in low concentrations or in the complete absence of air, therefore focal tuberculosis can be found in other lobes, but with less probability.

With focal tuberculosis, the Koch bacillus that was already living there appears or is activated in the lungs. It begins to produce various enzymes that eat away lung tissue. Living tissue turns into white, cheesy, dead masses called caseous necrosis. The main feature of such inflammation is its rapid delimitation from surrounding tissues.

For reference. Focal tuberculosis is a type of pathology that is characterized by a rapid change from the alterative phase of inflammation to the productive phase. Inflammation always goes through three phases: alterative, exudative and productive. With tuberculosis, the exudative phase is not pronounced, because the process is specific.

This means that while the microbe is destroying lung tissue, the immune system builds a cellular barrier around it. This is the so-called specific inflammation. All cells of this barrier are arranged in a strictly defined order. They prevent inflammation from increasing. If the barrier is absent, more diffuse infiltrative inflammation or even caseous pneumonia occurs.

If the focus of caseous necrosis disintegrates, a cavity will appear in the lung. Then focal tuberculosis will become a tuberculosis cavity.

If a large amount of connective tissue grows in the lesion, tuberculosis becomes fibrous-focal.

For reference. In general, focal pulmonary tuberculosis is one of the most favorable forms of this pathology. Loss of lung tissue is usually minimal.

Classification of focal tuberculosis

Focal pulmonary tuberculosis can be of several types. The classification is based on the number of lesions, their exact location, shape
inflammation, the size of each lesion and the method of infection.

According to the number, focal pulmonary tuberculosis is distinguished with:

• A single outbreak. In this case there is only one affect.
• Multiple foci. In this case, there are two or more lesions, but each of them has a size from 3 to 10 mm, they are not connected to each other and do not merge. One of these affects may be the main one, while the others may be metastatic, they are called screening foci.

According to the location of the outbreak:

• Upper lobe;
• Middle lobe (for the right lung);
• Lower lobe.

In addition, when describing the pathology, indicate the name of the segment in which it is located and its approximate boundaries along the intercostal spaces and conventional lines of the chest.

For example, a lesion in the apical segment of the left lobe of the right lung at the level of the second rib along the midclavicular line. In this way, the exact location of the affect is indicated.

The size of the lesions themselves can be:

• Medium - from 3 to 6 mm in diameter.
• Large ones - from 6 to 10mm.

For reference. There are also small lesions up to 3 mm, but they are characteristic of miliary tuberculosis. If the affect occupies more than 1 cm, it is not called a focus, but, for example, an infiltrate.

One more important characteristic of each outbreak - the method of its occurrence. According to this principle there are:

• Primary focus. In this case, we are talking about the focus of Gon, in which the activation of the mycobacterium occurred or about the affect at the first meeting with the mycobacterium.
• Secondary focus. It exists regardless of the focus of Gon, it is formed when microorganisms enter from the outside.
• Focus-dropout. In this case, there is already active tuberculosis with destruction in the lungs and the patient, coughing up necrotic masses with bacteria, infects himself.

Based on the form of inflammation, there are two possible types:

• Soft-focal (actually focal). In this case, the affect consists only of decaying tissues and inflammatory cells. This form occurs at the beginning of the tuberculosis process.
• Fibrous-focal. This view is more late form. At the same time, connective tissue appears in the lesion, replacing the foci of destruction and delimiting the affect from healthy lung tissue. Ultimately, the lesion can completely turn into metatuberculous.

Causes

For any forms and types of tuberculosis, there is only one reason - entry of the pathogen into the lungs and its activation. The only etiological factor of tuberculosis is Koch's bacillus.

Focal pulmonary tuberculosis can have one of two development mechanisms. The first is associated with the activation of a pathogen that was already in the body and resting in the Gon focus for a long time. The second is when the pathogen enters the lungs.

For reference. If the Koch bacillus enters the lungs for the first time, tuberculosis will be primary, if repeatedly, this condition is called superinfection. Any addition of a new pathogen to an existing one is called superinfection in medicine.

The question arises why in some people the mycobacterium remains in the Gon lesion all their lives and does not cause disease, in others it contributes to the development of lesions that are quickly cured, in others it becomes the cause of extensive necrosis of the lungs with fatal. The difference lies in the factors that contribute to the development of pathology.

Factors contributing to the occurrence of focal tuberculosis:

• Increased virulence of mycobacteria. This term means the aggressiveness of mycobacteria towards a susceptible organism and its danger to humans. An increase in virulence occurs if this strain of rods has been in the bodies of people with weakened immune systems for a long time. Nothing interfered with the mycobacterium, and it acquired new properties. If such a bacterium enters the body of a person with normal immunity, a tuberculosis focus will arise, but the body’s immune forces suppress inflammation, making it limited.
• Massive contamination. Even in a person with normal immunity, with a large microbial load, a tuberculosis focus may appear. However, in a healthy body this process will not spread more than 1 cm.
• Short-term decrease in immunity. The reason for this may be hypothermia, overwork, or acute illness. At the same time, at the moment of decreased immunity, either mycobacteria are activated in the Gon focus, or a focus appears when new bacteria enter. Then the immune system is restored and prevents tuberculosis from spreading further. At constant decline immunity, it is not focal tuberculosis that occurs, but its more diffuse forms.
• Restoring immunity. The opposite mechanism is at work here. A person has had reduced levels for a long time protective forces, as a result of which infiltrative tuberculosis arose. Then the immunity was restored and the inflammation began to decrease; the delimitation of inflammation led to the appearance of a focus instead of an infiltrate. At the time of examination, the patient was already diagnosed with focal tuberculosis. Such a mechanism is a rare occurrence.

For reference. If a mycobacterium with increased aggressiveness or a large number of Koch bacilli enters the body of a person with normal or slightly reduced immunity, focal pulmonary tuberculosis will occur. However, the body’s immune forces will prevent its spread, so the type of tuberculosis will be focal.

Symptoms of focal pulmonary tuberculosis

Since in this disease the affect is very small, symptoms may be absent or have an erased form. With multiple foci, the likelihood of developing a full-blown clinic increases. In the case of fibrous-focal tuberculosis, the patient may only be bothered by a prolonged paroxysmal cough.

Symptoms of focal pulmonary tuberculosis may be the following:

• Increased body temperature. Not always observed. A sharp increase in temperature is not typical for tuberculosis. More often there is an unexpressed subfebrile condition up to 37.5 ° C.
• Cough. Occurs if the focus is located close to the large or medium bronchi. Then the patient is bothered by a dry cough. When the lesion begins to disintegrate and its contents exit through the bronchi, the cough becomes productive with a small amount of viscous sputum.
• Symptoms of intoxication. As a rule, there is no acute severe intoxication with tuberculosis; it develops over a very long time. Patients with long-term tuberculosis experience decreased appetite, emaciation, general exhaustion of the body, pale skin, and fatigue.
• Hemoptysis. This symptom is also characteristic only of long-term advanced forms of tuberculosis.

Important. Very often, focal lung lesions are an accidental finding during the next fluorographic examination. The patient feels completely healthy.

Diagnosis of focal tuberculosis

This diagnosis is made on the basis of an X-ray picture of the lungs and examination of sputum for acid-fast bacteria. The main thing for the doctor is to determine when there are indications for radiography and microscopy of a sputum smear.

Attention. Indications for this study are cough for more than two weeks, prolonged low-grade fever body unknown origin, presence of active tuberculosis in the past.

The X-ray image shows foci of darkening (light) ranging in size from 3 mm to 1 cm, located anywhere in the lungs, but more often in them right lobe. Increased intrathoracic lymph nodes observed only in primary tuberculosis.

In the event of fibrosis, connective tissue is visible in the lesion, making it more clear and demarcated; calcifications may be visible against its background. If there is destruction, the lesion becomes heterogeneous, and clearing is observed in it.

Sputum smear microscopy must be performed twice. In the focal form of tuberculosis, the smear may be negative because too few mycobacteria are isolated for a reliable diagnosis. In addition, before the necrosis begins to disintegrate, the patient does not excrete Koch's bacilli at all. If the cough is not productive and it is impossible to take sputum, bronchial washings are examined microscopically.

If it is difficult to understand what the boundaries of the lesion are and whether there is decay in it, the patient is sent for a CT scan. You can also additionally detect lymphocytosis and relative neutropenia in the blood, and a slight increase in ESR. Other research methods are not very informative.

For reference. Fluorography has important to detect lesions, but only as a screening method. It can be used to suspect the presence of tuberculosis in persons who do not have symptoms. However, the diagnosis must be confirmed using radiography. A change in the reaction to the Mantoux test in focal tuberculosis is not typical due to the low content of bacteria in the body.

Treatment of focal pulmonary tuberculosis and prognosis

Treatment of focal tuberculosis is carried out in the same way as any other form. The patient is hospitalized or isolated at home. He is prescribed antibiotics according to a special regimen.

Isoniazid and rifampicin are used first, then pyrazinamide, ethambutol and other drugs can be added.

Attention. It is important to determine the sensitivity of mycobacteria isolated from a patient to antibiotics. This allows you to develop individual treatment regimens. As a rule, such therapy lasts 2-3 months. With timely treatment, the prognosis is favorable.

If a patient has fibrous focal tuberculosis, it is much more difficult to treat. The antibiotic almost does not penetrate into the lesion delimited by connective tissue. It is recommended for such patients surgical treatment with removal of the lesion and connective tissue around it. In this case, the prognosis is doubtful.

For reference. The outcome of focal lung damage is a metatuberculous focus. This is the place where there was once caseous necrosis, and now instead of the dead lung tissue, connective tissue has grown. A metatuberculosis focus, as a residual phenomenon of tuberculosis, with its small size, does not have any clinic.

Tuberculosis has several forms, each of which has its own characteristics and course. One of them is focal pulmonary tuberculosis. It is often detected during a routine fluorographic examination. The main difference is that the pathological process does not affect the entire organ.

The disease is a secondary form of tuberculosis and develops against the background of existing foci pathological process, which were previously treated. The disease, especially in the first stages, can be asymptomatic. Which makes diagnosis difficult. As a result, the inflammatory process spreads to large areas of the lung and is most often localized in the upper lobes of the lungs.

Pathology is detected most often during a fluorographic examination for preventive purposes, during a routine examination or as part of a medical examination. Today, there are two forms of pathology of focal tuberculosis. During healing, the focus of the pathological process is overgrown with fibrous tissue.

Classification

Focal pulmonary tuberculosis in medicine is divided into two forms depending on the nature of the course:

1. Fibrous-focal. It is distinguished by the presence of dense foci and the appearance of scars on the surface of the organ. In this case, the inflammatory process is insignificant or completely absent. Lung tissues become quite hard when calcifications are deposited.
2. Fresh soft-focal. This form is characterized by the formation of cavities. In cases where treatment was started at early stages, it is possible to completely stop the inflammation. The formation of areas with small compactions is also observed.

The form of the disease is determined based on the indicators of diagnostic measures. The further prognosis also depends on the type of pathology.

Reasons

Focal pulmonary tuberculosis in rare cases is primary disease. This form begins to develop in the presence of anti-tuberculosis immunity, after a person has already suffered an infection.

The cause of the development of the focal form may be the activation of a healed focus of the pathological process during secondary infection. This occurs with reduced immunity, which is influenced by the following factors:

1. Chronic pathologies of severe form. These include diabetes, stomach ulcers, and chronic pneumonia.
2. Regular use in large quantities alcoholic drinks.
3. Drug addiction.
4. Smoking.
5. Wrong lifestyle when a person eats foods instant cooking, fast food, there is no physical activity in his life.
6. Constant stress, neuroses, prolonged depression.

Many patients are interested in whether focal pulmonary tuberculosis is contagious or not. The answer is positive; re-development of the disease is also observed when long stay with an infected person.

Clinical picture

In the early stages of development, focal pulmonary tuberculosis can be asymptomatic. There are also periods of exacerbation, when signs of the disease appear with greater intensity, but cannot always be expressed clearly enough. Among the main symptoms of the pathology are:

1. A slight increase in body temperature, which is observed for 10-12 days.
2. Dry cough. But in some cases, a small amount of sputum is produced.
3. Weakness.
4. Increased sweating. Often observed at night.
5. Tachycardia.
6. The appearance of blood clots in the sputum. The symptom appears on late stages development when lung tissue disintegrates under the influence of a pathological process.

At the end of the acute phase, clinical manifestations become less pronounced. But symptoms of body intoxication may continue for several days. Patients complain about fatigue, decreased performance and constant fatigue.

Diagnostics

Focal pulmonary tuberculosis is most often diagnosed during routine fluorographic studies. To establish the nature of the pathology, severity and other features, following methods diagnostics:

1. X-ray examination. The image clearly shows focal shadows. They have vague boundaries, and at the stage of tissue decay, the presence of areas of clearing is noted. In this case, a tuberculosis focus should be differentiated from pneumonia and lung cancer.
2. Sputum examination. Laboratory research carried out to identify microbacteria. The analysis is performed three times.
3. Functional study of the respiratory system and blood vessels. During the diagnosis, no respiratory dysfunction was observed. In some cases, changes in blood pressure and tachycardia are observed.
4. Mantoux test.
5. Bronchoscopy. This method diagnostics are prescribed quite rarely.

Diagnosis of focal tuberculosis in certain cases is possible by clinical manifestations, since the focal form is most often asymptomatic. That is why you should undergo regular preventive examinations.

Treatment

In case of lesions of the right or left lung, if a focal form of tuberculosis is established, a comprehensive diagnosis is required. To relieve symptoms and slow the spread of the pathological process, the following groups of medications are prescribed:

1. Antibacterial. In the first two months, a combination of Pyrazinamide, Isoniazid, Ethambutol and Rifampicin is used. After this period of display, take Rifampicin and Isoniazid. The course of therapy is 4 months.
2. Immunomodulatory.
3. Hepatoprotectors. Necessary to protect liver tissue, since anti-tuberculosis drugs are quite toxic and can harm the organ.
4. Glucocorticoids. They are used in the focal form in exceptional cases, as they negatively affect the immune system. Prescribed for severe inflammatory processes. The course of therapy is short and is determined by the doctor depending on the intensity of the symptoms.
5. Vitamin complexes. When a patient is prescribed chemotherapy when focal tuberculosis is diagnosed, the use of vitamin complexes. This helps reduce the risk of side effects.

Patients with focal forms of pulmonary tuberculosis should also follow a special diet. First of all, you need to include dairy products in your diet, as they are rich in protein. Useful and fresh vegetables and fruits.

Forecast

When a diagnosis of focal tuberculosis is made, many patients are interested in further prognosis. Most often it is possible to stop the spread of the pathological process. After therapy, the lesions resolve, and tissue changes remain insignificant.

An unfavorable prognosis is established in cases where treatment was started in the later stages of the disease.

Focal pulmonary tuberculosis most often develops against the background of a previous illness, when the infection re-enters the body. The pathology is usually established during routine examinations, since at the initial stages it does not show symptoms. To prevent the re-development of tuberculosis, you should follow the rules of prevention and undergo regular examinations. In certain cases, when the disease is in advanced stages, the prognosis is poor and tuberculosis can develop into a chronic form.