Tuberculous pleurisy: symptoms and treatment


The disease, which is characterized by the emergence of acute, chronic and recurrent inflammation of the pleura, is called tuberculous pleurisy. This disease has a feature to manifestation through infection of the body with viruses of tuberculosis. Often pleurisy occurs if a person has a tendency to pulmonary tuberculosis.

Tuberculous pleurisy affects the serous membranes that form the cavity of the pleura and cover the lungs. The main sign of the disease is increased secretion of fluid or prolapse to the surface of the pleura of fibrin. A serious disease, which has been fighting for many millennia, but relapses occur even in these days. Tuberculosis malaise is caused not only by the possibility of rapid spread among people, but also leads to an increase in mortality, if the appropriate treatment methods are not applied, which this article will detail.

This kind of disease affects both the male body and the female. But nevertheless it was revealed that most often tubercular pleurisy occurs precisely in childhood. The disease occurs both in the form of a separate ailment, and in a complicated form. The complicated form is characterized by the activity of the spread of the tuberculosis bacterium through the body, which causes the disturbance of other organs of the person.

Pathogens

The causative agents of tuberculous pleurisy are viral mycobacteria, which in medicine are referred to as Mycobakterium . Scientists distinguish 74 varieties of this bacterium, which are widespread in water bodies, soil, among animals and directly occurs in humans. But the tuberculosis itself arises on the basis of a conditionally evolving complex called M.tuberculosis . In simple terms, it is a tubercle bacillus, which is characterized by spreading through a pathogenic way, that is, through the blood and by airborne droplets. This pathogen is resistant to the environment, withstands high temperatures and is capable of surviving during the cold season. The fight against the pathogen should be carried out in a complex manner, which causes a positive effect.

Classification and views

Depending on the pattern of the course of the disease and the features of pathogenesis, there are three types of tuberculous pleurisy:


  • Allergic
  • Tuberculosis of the pleura;
  • Perifocal.

Allergic pleurisy manifests itself against a background of hyperergic sensitivity. The main feature of this species is the nature of the course of the disease, which is caused by acuity of pain and rapid accumulation of exudate. Also a feature of the allergic appearance of pleurisy is a relatively fast reverse dynamics, which is characterized by the resorption of the formed exudate.

Tuberculosis of the pleura is manifested in the case of dissemination of many small and large foci. Often the disease is characterized by a vast caseous-necrotic reaction. Infection occurs by means of the hematogenous path or by the penetration of caseous foci directly into the cavity of the pleura. This type of tuberculous pleurisy is most aggravating.

Perifocal appearance occurs if the inflammation spreads to the pleura from the pulmonary focus, infiltrate, or with the primary subpleural effect. In this exudate in the pleural cavity can accumulate: from the minimum to the maximum number. In exudate, bacteria are found infrequently, and the nature of the flow is long and recurrent.

In addition, tubercular pleurisy is classified by the nature of the pleural composition. Classification types are named:


  1. Fibrinous or dry;
  2. Exudative;
  3. Purulent.

Fibrinous appearance is characterized by the course of the inflammatory process in certain areas of the pleura, where the filaments of fibrin are deposited. As a result of pathological influence, the pleural smoothness is lost. This species is characterized by a favorable cure if timely measures are taken.

Exudative pleurisy refers to the forms of pleurisy of tuberculosis etiology. This species has the opposite form of manifestation with the previous fibrinous pleurisy. In the course of inflammation, an active release of fluid from the pleura begins (this fluid is called exudate), which accumulates in the pleural cavity. Often has a subacute or complex picture of symptoms. Often it happens that initially a dry appearance appears, which with localization smoothly flows into the exudative.

Purulent pleurisy is due to the most complex nature of the predominance. At its base lies the process of affecting the pleura, which is triggered when a dose of MBT hits it or when a subpleural foci or cavern rushes.

Tuberculosis etiology is divided into three types, which are called:


  • infectious , which is characterized by the provocation of the disease by getting into the lungs of bacteria: staphylococcus, pneumococcus, streptococcus and tubercle bacillus
  • non-communicable , which arise through other types of diseases, such as lung cancer, rheumatism, etc.
  • idiopathic , that is, those that manifest themselves for unknown reasons.

Depending on the course of the disease, pleurisy is divided into acute, subacute and chronic. Each species has its own characteristic symptoms and duration of leakage, but these signs will be considered below. Initially, it is necessary to find out the reasons why a person has tuberculous pleurisy.

Causes of development of the disease

Tuberculous pleurisy refers to a number of pathological diseases that occur primarily on the basis of infection or lung failure. As already mentioned above, the etiology of pleurisy is divided into three types, which have corresponding causes, causing infection of the body.

The causes of infection are in the following types of pathogens:


  1. Bacterial infections (staphylococcus, gram-negative flora, etc.)
  2. Viruses and parasitic organisms : amoebiasis and echinococcosis, as well as mycoplasmal infections
  3. Tuberculosis infection , which has a predominantly wand shape. There are two types of tubercle bacilli: human and bovine. They differ in the shape and size of the pathogen, as well as in the dynamics of the disease;
  4. Fungal parasites : candidiasis, blastomycosis
  5. Syphilis, typhoid, brucellosis.

All these infections lead to the development of such ailment, as pleurisy, in particular, tuberculosis.

Non-infectious causes lie in the following:


  • when forming malignant tumors in the lungs, mammary glands, ovaries, etc.
  • myocardial infarction
  • leukemia, pancreatitis, and the like

There are also a number of unknown causes that provoke the development of tuberculous pleurisy. These include injuries of various kinds, gunshot wounds or surgical interventions that led to infection of the body. These causes are diagnosed in the hospital after excluding all the above factors.

The causative agent penetrates into the human body and reaches the pleural cavity into which it enters in various ways. These ways are:


  1. contact
  2. Lymphogenous
  3. hematogenous.

Depending on the formation of the pleural composition, the causative agent of tuberculous pleurisy causes the appearance of symptoms of the disease.

Symptomatic of the disease

As mentioned above, there are three types of tuberculous pleurisy, which have corresponding symptoms.

Dry tuberculous pleurisy both in children and adolescents, and in adults, is a manifestation of active lymphohematogenous spread of infection. Symptoms of this kind are characterized by the formation of soreness in the chest, increased subfebrile or febrile body temperature, as well as general complaints of the patient. A person inherent in the process of localization of the disease occurrence of general weakness, malaise and intoxication of the body. The appetite decreases or disappears altogether, which leads to an active decrease in weight.

It is not always possible to identify the disease by the first signs, since the signs of lung and lymph node involvement do not reflect the complete picture of the disorder of the organism. And therefore, before the onset of pain, the disease is almost impossible to recognize.





When inhaled, the pain sensations increase and become acute. Also, pain occurs when coughing, sneezing, various movements of the body. Symptoms of pain appear mainly in the lower parts of the sternum and are capable of radiating to the upper part (neck, shoulder) and lower (abdominal cavity). Severe pain contributes to the fact that a man grasps the stomach and can not continue further movement. Rarely pain can contribute to a patient’s loss of consciousness.

For information! Symptoms of dry pleurisy are very similar to those of neuralgia, so it is important to distinguish them at the first manifestations. With dry pleurisy, the patient assumes a position — lying on his side, and on the side where painful sensations appear. If the patient tries to accept the situation — lying on the other side and his pain symptoms will be amplified at the same time, this indicates the presence of tuberculous pleurisy. Symptoms of intercostal neuralgia appear in the reverse order.

From the side of pain localization when listening to a stethoscope, characteristic noises of friction of the pleura are observed. With the development of the disease, the adhesions and the infection of the rib-diaphragmatic sinus are formed. Often to determine the dry form of pleurisy by blood is almost impossible, because there are no significant changes in it. Occasionally, a slight increase in ESR can be observed.

Exudative appearance is characterized, first of all, by the location of the virus infection. When the respiratory tract is injured, there is an effusion of a free character. Symptoms are caused by the onset of dyspnea and an increase in body temperature. There is a cough, chest pain and dry mouth. Most often, the symptoms of the disease become acute and severe in nature, but sometimes children and adolescents have a picture of asymptomatic pleurisy. It can be detected during upper respiratory tract examinations.

With exudative pleurisy, pain occurs in the chest area directly from the side where the pathogen is located. The patient has a body temperature up to 38-39 degrees, there is weakness, malaise and slight signs of coughing, which eventually increase. When fluid or exudate accumulates in the pleural cavity, the symptoms of pain can disappear, leaving only the heaviness in the side. The amount of exudate can reach 2 liters or more.

When accumulating the patient’s exudates, headaches can sometimes be troubling, which sometimes lead to dizziness. In children, the symptoms of an ailment are manifested in the form of shortness of breath, rapid breathing, changes in the color of the skin of the body and face. Children become listless, frightened, pale and take a position — lying on a sore side. There is nausea, which goes into vomiting, and when swallowing pains arise.

Symptoms of purulent tuberculous pleurisy have almost no pronounced signs. Purulent form of the disease occurs if the first two methods have not found the appropriate type of treatment. This causes festering of the foci by means of a dose of MBT. With purulent pleurisy, the patient’s condition may remain unchanged, but such symptoms remain: shortness of breath, sore, high fever and weakness. Often, the condition can worsen until the patient is unable to get out of bed.

Symptoms of the subtypes of tuberculous pleurisy

Consider what symptoms are inherent in allergic, perifocal and tuberculosis of the pleura.

Perifocal is characterized by meager symptoms. Minor pain in the chest, slight weakness and the presence of noise when listening to the sternum. This species is characterized by the duration of the course with the appearance of relapses. Often there is an accumulation of exudate, which leads to the emergence of more severe symptoms:


  • body temperature increases;
  • sweats increase;
  • tachycardia occurs.

For allergic pleurisy is characterized by pronounced symptoms, which causes a temperature increase of 39 degrees. Exudate accumulates in a few days, there is tachycardia and shortness of breath in the side. Severity of inhalation and pain in the side. But these symptoms quickly disappear, just as they do. Allergic pleurisy is often formed from primary tuberculosis in case of infection or chronic symptoms.

Symptomatic of pleural tuberculosis is characterized by an increase in temperature to a critical level of 40 degrees, which requires immediate hospitalization of the patient. At night the patient wakes up because of the high sweating and disturbing painful sensations in the side. Also characteristic is the appearance of dry cough and increased dyspnoea. If the disease has a sharp sign of manifestation, then the following symptoms also arise:


  1. air insufficiency
  2. swelling of the cervical veins and lymph nodes
  3. cyanosis of the lips.

With the first symptoms noted, you should immediately call an ambulance or, if possible, ask your relatives to be taken to the clinic. Sits behind the wheel in a state of tuberculous pleurisy with severe symptoms is strictly prohibited.

Diagnostics

Diagnosis of tuberculous pleurisy has considerable difficulties. Thus, in order to correctly establish a diagnosis, it is not enough to know the symptoms, it is necessary to conduct clinical studies of the patient. Based on the data obtained, an experienced doctor will make an appropriate conclusion, diagnose and prescribe the necessary treatment. Diagnostics includes:


  • Collecting general information about the disease manifestation and asking the patient for complaints.
  • Conducting tuberculin samples, on the basis of which, a conclusion is drawn. The presence of tuberculosis on the test is displayed in the form of an increased number of samples.
  • X-ray tomographic examination of the patient. Through these studies, a picture appears that reflects the presence of changes in the lungs and intrathoracic lymph nodes.
  • A clinical blood test. Through the analysis, the composition of leukocytes in the blood is determined, and a moderate shift of the leukocyte formula to the left presupposes the presence of foreign bodies. Often, can be diagnosed with leukopenia, which subsequently goes to monocytosis. Particularly pronounced changes in blood in a purulent stage of pleurisy
  • Urine analysis. On the basis of this, the presence of protein is determined, if it is found, the diagnosis becomes obvious.
  • Bronchial examination — bronchoscopy. By means of a bronchoscope, it is possible to conduct a study on the basis of which it is possible to identify: bronchial tuberculosis, scars and signs of hyperplasia of VGLU.
  • Exercise of exudate. With tubercular pleurisy, exudate has a protein content of 30-40 g / l. At the same time, it reduces the amount of glucose in its composition.
  • Serological study. If high antibody titers are found in reactions such as RNGA and ELISA, the predominance of tuberculosis infection in the body will be noted. Antibodies are determined in both blood and exudate.
  • Tomography. A tomography of the thoracic cavity is performed, through which the etiology of pleurisy is revealed.

Based on the research, a conclusion is made and treatment is prescribed.

Treatment

If the diagnosis was made correctly, then it is necessary to proceed to the treatment process. First of all, therapeutic measures should be aimed at inhibiting the destruction of tissues.

For this, resort to the use of medications, such as:


  1. Rifampicin;
  2. Pyrazinamide
  3. Etambutol
  4. Streptomycin.

Treatment of the disease in the last stage of streptomycin is not allowed. The duration of drug treatment is from 8 to 10 months and not less. But if tuberculosis of the lungs is observed together with pleurisy, then the duration of treatment is doubled.

Effective drugs in the fight against viruses and bacteria of the causative agent of tuberculosis are corticosteroids. The most famous and effective of them is Prednisolone. In order for the lung to take a normal shape, it is necessary to pump out the liquid. If the liquid is not pumped out in a timely manner, then a layering can form.

Treatment of tuberculous pleurisy is carried out with the help of immunostimulating therapy, which includes the use of «Levamisol», «Tactinone» and similar drugs. If the above treatments fail to produce the desired results, then they resort to surgery.

Preventive measures

In order to be able to prevent the disease at an early stage of localization, it is necessary to carry out preventive maintenance. It includes, first of all, the passage of the annual lung fluorography. At the first sign, radiography is also assigned, which makes it possible to obtain a more accurate picture. Through these two simple and inexpensive tests, it is possible to detect tuberculous pleurisy at an early stage. Early signs of an ailment are easier to eliminate than treat a complex form of the disease.