Tuberculous pleurisy - Causes, symptoms and treatment. MF.

Tuberculous pleurisy is an inflammatory reaction of the pleura caused by mycobacteria of tuberculosis, penetrating into the body lymphogenous( through the lymph) or hematogenous( through the blood) way.

Causes of tuberous pleurisy

Often occurs in young people as a result of hypersensitivity. More often there is a combined pathology: tuberculosis of the pleura and lungs. The reason may be a decrease in immunity due to various diseases( cancer, diabetes, glucocorticoids, etc.), a predisposition to tuberculosis, close contact with a sick tuberculosis. The whole set of these causes can lead to the development of the tuberculous process in the pleura.

Symptoms of tuberous pleurisy

The clinical picture depends on many factors: the age and general condition of the patient, the degree of sensitivity to tuberculosis, the presence or absence of damage to other organs of tuberculosis, the nature of the changes in the pleura, the type of exudate, its quantity, the localization of pleurisy.

There are three main variants of tuberculous pleurisy: allergic, perifocal, pleura tuerculosis.

Allergic pleurisy is characterized by a sharp onset with an increase in temperature to 38 and above. There is a rapid accumulation of exudate, there is tachycardia, dyspnea, pain in the side. These phenomena quickly fade away, and then completely disappear. Allergic pleurisy occurs in patients with primary tuberculosis with fresh infection or chronic infection.

Perifocal pleurisy , as a rule, is the result of involvement in the inflammatory process of pleural sheets in the presence of pulmonary tuberculosis - focal, infiltrative or cavernous. Symptoms are meager. There are pains in the chest, the noise of friction of the pleura can be dried. The course is long, often there are relapses. It can flow with the accumulation of exudate, then the clinical picture becomes brighter( fever, sweating, tachycardia, etc.).

Pleural tuberculosis is characterized by the following features:

1) multiple dissemination with small foci,
2) single large foci with elements of caseous necrosis,
3) extensive caseous necrotic reaction.

It can be both an independent disease, and in combination with a tuberculous lesion of other organs. Has exudative nature of effusion.

Aside can develop purulent tuberculous pleurisy( empyema) .Body temperature reaches 40 degrees, worries night sweats, reduces body weight, can be a dry cough, pain in the side.

May leak and is erased, the patient is worried only by increasing shortness of breath.

Symptoms of acutely developing pleurisy: dry cough, feeling of lack of air, the patient lies on the sore side or sits, the face is puffy, the cervical veins are swollen, cyanosis of the lips.

Assays for suspicion of tuberous pleurisy

Allergic pleurisy in the general blood test shows: eosinophilia, acceleration of erythrocyte sedimentation rate. With purulent it is noted: lymphocytosis, neutrophil shift to the left, sedimentation rate of erythrocytes is sharply increased. All this is due to intoxication of the body.

Radiographically, there is a darkening of the pulmonary field in the lower parts, more often in the form of an oblique line. With interlobular pleurisy, there is a triangular shadow with indistinct contours. They also perform ultrasound of the pleural cavity, to clarify the presence of fluid and its amount, put a point for subsequent puncture.

Left-sided exudative pleurisy of

The most important diagnostic method is the investigation of pleural fluid. Its color will be straw-yellow, specific gravity 1012-1015, Rivalta's test is positive, the protein is increased, lymphocytes prevail in the sediment( with purulent neutrophils).The enzyme LDH is also examined, which will be increased both in the punctate and in the blood. Studies are conducted on mycobacterium tuberculosis( rarely found).

Great value now also has videotorakoscopy with puncture.

Tuberculosis tests in pleurisies are positive in 90% of cases.

Differential diagnosis is performed with pleurisy of another etiology: parapneumonic, tumor, associated with cardiac pathology, etc. If the above symptoms occur, especially in the acute stage, it is necessary to undergo inpatient treatment to improve the clinical and radiological picture, which will take about 2 weeks, and when establishing a tuberculosis etiology 2 months, with transition to outpatient treatment and control.

Treatment of tuberculous pleurisy

The establishment of tuberculous etiology of pleurisy is treated with standard antibiotic regimens. In addition, anti-inflammatory drugs( non-steroidal anti-inflammatory drugs, glucocorticoids), physiotherapy - electrophoresis with lidase, potassium iodine, exercise therapy, massage, etc. are used. Puncture of the pleura is performed to remove the exudate and injected into the cavity of the glucocorticoid. At the first stage, inpatient treatment is needed.

Treatment with folk remedies

The use of various herbal decoctions during treatment is best restricted, since it is necessary to consume less fluid due to pleural effusion. At the stage of treatment, before recovery, it is better to take only medicines as prescribed by the doctor.

Diet for tuberculous pleurisy

High-protein diet: meat, fish, dairy products, milk. The use of easily assimilated carbohydrates: bakery products, as well as porridge( semolina, rice, millet).No less important is the content of mineral acids, the physical need for them is covered by the consumption of vegetables and fruits. The norm of a liquid per day should not exceed 1 liter. A salt-free diet is prescribed.

Rehabilitation after a tuberculous pleural effusion

Rehabilitation is possible in TB sanatoriums about once a year( for 2 weeks), within two years after recovery.

Possible complications of tuberculous pleurisy

If untimely treatment, secondary infection occurs, empyema develops, then phlegmon of subcutaneous tissue and intercostal muscles may form. Eventually, a thoracic fistula is formed. Valvular pneumothorax may develop.

Forecast

With a timely treatment, the prognosis is favorable. Complications occur in 1% of cases.

Prophylaxis of tuberculous pleurisy

Avoid hypothermia, the annual passage of fluorography. If possible, exclude contact with a patient with tuberculosis.

Doctor phthisiatrist Kuleshova LA