Primary Tuberculosis: Causes, Symptoms, and Diagnostic Methods

Primary Tuberculosis: Causes, Symptoms, and Diagnostic Methods

Question. Write short note on primary tuberculosis and its investigations.

Answer. Primary tuberculosis is the fist lesion that develops in a previously unexposed non­sensitized individual irrespective of the age.

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Pathology

1. Reinfection of a sensitized person or reactivation of a primary dormant lesion is called secondary or postprimary tuberculosis.
2. The initial lesion after ingestion of tubercle bacilli which mainly occurs in the lungs constitutes primary tuberculosis.
3. It commonly involves children and is in the form of subpleural lesion either in the lower part of upper lobe or upper part of lower lobe.
4. The initial entry of the bacilli initiates non­specific inflammatory response which hardly produces any symptoms. Bacilli are transported to regional lymph nodes and parenchymal lesion in the lungs (Ghon Focus) along with enlarged lymph nodes which may calcify over a period of time and this constitutes primary complex (Ghon’s complex).
5. A case of primary tuberculosis draws attntion when a child may present with a nonspecifi pneumonia or bronchial obstruction because of enlarged hilar gland or low-grade fever with pleural effsion.
6. Primary complex heals leaving a calcifid lesion.
7. Bacilli may remain for years and may become reactivated when body’s immunity falls as in malnutrition, debilitating disease and following severe form of measles, whooping cough.

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Clinical Features primary tuberculosis

As tuberculosis remains symptom­free and is diagnosed on routine radiography.

Symptoms primary tuberculosis

1. Evening rise of temperature
2. Night sweats
3. Malaise and cachexia
4. Irritability and diffilty in concentration.
5. Cough and expectoration for more than three weeks.
6. Pleuritic chest pain
7. Breathlessness is the feature of advanced disease.
8. Indigestion and dyspnea
9. Amenorrhea often in young women
10. Hoarseness of voice.
11. Sputum can be mucoid, purulent or blood stained.
12. Hemoptysis is a classical feature
13. Presence of localized wheeze from local ulcer or narrowing of major bronchus.
14. Presence of recurrent cold.

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Physical signs primary tuberculosis

1. Fever and weight loss
2. Tachycardia and tachypnea
3. Rapid pulse rate
4. Physical signs of collapse, consolidation, cavitation, firosis, bronchiectasis, pleural effsion or pneumothorax.
5. In some cases, only localized *rhonchi or rales are present.
6. Clubbing of figers is present in chronic disease.
7. Most common physical sign of chest is fie crepitation in the upper part of one or both the lungs. This is heard on taking a deep breath after coughing.
8. Later on, there can be presence of dullness to percussion or bronchial breathing in upper part of one or both the lungs.
9. In chronic cases there is evidence of volume loss and mediastinal shift.
10. Hilar, mediastinal and cervical groups lymph nodes are enlarged with splenomegaly.

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Investigations primary tuberculosis

1. Sputum examination (for acid fast bacilli): By direct smear
   examination (Ziehl­Neelsen stain). At least, three smears must be examined before fially reaching a conclusion.
   When direct smear is negative, sputum examination be done by concentration method using 24 hours collection of sputum. Further confimation is done by sputum culture by animal inoculation which takes 4–8 weeks. If adequate amount of sputum is not available, bronchoscopic
   aspiration of secretions be made and submittd for smear and culture examination.
2. Serology: In this ELISA, technique is used which helpful in diagnosis of tuberculosis in children. PCR technique is more specifi and sensitive serological test than ELISA,but PCR is less used due to its high cost.
3. Chest X-ray: Presence of multiple nodular infitrations or ill-defied opacities in one of upper lobes is characteristic for pulmonary tuberculosis. An area of translucency in radiopacities is indicative of cavitation. Presence of cavity is indicative of an active lesion. In some of the patients multiple thick­walled cavities can be seen. At the time of firosis, trachea and mediastinum shift to same side.
   Fibrosis can also cause calcifiation
4. Pathological tests:

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1. Blood examination: Peripheral blood examination shows monocytosis, i.e. 8 to 12%
2. ESR is elevated.
3. Tuberculin test: It is a test to recognize prior tubercular infection, and is done by injecting one unit of purifid protein derivative (PPD) on the forearm and readings taken after 48 hours. Induration of more than l5 mm indicates a positive test. The younger is the patient, greater is signifiance of positive test. A negative test does not always exclude tubercular infection since it may be negative in patients of blood malignancies,malnourishment and those on immunosuppressive therapy. Tuberculin test is non­specific and only indicates prior infection. Its sensitivity wanes with age.