Tuberculosis of intestines, peritoneum, mesenteric lymph nodes

Description:

According to localization allocate tuberculosis of intestines, a peritoneum and mesenteric lymph nodes. Such division is conditional as at tuberculosis of an abdominal cavity all groups of lymph nodes at the same time are surprised. At the same time symptoms of a disease can be specific, connected with preferential localization of process.

Symptoms of Tuberculosis of intestines, peritoneum, mesenteric lymph nodes:

Distinguish 3 forms of tuberculosis of intestines:
1) primary;
2) secondary;
3) hyperplastic iliocecal tuberculosis.

The clinical picture of primary and secondary forms differs a little.

Primary tuberculosis of intestines.
The tuberculosis infection can get into intestines in three ways:
1) through milk of tubercular cows which was given to the child without preliminary boiling;
2) through foodstuff or liquids, the ware infected with MBTI other, belonging to the bacillar patients who is not observing personal hygiene;
3) hematogenous dissimination of MBT from primary focus in lungs, in lymph nodes is possible.

Primary tubercular focus can be in a lymph node of intestines or a mesentery. In process of development of a disease nodes increase, become soft, and their contents can get into an abdominal cavity. As a result free liquid (ascites) collects and there is abdominal distention. In other cases nodes do not collapse, and merge, causing adhesion of loops of intestines.

Secondary tuberculosis of intestines.
Secondary forms of abdominal tuberculosis arise when MBT get into intestines by means of swallowing saliva and a phlegm by patients at damage of lungs. MBT infect an intestines wall, preferential ileal gut, and cause ulcerations and fistulas. The infection can extend in an abdominal cavity and to become the ascites reason.

Peritoneum tuberculosis.
This disease arises at hematogenous dissimination, is more rare as a complication of local forms of lymphadenitis, tuberculosis of other abdominal organs and a basin. In an initial stage grumous rashes on a peritoneum are formed.

Clinical symptoms in an initial stage are not expressed, intoxication is absent. Further at emergence of exudate symptoms of intoxication, dyspepsia are found, body weight decreases.

At an adhesive (adhesive) form usually there are intoxication phenomena, dyspepsia, develops partial intestinal obstruction.

The knotty and tumoral form proceeds with the expressed intoxication, formation of conglomerates in an abdominal cavity from the soldered loops of guts, an epiploon, the sacculated exudate with symptoms of partial intestinal obstruction.
Tuberculosis of mesenteric lymph nodes

Tuberculosis of mesenteric lymph nodes in an infiltrative phase is characterized by inflammatory infiltration in mezenterialny lymph nodes without the expressed perifocal phenomena and symptoms of intoxication; in a caseous and necrotic phase a hyperadenosis, perifocal reaction, involvement in process of a peritoneum.

General clinical symptoms of tuberculosis of intestines, peritoneum of mesenteric lymph nodes, etc.:
1. Intoxication: loss of appetite, body weight, fever, night sweats; diarrhea; lack of periods.
2. Abdominal pain (often uncertain).
3. Existence of educations in an abdominal cavity (at a palpation often having a soft consistence).
4. Ascites in an abdominal cavity. Sometimes so it is a lot of liquid,
that there is no opportunity to probe pathological educations in an abdominal cavity.
5. Attacks of intestinal impassability in combination with an acute pain and stretching of a stomach.
6. Cough and a phlegm if abdominal tuberculosis is caused by swallowing the infected phlegm or saliva at a secondary form of a pulmonary tuberculosis.

At hyperplastic ileocecal tuberculosis there are complaints to pain, at the same time it is possible to probe education in the right lower part of a stomach. Such symptoms can be taken for intestines cancer.

Reasons of Tuberculosis of intestines, peritoneum, mesenteric lymph nodes:

Mycobacteria of tuberculosis (MBT) - optional intracellular parasites.

Mycobacteria of tuberculosis (MBT) concern to family of bacteria Micobacteriacae, Actinomycetalis order, the sort Mycobacterium. The sort Mycobacterium contains over 100 types, the majority of which are saprophytic microorganisms, eurysynusic in the environment.

Etymologically the word "mycobacterium" comes from the Greek words of myces - a mushroom and bacterium, bactron - a stick, a twig. The component of the name "mushroom" is caused by a tendency of these microorganisms to form the filamentous and branching forms similar to a mold.

From positions of clinical medicine the tuberculosis mycobacterium opened by the German scientist Robert Koch is the most important species of actinomycetes who are united in the complex including M. of tuberculosis (MBT); M of bovis and its option of BTsZh (Kalmetta-Geren's bacillus); M of africanum and M. of microti. This group of a mycobacterium differs in the expressed genetic similarity.

The m of microti is considered not pathogenic for the person, however causes the disease at mice reminding tuberculosis. The culture of BTsZh is not pathogenic for the person. The mycobacterium of tuberculosis (MBT) is to 95% of cases a cause of illness tuberculosis of the person depending on the territory of accommodation. At the same time M. of bovis and M. africanum cause a disease in the person, clinically not different from classical tuberculosis.

The mycobacteria which are not entering the Tuberculosis complex M. can become the reason of mikobakterioz. Such mycobacteria combine in complexes, the most important of which are: M of avium, M. fortinatum and M. of terrae, M. leprae, M. ulcerance.

The materials about tuberculosis presented further are related only to the disease caused by M. tuberculosis (MBT) - the Koch's bacterium (KB), typus humanus.

Natural tank of a tubercular mycobacterium - the person, house and wildings, birds.

MBT externally represent the thin curved sticks resistant to acids, alkalis and drying. The outside cover of a bacterium contains difficult wax and glycolipids.

MBT can breed both in macrophages, and out of cells.

MBT breed rather slowly. Reproduction happens generally by simple cellular division. On the enriched MBT nutrient mediums breed with the period of doubling from 18 to 24 h. Growth in culture of a mycobacterium of tuberculosis, received in clinical conditions, requires from 4 to 6 weeks.

The genetic structure of MBT is established. It is possible to get acquainted with the nucleotide sequence of MBT in the international data banks. The nucleotide sequence of MBT (H37Rv strain) contains 4,411,529 b.p.

Do not possess the independent movement MBT. Temperature borders of growth are between 29 and 42 °C (optimum - 37-38 °C). MBT have resistance to physical and chemical agents; they keep viability at very low temperatures, and can maintain increase to 80 °C within 5 min.

In external environment the mycobacterium of tuberculosis is rather steady. In water it can remain up to 150 days. The dried mycobacteria cause tuberculosis in Guinea pigs in 1-1,5 lyophilized and frozen are viable up to 30 years.

At intensive radiation by the sun and at high temperature of the environment viability of MBT sharply decreases; on the contrary, in the dark and dampness their survival is very considerable. Out of a live organism they remain viable within many months, in particular in dark, crude rooms.

MBT come to light by means of the unique property to coloring (acid resistance) distinguishing them from many other contagiums. Ziehl and Neelsen in 1883 developed the special contrast method of coloring of MBT based on property of acid resistance. Unlike not acid resisting bacteria, tubercular mycobacteria are painted in red color, do not become colourless at effect of acid solution and are well visible on a blue background at microscopy. Tsilya-Nielsen's way still is one of the main methods of coloring of MBT at microscopy. Than a kisloustoychivy method of coloring, coloring by MBT auramine with the subsequent fluorescent microscopy is more sensitive.

Connect acids, alkalis and alcohols resistance of causative agents of tuberculosis with lipid fraction of an external cover of MBT.

Variability of morphology of MBT. The morphology and the MBT sizes are not constant, it depends on age of cells and especially on living conditions and composition of nutrient medium.

Cord factor. Lipids of a superficial wall of a mycobacterium define its virulence and ability to education in culture of accumulations of bacteria in the form of braids (cord factor).

About a cord factor it was told still by Koch in his initial message concerning MBT. Originally the cord factor was connected with virulence of MBT. Ability to create braids is observed among others a mycobacterium, having low virulence or not having it at all. The cord factor as it was established later, is connected with the unusual biological substance trehalose 6,6-dimyco-late which has high virulence.

L-forms. One of important types of variability of MBT is formation of L-forms. L-forms are characterized by a reduced metabolic rate, the weakened virulence. Remaining viable, they can be a long time in an organism and induce antitubercular immunity.

L-forms differ in the expressed functional and morphological changes. It is revealed that transformation of MBT in L-forms amplifies at long influence of antibacterial therapy and other factors which break their growth and reproduction, formation of a cellular membrane.

It is established that in a phlegm of "abacillary" patients with destructive forms of tuberculosis there can be MBT L-forms capable at the corresponding conditions to reverse (to be modified) in rhabdoid option, causing thereby reactivation of tubercular process. Therefore, the abatsillirovaniye of cavities of such patients does not mean their sterilization concerning MBT yet.

MBT by the nature are insensitive to many antibiotics. This property first of all is connected with the fact that the high-hydrophobic cellular surface serves as some kind of physical barrier to therapeutic agents and antibiotics. The main reason of stability is coded in structure of a genome of a tubercular stick.

At the same time MBT can develop antitubercular drugs resistance (resistance). Simultaneous medicinal several drugs resistance of MBT considerably reduces in recent years efficiency of treatment of tuberculosis.

As a result the modern health care deals not just with the dangerous causative agent of tuberculosis, and with the whole set of its strains steady against different drugs. In practice for the organization of effective treatment of tuberculosis important not only to find MBT, but also in parallel to define their resistance, and quickly enough - within two-three days in time to appoint effective chemotherapy.

In the late eighties of the last century there was a method considerably reducing time of such analysis. New diagnosis is based on selective amplification of nucleic acids (DNA or RNA) by in vitro by means of the polymerase chain reaction (PCR).

The PTsR method has great opportunities and is the cornerstone of exact DNA diagnosis which allows to identify any strain of MBT and to define the prime cause of this or that resistance to drugs.

Laboratory researches showed that emergence of resistance at M. is connected by tuberculosis with nucleotide replacements (mutations) in the genes coding various enzymes which directly interact with medicines.

Resistance of some strains of MBT to an isoniazid is connected with the mutations in katG gene leading to replacement of some amino acids in enzymes - a catalase and peroxidase.

Nonsensitivity of MBT to streptomycin is connected with a missens-mutation in rpsL gene coding S12 mitochondrial protein or with nucleotide replacements in rrs gene coding 16S of RNA.

Infection source. The main source of MBT is the suffering from tuberculosis person, the extending MBT (batsillovydelitel).

The center of a tuberculosis infection becomes dangerous when patients suffer from an open form of tuberculosis, i.e. allocate tubercular mycobacteria. Special value at infection with tuberculosis has direct, long and close contact of the healthy person with a batsillovydelitel. Infection can occur most often in a family, in the place of residence or in collective in which there is a TB patient allocating mycobacteria. Danger of dispersion of the infectious beginning is eliminated if the batsillovydelitel is timely revealed and isolated.

Emergence and the course of an infection depend not only on virulence of the activator, but also a condition of stability and reactivity of a macroorganism.

The great value takes place of penetration of MBT into an organism where primary contact with a microbe (entrance infection atriums) is started. Distinguish the next ways of transfer of tuberculosis:
1) airborne;
2) alimentary (through a digestive tract);
3) contact;
4) transplacental infection tuberculosis.

Airborne way of infection with tuberculosis
Tubercular mycobacteria get to air with droplets at cough, a conversation and sneezing of the patient with active tuberculosis. At inhalation these infected droplets get into lungs of the healthy person. This way of infection received the name of droplet infection.

Depending on force of tussive impulses and the sizes of droplets of MW extend in air to various distances: at cough - to 2 m, when sneezing - to 9 m. On average particles of a phlegm dissipate on distance of 1 m directly before the patient.

The droplets of a tubercular phlegm which settled on a floor dry and turn into motes. The tubercular mycobacteria which were in them some time remain viable in dust. It is established what by 18th day in the dried-up phlegm remains to 1% of live bacteria. At the strong movement of air, sweeping of a floor, movement of people of a mote, the containing tubercular mycobacteria, rise in air, get into lungs and cause infection.

Alimentary way of infection in digestive ways
Special experiments on animals show what at an alimentary way is required is considerable bigger quantity of a mycobacterium, than at aerogenic infection. If at inhalation it is enough of one or two mycobacteria, then for infection through food hundreds of microbes are required.

Ways of distribution tubercular defiantly show to a mycobacterium in a human body at alimentary infection with tubercular culture the section materials published in connection with trial in Lubeck. By mistake of 252 babies at vaccination of per os the tubercular culture (the Kiel strain) instead of BTsZh was entered. Owing to infection died of tuberculosis of 68 children, 131 children got sick and 53 remained healthy.

When opening corpses of 20 died children it was established that in most cases process was localized in abdominal organs.

Digestive organs were entrance infection atriums.

One of features of this way of infection at small children is frequent defeat by tuberculosis of mezenterialny lymph nodes.

It must be kept in mind that penetration tubercular mycobacteria in intestines can happen also when swallowing by patients with pulmonary tuberculosis own bacillar phlegm that is confirmed when using a method of flotation of washing waters of a stomach.

Contact way of transfer of tuberculosis
Infection cases through a conjunctiva of an eye of small children and adults are described; at the same time acute conjunctivitis and an inflammation of the lacrimal sack sometimes is found.

Infection with tuberculosis through skin meets seldom. Cases of diseases of tuberculosis of milkmaids at penetration of MBT through the injured skin of hands from suffering from tuberculosis cows are described.

Transplacental infection tuberculosis
The possibility of infection with tuberculosis of a fruit in the period of an antenatal life is established on section by tuberculosis cases at the children who died in the first days after the birth. Infection occurs or at defeat by placenta tuberculosis, or at infection of the damaged placenta at the time of delivery with tubercular mother. Such way of infection with tuberculosis meets extremely seldom.

Immunity
Morphological and biochemical components of a microbic cell cause various reactions in an organism.

The MBT main biochemical components are proteins, carbohydrates, lipids.
Proteins (tuberkuloproteid) are the main carriers of the MBT antigenic properties.

Tuberculine - one of tuberkuloproteid which is widely used in practice for identification of infection of MBT.

Hypersensitivity of the slowed-down type (GChZT)
The substances which are a part of an external cover of MBT induce specific fabric inflammatory reaction of a macroorganism and formation of a granuloma. At the same time there is a hypersensitivity of the slowed-down type (GChZT) defined on reactions to tuberkulinovy tests, and weak antibodyformation.
In the main GChZT it is used for the characteristic of an immune response of the IV type (existence of the induration which developed in 48 h on the site of intradermal administration of tuberculine) at the individuals infected with MBT. At the same time GChZT connect with an immune response on the factors damaging fabrics.

Communication between an immune response and a pathogeny
Local and generalized tubercular damages to an organism are defined by defense reactions which are made by immune system of an organism against MBT. At the description of this most difficult process we will be limited to simple transfer of the events which are taking place from the moment of primary penetration of MBT into alveoluses to results of natural fight between a macroorganism and MBT. This process defines destiny, at least, of a third of world's population which is infected with tuberculosis mycobacteria.

The tuberculosis development cycle from infection of an organism with mycobacteria of tuberculosis before clinical displays of a disease and distribution of MBT in the environment can be divided into 5 stages conditionally.

Stages.
1. Spread of an infection (infection).
2. The beginning of an infection, proliferation and dissimination in the infected organism.
3. Development of an immune response of an organism.
4. Kazeation (development of a caseous necrosis) and the accelerated reproduction of MBT.
5. Secondary spread of an infection (ability to infect, infect).

Treatment of Tuberculosis of intestines, peritoneum, mesenteric lymph nodes:

The chemotherapy is rather effective, even big specific damages of intestines recover. After treatment there can be commissures between loops of intestines or hems. These educations can sometimes be an origin of the mechanical intestinal impassability demanding an operative measure. If in an abdominal cavity there is a large amount of liquid, it needs to be deleted.