The tuberculosis of lymph nodes is a disease that is not so much known. By virtue of the circumstances (insufficient awareness in the media, propaganda of the achievements of domestic medicine in the fight against tuberculosis, the ignorance of the importance of lymph nodes for the human body) the topic has little studied.

What is the lymphatic nodes

Perhaps many subjective idea of \u200b\u200bthe importance of this body. But it's really impossible to live without it. When the body for some reason is deprived of a certain organ, he tries to shift its functions to others. Of course, the replacement cannot be full, but the body system continues to work. What you can not say about lymphatic nodes.

Lymphatic nodes - a person's protection center from everywhere of banging microbes. Their goal is to develop lymphocytes propagating blood flow to the place of lesion. Human bodydevoid of protective cells turns out to be powerless and is doomed to death (for example, the well-known AIDS disease).

The human body is constantly in an environment overcrowded by invisible alien agents. One of the most common and dangerous pathogenic organisms is a tuberculosis wand. It is it that causes the tuberculosis of the lymphatic system.

Of the 700 lymph nodes located in the loose fiber, they are divided into groups depending on the location sites (cervical, inguinal, submandibular, axillary, intrathoracic, mesenteric and others). There are also single lymph nodes.

The value of lymphatic nodes is both in the development of immunity and in the removal of the products of the decay of cells, pathogenic flora, foreign languages. Lymph nodes are available in each body portion. Any regional (local) node provides defense from the introduction of microbes and prevents them from spreading throughout the body.

In a healthy body, lymph nodes are absolutely not noticeable, do not fit with palpation. Only the use of special diagnostic methods (radioisotope,) will allow them to be detected.

Dangerous symptoms

The first alarming signal should be an increase in lymph nodes, noticeable as a naked eye and with palpation. This symptom requires immediate conversion for help in medical institution. A common cause of an increase in lymph nodes is tuberculous lymphadenitis caused by tuberculosis infection (koche stick).

Tuberculosis mycobacterose is a culprit of the disease called tuberculosis of lymph nodes. Mycobacteria does not have the ability to self-reading. In the body they can move along with a fluid current. This characteristic is determining in the development of this disease.

Once in the body, mainly through the respiratory system, tuberculosis bacteria is filled with intercellular spaces. By choosing a favorable environment for habitat, they form a tuberculous focus. Further on the lymphatic vessels move to any regional lymph nodes. A weakened lymphatic system cannot create a sufficient barrier to prevent mycobacteria from entering blood. Thus, the tuberculous wand is distributed throughout the body, forming tuberculosis of peripheral lymph nodes.

The tuberculosis of the lymphatic system is the initial stage of the disease. With the defeat of the koch of the regional node, tuberculosis lymphadenitis occurs. Symptoms of the disease are expressed in the form of tuberculous formations. Merging, they form a granule that causes necrosis (death) at the localization site.

Stages of development of the disease

Depending on the period, the degree of infection, the general reactivity of the body allocate the following stages:

1. Proliferative (When cell reproduction occurs and, respectively, an increase in lymph nodes, but without their death).
2. Caseous (the presence of dead cells in the form of a curly mass).
3. Absucing (with the advent of abscesses containing purulent fluid).
4. Speshchee (the final stage characterized by a breakthrough of a fistula with pus is influenced).

The danger of this disease is that single inflammatory foci appear quite rarely. In the main group of nodes, with an increase, merge, which complicates the diagnosis of the disease and its treatment.

Often tuberculosis of lymph nodes is the only manifestation of the existing infection with a tuberculosis wand. For example, diseases such as tuberculosis of mesenteric lymph nodes or tuberculosis, peritoneum and mezentheral lymph nodes, more complex diagnostics.

The tuberculosis of intragenic lymph nodes is another common form of the disease. It is possible to detect it using an x-ray examination of the region chest. The pathogenesis of tuberculosis of intragenic lymph nodes diagnosed by the phthisiart will allow you to distinguish structural changes in lymph nodes.

The tuberculosis of intragenic lymph nodes in children is greater danger. Treatment of disease B. childhood Requires a responsible approach to the diagnosis and tactics of treatment in connection with the rapid growing organism, the immunity of which is only formed.

Differential diagnosis of tuberculosis of intragenuous lymph nodes allows the doctor during the survey to determine the true causes of the appearance of the ailment. The lesion of lymphatic nodes may be present without other clinical manifestations Foci of inflammation in the active stage or in a state of remission.

Tuberculosis is not confirmed in all cases. Its symptoms are often similar to a cancer tumor or in any inflammatory process in the body (surface or internal jets, inflamed almonds and other reasons). Metatuberculosis changes in intragenic lymph nodes require strict observation of a narrowly profile specialist against the background of a comprehensive examination.

Mycobacteria of tuberculosis, which fell into lymph nodes, are actively attacked by immunity protective cells. Bacteriological research conducted at the very beginning of its development may not reveal the pathogen, and tuberculous tubercles (as the main symptom of tuberculous lesion) have not yet been formed. This is the essence of differentiation. Only a comprehensive examination, taking into account all the available features and clinical manifestations, special complex techniques, will help determine the tactics of treatment.

Forms of diagnostics

In order to confirm the tuberculosis nature of the disease or its refutation, the following forms apply:

• (with histological and bacteriological examination of the material);
• the introduction of subcutaneously tuberculin to detect antibodies (the most common diagnostic method).

Perspectives of treatment

In the case of confirmation of the tuberculosis of lymph nodes, treatment tactics is based on several factors: the existing stage of the disease, the degree of infection, the overall resistance of the body.

Propagating lymphoid cells - lymphocytes and macrophages struggled to neutralize the introductions of the microbes. But this is not enough. Modern anti-tuberculosis preparations with bactericidal (bacteriostatic) properties come to the rescue.

The main preparations of treating this disease are considered: rifampicin, isoniazide, streptomycin and others. The main antibacterial therapy is complemented by other drugs: anti-inflammatory, steroid, painkillers.

The conservative path of treatment involves the use of anti-tuberculosis drugs for a long period (sometimes up to 1 year) against the background of a combination of several drugs.

For conservative treatment Anti-tuberculosis drugs are distributed throughout the body, because the affected lymph node in most cases is not the only defeat of the body. This method is effective in the initial stage of the disease. It is considered as favorable as possible, since all the functions of immunity are saved.

Treatment in late stages

Later the stages of the disease require another treatment regimen. The absence of lymphoid fabric and the appearance in its place granuloma cannot be eliminated by drugs. The impaired blood circulation in the resulting hillock prevents the drug in the focus of inflammation.

Difficult forms of illness or long current, toxic adverse reactions On the therapy used, require the application of the operational method of treatment. Surgical removal of the affected node is not the only effective method of treatment in this situation. There is also a hope for the use of antibacterial surgical option. The introduction of antibiotics directly to the node allows you to save it in some cases.

The removal of lymph node is not only eliminating the focus of infection. This is a serious loss of an important organ immune defense. A rational approach to the elimination of the problem is required. Fast result - not always reliable. There is a risk of in vain operational intervention, not only not justified, but also harmful. Modern statistics records up to 40% of such cases.

Domestic science has not yet own 100% the method of accurate diagnosis of this disease. Therefore, a reliable way to identify the disease and the choice of the treatment method is still relevant. The use of new super-modern diagnostic tools (computed tomography, ultrasound research, nuclear magnetic resonance and others) allows you to hope for the success of treatment.

Tuberculosis lymphadenitis is the form of tuberculosis, initially it was included in the concept of "crofulosis". The disease amazes in most cases lymph nodes located on the neck, as well as submandibular. Such localization of the pathological process is explained by the penetration of causative agents of the disease through the oral mucosa and nasopharynx.

Causes of tuberculosis lymphadenita

Lymphadenitis is a disease at which lymphatic nodes are in size. Symptoms characteristic of this disease can appear in patients with primary or secondary tuberculosis. The cause of tuberculous lymphadenitis is considered a tuberculous stick, which penetrates the lymph nodes and causes inflammatory processes in the tissues.

In the process of disease, lymph nodes increase in size, become softer. Their autopsy is accompanied by the separation of purulent contents having a gray color in which tuberculosis sticks can be detected with a laboratory study.

Symptoms and diagnosis of tuberculosis lymphadenitis

Tuberculosis lymphadenitis, in which the cervical lymph nodes are affected, is characterized by low-heated shared phenomena. In most cases, the pathological process affects lymph nodes located on both sides. At the beginning of the disease, lymph nose still have a dense consistency, they are movable, their palpation does not cause pain sensations. Later, when the inflammatory process covers the shell of lymph nodes and develops periathenitis, the nodes are connected to the packages. In the central part of the inflamed area of \u200b\u200bthe skin, a curly necrosis appears, and the inflammatory process applies to surrounding cells. Lymph nodes are growing with the skin, which covers them, fluctuation can develop on such spikes. In the place of the revealed glandy appears, a fistula with purulent contents that have a characteristic rumbling consistency.

The diagnosis of tuberculosis lymphadenitis is put on the basis of the generally accepted principles of identifying, the data of the microscopic study of the purulent discharge can also lie.

When making a diagnosis, a lymphosarcoma, lymphogranulomatosis, non-specific lymphadenitis, cervical fistula, the process of propagation of metastasis with malignant tumors was shown. Non-specific lymphadenitis, in contrast to tuberculosis, has a specific source of the disease, it is characterized by an acute beginning of the inflammatory process, which is accompanied by high temperatures. Cysts and fistulas located on the neck on the sides have elastic formations, lymph nodes in the pathological process are not involved.

Treatment of tuberculosis lymphadenita

Local treatment of tuberculosis lymphadenitis is reduced to generally accepted schemes for the treatment of purulent wounds. Specific methods of drug therapy include the purpose of antibiotics, such as streptomycin, kanamycin, cycloserine.

Effective combination various drugsWith antimicrobial activity. So, streptomycin can be recommended together with a pages or fivazide. It should be remembered that streptomycin while simultaneously use with kanamycin leads to amplification side phenomenaIn particular, the likelihood of the development of the neurotoxic effect increases.

To specific drugswhich are used to treat tuberculosis lymphatoenitis include cycloserine. The drug is accepted inside. It can be successfully combined with other anti-tuberculosis drugs.

Cold came, evil infections are circling on the streets in search of tired adults and weakened children. In the wet, polluted streets of infections are pathogens, harmful substances, Street dust allergens and gasoline combustion products penetrate each pedestrian almost every second. But there are clocks in the body - lymphatic nodes that are continuously in the post not to miss the enemy. The cervical lymph nodes are usually the first to meet. Develops sheen lymphadenit.

Characteristic of the disease

Lymphadenitis is generally inflammation of lymph nodes at the site of the penetration of the causative agent of infection or any pathogen, which, falling into the body, then the Lymph current is entered into the lymph node. Pathogen may not be strangers, the reaction occurs on own cellsadopted for alien: with autoimmune reactions, tumor diseases.

The activation of leukocytes in the free state of blood and ripening in the lymph node occurs. Due to the enhancement of the operation of these immune cells, the lymph node increases, becomes noticeable, painful to the touch, which is not in normal state, since its size does not exceed 1-2 cm.

Inflammatory process - In essence, the war in which immune cells beat with the enemy is not for life, but to death. Noticeable externally changes in lymph nodes - only its consequences.

Causes of occurrence

The cervical lymphadenitis occurs when the pathogens is admitted to the body:

• through the upper respiratory tract (nose, throat, larynx);
• upper departments of the digestive tract (mouth cavity, esophagus);
• with infectious, autoimmune or tumor lesions of organs located in the neck area, for example, thyroid gland;
• when lesions of the scalp and neck leather, including the wound infection of these regions.

Classification of pathology

Classifications are conditional and used for convenience. The cervical lymphadenitis (Code of ICD-10: L04.0) is characterized by localization of specific lymph nodes, which are located like borders, several pieces in areas between muscles and organs, as well as they are on the neck.

Select deep and surface lymphadenitis neck.

External changes can be seen in surface lymph nodes. Deep unavailable for ordinary inspection and palpation.

Surface lymph nodes include:

• the front cervical is responsible for the throat and the thyroid gland; located along the front surface of the neck from the chin to the jugular hole;
• the rear, arranged on the back of the neck, on the rear surface of the neck; Their inflammation may indicate the defeat of the bronchi;
• almonds are located under lower jaware responsible for the tonsils and the rear wall of the alignment;
• subbands, the most frequently detectable, since they are inflated with common diseases of the ENT organs (rhinestone, hyimorite, pharyngitis, otitis), language, salivary glands, dental infections (stomatitis, periodontitis); Located along the lower jaw;
• eased, they are sometimes referred to a separate group, and sometimes - to cervical nodals; They are inflated during lesions of the skin in the field of the nape, the patterns;
• chiffers are responsible for the condition of the cheeks, the bottom lip, the teeth of this zone;
• included, collect lymph from the lungs, esophagus, hearts, in connection with which their inflammation is usually talking about serious disease These organs.

There is a classification of cervical lymph nodes along the levels of their location with the release of 6 groups:

1. 1 level - chin and submandibular;
2. 2 level - upper vague;
3. 3 level - medium vague;
4. 4 level - lower vigorous;
5. 5 level - rear group;
6. 6 level - front group.

Such anatomical classifications are convenient to determine the localization of the organ from which the pathogen penetrates into the lymphatic assembly.
There is division into non-general and odontogenic neck lymphadenites associated with their reasonable cause in the form of dental damage in children, both dairy and constant.

See also:

Tuberculosis of intragenic lymph nodes in children and adolescents: symptoms, diagnosis, treatment

For the purposes of determining etiology - direct cause that caused cervical lymphadenitis, the classification of the pathogen is useful.

Like any inflammation, cervical lymphadenitis can be called nonspecific bacterial flora, viruses and specific microorganisms: tuberculosis stick, AIDS virus, actinomycete mushrooms. Tumor and autoimmune lymphadenitis also refer to specific.

By the nature of the inflammation of the lymphadenitis of the neck divided:

• serous (they are viral or non-infectious lymphadenitis);
• purulent (caused by bacteria);
• hemorrhagic (proceeds with hemorrhages in the tissue of the node);
• fibrinic (there is a gradual necrosis of lymphoid tissue with a substitution with a tissue containing fibrinogen).

For the flow of inflammation of the cervical lymph nodes is sharp, on the background acute infection, and chronic, developing gradually, with sluggish diseases.

With multiple repeated inflammation, the disease is called recurrent.

Symptoms and signs

Symptoms of infectious lymphadenitis in children are usually nonspecific. The lymphatic node or nodes are increased in size (before the beans or more), become visible on the neck, sometimes with redness of the skin in the region of their rounded filling. To the touch leather here is hotter than usual, and the repeated bump itself is dense, compared to adjacent tissues (infiltrate). The pain can be observed both alone and when the enlarged node is torn, when the head moves, if the node arrives to the appropriate muscle. For example, when lescriminate submandibular nodes, due to pain, children can limit turns and tilts of the head.

With purulent lymphadenitis on the neck, all the symptoms are stronger, the body temperature rises to febrile numbers, the child's condition suffers - it is apaticated or capricious, the appetite is reduced.

On the contrary, the inflammation of the lymph nodes of the neck flows sluggishly and for a long time. The child is losing weight, cough is observed, the knots are soldered among themselves.

In chronic inflammation of the cervical lymph nodes, they remain enlarged for a long time, but are uncomfortable, they are not soldered together, moving when palpation.

Diagnostics

An experienced doctor may assume the correct cause of inflammation of cervical lymph nodes already with the abrasing of the child's parents and its careful inspection.

To this doctor will indicate data about:

• what shortly before the development of symptoms of lymphadenitis got a child or continues to hurt at present, led to countries where unusual infections are found;
• what is getting the closest environment of the child;
• as the child's weight has changed lately, his appetite, mood;
• what is his temperature;
• what is the area of \u200b\u200bthe projection of lymph nodes - the condition of the skin, its density, soreness, or painlessness, redness (hyperemia), mobility, spares with surrounding tissues;
• whether there is a defeat of other lymph nodes (, elbow,);
• there is no violations of swallowing and respiration, voice timbre, which may indicate both the upper respiratory tract.

All this will help to assume the localization, specific or non-specific character of inflammation, its etiology is viral, bacterial, autoimmune, endocrine or tumor.

The clinical analysis of the blood is obligatory, which in terms of the amount and ratio of leukocyte fractions will allow you to say, acute or chronic current inflammation, viral or bacterial.

In the case of suspicion of the pathology of the thyroid gland, the blood test is prescribed to determine the level of hormones, antibodies to the gland tissue to confirm the autoimmune character of inflammation.

If the doctor suggests the tuberculous etiology of lymphadenitis, we need data on the child's manta, diaskin sequence, BCG vaccination, radiography.

In the case of suspicion of tumor lymphadenitis, an ultrasound study of neck lymph nodes and a body, suspicious as the cause of inflammation, magnetic resonance imaging (MRI) of lymph nodes and relevant authorities may be carried out. The two methods are not accompanied by radioactive radiation, so safe for the child.

If suspected malignant neoplasm prescribed a lymph node biopsy. This is an invasive method in which the small part of the node tissue is taken by surgical path or needle to then hold microscopic and histological examination.

Possible complications and consequences

Acute infectious non-resident lymphadenitis, which developed as a complication of a conventional respiratory viral infection, as a rule, will be held on the cure of the underlying disease.

Lymphadenit (lymphadenitis; Lat. Lympha Clean water, moisture + Greek, ADEN Iron + -itis) - Inflammation of lymph nodes, arising as a complication of various purge differ diseases and specific infections (tuberculosis, plague, actinomycosis). T. about., L., as a rule, is a secondary process.

L. sharp and chronic, specific and nonspecific.

Non-specific lymphadenitis

Non-specific L. is most often caused by staphylococci, less often streptococci and other global microbes, their toxins and spree products from the primary foci of the purulent process. The primary foci can be an purulent wound, a furuncle and carbuncoon, panaria, a grinding inflammation, osteomyelitis, thrombophlebitis, trophic ulcers, etc. in lymph, microbic nodes and their toxins come with lymphogenic, hematogenic and contact paths. Penetration of microbes can be penetrated directly into the lymph, the node when it is injured. In such cases, L. acts as a primary disease.

The inflammatory process in lymph, nodes develop and proceeds total type (see inflammation). Depending on the nature of the exudation, serous, hemorrhagic, fibrinous, purulent L. The progression of purulent inflammation can lead to destructive forms of L.-abscedization and necrosis, and with a pendant infection - the ompheomous decay of lymph, nodes. In the initial stage, the change is reduced to damage, the lunch of endothelium, the expansion of sinuses, stagnant hyperemia. The exudation that began leads to the serous impregnation of lymph tissue, the node, followed by cell infiltration due to the migration of leukocytes and the proliferation of lymphoid cells. This stage of serous edema is denoted as simple, catarrhal L. with simple L. The inflammatory process is more often outside the limits of lymph capsule, node. With destructive forms of L. The inflammatory process applies to the surrounding tissues (paralymphadenitis). At the same time, changes in the surrounding tissues can limit the serous inflammation or go to purulent to the formation of adenoflems. Special severity and extensity?: »The defeats of the surrounding tissues are different from ompheomy L.

Acute nonspecific lymphadenitis

The disease begins with the pain and increase in lymph, nodes, headaches, weakness, malaise, increasing body temperature. Often sharp L. proceeds with inflammation of lymph, vessels (see lymphangitis). The severity of signs of acute L. is determined by the form of the disease and the nature of the main inflammatory process. In some cases, when subscribing the main process of L. can acquire a dominant value in a wedge, picture. As a rule, with a catarile (serous) L. The general condition of the patients suffers from little. They mark pain in the area of \u200b\u200bregional lymimph, nodes, which are increased in size, dense and painful during palpation, are not fast, the skin is not changed over them.

Under the progression of the process, the development of periathenitis, the transition of inflammation into destructive, purulent form said wedge, signs are expressed to a greater extent: pains are sharp, skin over lymph, hyperemic nodes; Palpation Lymph, nodes causes soreness, clearly palpable lymimph, the nodes merge among themselves and the surrounding tissues become fixed. At adenoflemone, diffuse hyperemia are determined, dense without clear boundaries infiltrate with softening foci. The general condition of patients with purulent L. suffers to a greater extent: the temperature rises to high numbers, chills appear, tachycardia, headaches, severe weakness. In the pendant phlegmon, the attitudes determine the attitudes in the lesion focus.

Forecast In the initial forms of L. and in a timely manner, a favorable treatment is more favorable. Destructive forms of L. lead to the death of lymph, nodes, followed by substitution by their scar tissue, which during localization on the limbs can lead to a violation of lymphottock and the development of lymphostasis (see), and in the future to elephants (see).

Prevention: Prevention of injuryism (wounds, microtravum), fight against wound infection, rational treatment of purulent inflammatory diseases.

Chronic nonspecific lymphhadenitis

Chronic nonspecific lymphadenitis can be primary-chronic as a result of exposure to a weakly generable microbial flora, with sluggish, recurrent inflammatory diseases (hron, tonsillitis, inflammatory diseases of teeth, infected to feet losses, microtraums, etc.) or the outcome of acute L., when the inflammatory process in Lymph Nodes are not allowed, but takes a protracted hron, the flow. CHRON, inflammation of lymph, nodes are productive, the transition to the purulent phase is extremely rare. The purulent melting of lymph, nodes can be observed when the latent infection is inhibited.

Clinical picture: The increase in lymph, nodes, which are densely tight to the touch, are uncompressed, are not laugmented with each other and surrounding tissues. Lymph, nodes remain enlarged long, but in the end, the growth in them connective tissue leads to their decrease.

In some cases, the pronounced arrangement of the connective tissue, the wrinkling of the nodes can lead to a disorder of lymphorty, lymphostase, edema or elephantability.

Cryron, nonspecific L. should be differentiated with an increase in lymph, nodes with inf. and some other diseases (scarletta, diphtheria, influenza, syphilis, tuberculosis, lymphogranulomatosis, malignant neoplasms, etc.). Circuit recognition. L. should be based on the assessment of the entire set of wedge, signs of the disease. In doubtful cases showed the puncture biopsy Lymph, a node or removal of it for histol, research, which is particularly important in differential diagnosis Cron. L. and metastases of malignant neoplasms.

Treatment It should be aimed at eliminating the underlying disease, which is a source of hron, nonspecific L.

Forecast In most cases, the scarring is favorable, the outcome of the disease is the scarring: the lymphoid tissue is replaced by the connective, lymph, the node is wrinkled, decreases in size, becomes dense. In some cases, elephantity can develop.

Prevention: Compliance with personal hygiene, timely treatment inf. Diseases, acute L., increasing the resistance of the organism by tall treatment.

Specific lymphhadenitis

The Group of Specific includes L., caused by pathogens of actinomycosis, syphilis, tuberculosis, tularemia, plague, etc. Clinical picture, diagnosis and treatment of the main species of specific L. in articles actinomycosis, syphilis, tularemia, plague.

Tuberculosis lymphadenitis

Tuberculosis Lymph, knots - manifestation of tuberculosis as a common disease of the body (see tuberculosis). More often, especially in childhood, the period of primary tuberculosis is combined with the damage to the intrathless lymph, nodes (see bronctery). It is possible a relatively isolated lesion of individual groups of lymph, nodes, a cup in adults, against the background of old inactive tuberculous changes in other organs, when tuberculosis L. is a manifestation of secondary tuberculosis. The frequency of tuberculous L. depends on the severity and prevalence of tuberculosis, social conditions. Among children, tuberculous lesion of peripheral lymph, nodes, according to E. I. Guseva (1973), P. S. Murashkina (1974), etc., is observed in 11.9-22.7% of patients with active forms of extrapulic tuberculosis.

The tuberculosis of peripheral lymph, nodes are called mainly by mycobacteriums of human and bull type tuberculosis. Bovine-type mycobacteria is usually the pathogen in tuberculosis lymphadenitis in S.-H. cattle breeding, r-nah.

The dissemination paths of infection are different. Submitted by B. P. Alexandrovsky et al. (1936), A. I. Abrikosova (1941), F. L. Elinson (1965), V. A. Firsova (1972), Kurilsky (R. Kourilsky, 1952), etc., the entrance gates of infection may be almonds, Under the defeat of the reasons in the process, the cervical or subband lymph is involved. nodes. The infection is most often propagated by a lymphohematogenic method from affected intragenic lymph, nodes, lungs or other organs.

Patomorphol, changes in affected nodes depend on the massiveness of infection, the state of the patient's body, such as mycobacterium tuberculosis and other factors. A. I. apricot distinguishes five forms of tuberculous lesion lymph, nodes: 1) diffuse lymphoid hyperplasia; 2) Miliary tuberculosis; 3) tuberculous large cell hyperplasia; 4) caseometric casomic tuberculosis; 5) Indurative tuberculosis. In Wedge, the practice is used by the classification proposed by N. A. Shmelev, in which there are three forms of tuberculous l.: Infiltrative, caseous (with fistulas and without them) and indurative.

In the acute beginning of the disease, there is a high temperature, symptoms of tuberculosis intoxication, an increase in lymph, nodes, often with severe inflammatory-necrotic changes and perifocal infiltration.

A characteristic sign of tuberculous L., distinguishing it from other lesions of lymph, nodes, is the presence of periathenitis. The affected lymph, the nodes represent the conglomerate of the fragmented formations of various sizes. Adults more often than in children, the beginning of the disease is gradual, with a smaller increase in lymph, nodes and a more rare formation of fistulas due to the mainly productive nature of inflammation.

A number of researchers acute the beginning of the disease and the inclination to the rapid formation of caseosa and fistula connects with infection by the bullish type of mycobacterium tuberculosis.

The most often affected cervical, submandibular (subband, T.) and axillary lymph nodes. Multiple lymph groups, nodes from one or both sides can be involved in the process.

Diagnosis They put on the basis of a comprehensive examination of the patient, taking into account the presence of contact with tuberculosis patients, the results of the reaction to tuberculin (in most cases it is pronounced), the presence of tuberculous lesion of the lungs and other organs. An important role for the diagnosis is played by the data of puncture of affected Lymph. node. In lymph, nodes can form calculations, detected radiologically as dense shadows in soft tissues Neck (Fig.), submandibular region (subband triangle, T.), axillary and inguinal regions. Tuberculous L. differentiate with non-specific purulent L., lymphogranulomatosis, metastasis malignant tumors and etc.

Treatment Determined by the nature of the lesion of lymph, nodes and the severity of tuberculosis changes in other organs. In the active process, the first row preparations are prescribed: tubazide, streptomycin in combination with PASK or ETIONAMIDE, protionamide, pyrazinamide, ethambutol. Treatment should be long - 8-12-15 months.

In addition, in the affected node (or glue it) streptomycin, impose bandages with streptomycin, tubazide, thibonic ointment. With a pronounced purulent process, antibiotics are prescribed wide spectrum actions. With caseous lesion, the lymph, nodes showed surgery against the background of the general course of anti-tuberculosis therapy (see tuberculosis).

Forecast with timely recognition of the disease and the treatment of L. favorable.

Prevention of tuberculous L.- cm. Tuberculosis.

Features of lymphadenitis in children

L. is observed especially in children early age. This is due to the function and morphol, the imperfection of lymph, the child's apparatus (wide sinuses, a thin gentle capsule of lymph, nodes, increased susceptibility to infection, imperfection of the barrier function). L. in children can be non-specific and specific.

The reasons leading to L. in children are diverse. L. The submandibular region extremely rare can be primary disease. Most often this is a limf reaction, nodes for inflammatory processes in various foci. Careful identification and rehabilitation of these foci ensure the success of further treatment.

In children (especially between the ages of 1 and 3 years), with L., the submandibular lymph are most often inflamed, the nodes, since the Lymph outflow is made from most of them, the oral cavity and teeth. The chiffers are stronger (pre-arms, T.), cervical lymph, nodes, even more rapidly axillary, poning, inguinal and elbow. Perhaps inflammation of deep lymph, nodes (iliac, pelvic, etc.).

It has been established that odontogenic L. in children are less common than the uncommon. The reason for the occurrence of uncommon L. (mainly in young children) are Qatar of the upper respiratory tract, flu, angina, hron, tonsillitis, otitis, exudative diathesis, pyoderm, skin injury and mucous membranes. The source of an odontogenic infection is more often sick milk, less often constant teeth.

Most frequent cause Mortal and elbow L.-inflammatory processes in the field of upper extremities (furuncules, parasis, infected wounds, mass, etc.), and inguinal and poning - similar processes on the lower limbs.

In the pathogenesis of the disease, preliminary sensitization of the body plays a major role as a result of infected infections or purulent diseases.

In children L. leaks more violently than adults, with pronounced signs of a common and local nature. Most often, the disease begins with an increase in temperature (up to 38 ° and above), malaise, appetite loss, headaches, sleep disorders.

With L. maxillofacial region It is often observed pain and difficulty with chewing and swallowing. In the children of the first years of life and especially breast age in Wedge, the picture to the fore the symptoms of intoxication are the symptoms. The cervical and submandibular L. at this age, as a rule, flow adenoflems with pronounced edema and perifocal reaction.

The iliac L. begin with a general ailment, pain in the lower half of the abdomen, increasing the temperature, flexion contracture of the thigh on the same side. The inflammatory infiltrate is located directly above the groove bunch and closely arrive at the wing of the iliac bone.

The most serious complications are the metastasis of the purulent focus and the development of sepsis (see).

Differential diagnosis must be carried out with specific processes in Lymph, nodes and systemic blood diseases (leukemia, lymphogranulomatosis), tumors. Of the specific L. in children are more often found lymphadenoactivity and tuberculosis lymph. nodes.

In early age children when defeating inguinal lymph, nodes are often tumor adopted for the impaired inguinal garry. Lack of chair with a disadvantaged hernia, vomiting, inxication phenomena, X-ray data, research abdominal cavity allow you to distinguish hernia from L.

Epiphyseal osteomyelitis of the femoral bone sometimes has to be differentiated with inflammation of deep pelvic lymph, nodes, since, for both of these diseases, high temperature, pain in the area of \u200b\u200bhip joint, flexion-leading hip contracture has been characterized. However, with L. in the pelvis, a painful infiltrate is determined under a groove, and all movements are preserved in the joint although in limited volume.

With a severe course of L. with phenomena of toxicosis, especially in small children, conduct active infusion therapy aimed at removing intoxication. The antibiotics of a wide range of action, immunopreparations, desensitizing and constructive therapy are prescribed. Operational treatment lies in the opening and drainage of inflammatory infiltrate; It is produced, without waiting for softening. If the pus does not stand out, the rubber graduate is left in the wound. Do not make big cuts. A section of 2-3 cm incision is most often sufficient to open the purulent cavity. Only extensive adenoflems are an indication for wider cuts. Proteolytic enzymes are locally used while simultaneously appointing physiotherapy.

The forecast for timely and proper treatment is favorable.

Prevention: Events by hardening the body of the child, timely treatment of inflammatory foci, which may cause L.

Bibliography: War-Yasenetsky V. F. Essays of purulent surgery, L., 1956; Davydovsky I.V. General pathology of man, p. 408, M., 1969; Diagnosis of surgical diseases, ed. V. S. Levita, p. 417, M., 1959; Dmitriev M. L., Pugachev A. G. and Kushz N. L. Essays of purulent surgery in children, M., 1973, bibliogr.; Dolletsky S. Ya. And Isakov Yu. F. Children's surgery, part 1, p. 194, M., 1970; Pops r about in S. Penno-septic surgery, per. with Bulgarian., p. 171, Sofia, 1977; Pokhitonov M. P. Clinic, Treatment and Prevention of tuberculosis in children, M., 1965; Strołkov V.I. Purulent surgery, p. 71, M., 1967.

V. I. Stolovkov, V. K. Gazeshev; A. F. Dronov (Children. Hir.), V. A. Firsova (Phys.).

F.V. Shehiban

Tuberculosis lymphadenitis, or tuberculosis of peripheral lymph nodes In most cases, it is related to the primary period of the disease and is associated with a ferrous component of the primary complex, but may be post-transient lymphadenites.

The damage to tuberculosis peripheral lymph nodes is more often observed in children and adolescents, less often - in adults and extremely rarely in the elderly. In children, there are often several groups of peripheral lymph nodes with tuberculosis; Palpation is determined by increased lymph nodes of soft or dense consistency, beanoid or round shape. Small lymph nodes located with a chain can be detected.

For chronic flow Tuberculosis Lymph nodes are presented in the form of very dense formations. The sizes of them can be to a pigeon egg.

Tuberculosis amazed mainly cervical and submandibular nodes; The axillary nodes are rarely affected and even less often - thoracic, inguinal and elbow.

The beginning of the disease tuberculosis of peripheral lymph nodes It may be sharp, with high fever and pronounced intoxication, but more often it is gradual. The disease proceeds wave: periods of exacerbation are replaced by periods of inpatient flow without clinical manifestations of the disease. The inflammatory process from lymph nodes can spread to the surrounding subcutaneous tissue and skin. In such cases, dense, large, sedentary packets of nodes are formed.

If tuberculosis of lymph nodes remains without treatment, Embodentity arises, hyperemia of the skin appears above the lymph nodes, the fluctuation, then the pussy breaks out and formed long-lasting fistulas. In case of effective treatment, there is a decrease and sealing of lymph nodes, sometimes, followed by the formation of petrifists in them, the fistulas are closed. Scars after fistulous forms have an irregular form: can be sclerosic or keloid scars.

In the acute beginning of lymphadenitis and during the exacerbation of the processEspecially with the suppuration, fever occurs, the ESP increases, moderately pronounced leukocytosis with a laid shift and monocytosis appears in the hemogram.

Often simultaneously with the damage to peripheral lymph nodes in patients there is a damage to tuberculosis of intrathless and intraperitoneal knots and internal organs. More often the lungs are amazed, less often - other organs. In the lymphadenitis arising from the primary tuberculosis, there may be flusted keratoconunctivitis, nodular erythema, polyporosites.

To diagnose outdoor tuberculosis lymphadenitis The presence of a history of contact with tuberculosis patients, lymphadenitis in childhood, scars on the neck, eye disease, noded erythema, plerites, polyporosites, damage to internal lymph nodes.

Tuberculin test Mantu With tuberculosis lymphadenitis, it is often sharply positive. Miccobateria of tuberculosis can be detected in the dumpy of fistulas with tuberculosis lymphanets. Punny fistula and punctate from the jointed lymph nodes should be investigated on the mycobacterium tuberculosis not only by bacterioscopy and flotation, but also sowing, which increases the percentage of the detection of mycobacterium tuberculosis.

To diagnose tuberculosis process in lymph nodes Currently, the method of cytological research of identities of lymph nodes is widely applied. In difficult diagnostic cases, when cytological research It does not allow to clarify the diagnosis, it is recommended to make a biopsy and produce histological examination of the tissue obtained during biopsy.

Three forms of lymphadenitis distinguish: Infiltrative, caseous and indisive.

• Infiltrative lymphadenitis It takes the most favorable. Palpation In these cases, increased, but small sizes are found, more often on one side, dense consistency of lymphatic nodes. With this form there is only a hyperplasia of lymphadendic tissue.
• Casomic form It takes more hard, with the defeat of several groups of lymphatic nodes. This form is often complicated by the suppuration with the formation of fistula and ulcers. With caseous form in lymphatic nodes there is a curly necrosis. When the lymph node can be obtained by a pus, in which mycobacterium tuberculosis is found very often (in 80% of cases).
• Industenant, or fibrous, form of lymphadenitis less severely clinical picturethan caseous, but more durable for the flow. When palpation, in these cases, dense lymph nodes are determined with the petrification of some of them, with the scars on the skin after healing fistulas. This form is the outcome of the tightened occasion of caseometric shape and less frequently infiltrative with an unfavorable course of the latter.

The main method of treatment of lymphadenitis Currently is antibacterial therapy. Treatment should be carried out by three main drugs. The treatment with streptomycin is shown in all forms of the tuberculosis process in lymphatic nodes, with an acute and subacute of its flow, as well as with exacerbations. For the treatment of lymphadenitis, approximately 100-150 g of streptomycin is necessary; Daily dose 1 g (for adult).

Intramuscular administration of streptomycin with caseaseous form, especially complicated with fitting and fistula, is recommended to combine with local application Streptomicin by smoking the lymph nodes affected by tuberculosis and the introduction of streptomycin in the tissue around the nodes. When supposedly in lymph nodes, pus and introduction should be evacuated medicinal preparations Directly into the lymphatic node.

Gink preparations (isoniazide, fivazide, metaside, Lasurian, Salyzide) are used for all forms of tuberculous lymphadenitis, both in acute and chronic flow. Daily dose Isoniazid 0.6 - 0.9 g. For administration in the tissue, a soluble drug of isonicotine hydrazide is recommended - 5% of the discharge in a dose of 0.5-1 g. The treatment of isonicotine acid preparations is recommended to be combined with the purpose of PAK, etcutol and rifdine.

With long-term treatment, it is necessary to alternate the use of both the main preparations (streptomycin, isoniazide, PASK, RFIDADA) and drugs II. At the same time with antibacterial drugs It is necessary to assign vitamins of groups B and ascorbic acid.

In patients with a caseous form of lymphadenitis, with isolated damage to tuberculosis, lymphatic nodes can be used surgerywhere the entire package of modified lymph nodes is deleted. The use of rational treatment methods ensures the recovery of the patient.