Syndromes in tuberculosis

Congenital Syndrome

Develops upon infection of the fetus from an infected mother. Transmission occurs predominantly transplacentally (via the circulatory system), while the ascending transmission route is less common if the mother is diagnosed with genital tuberculosis.

Clinical symptoms after birth lack strict specificity, making pathomorphological diagnosis paramount.

Morphological features:

• Macroscopically: Foci of caseous necrosis are found in the liver and spleen parenchyma. The process is frequently accompanied by fibrinous peritonitis.
• Microscopically: Necrotic masses (caseum) totally predominate in the affected tissues. Fully formed granulomas do not develop—epithelioid and Langhans multinucleated giant cells are detected extremely rarely. Due to the absence of this typical cellular response, confirming the diagnosis without additional bacteriological studies is extremely difficult.

Hematogenous pulmonary tuberculosis: general characteristics

Hematogenous forms are characterized by multiple eruptions of tubercles in the lung tissue with single (or completely absent) involvement of other organs. The course of the disease varies from acute to chronic.

To distinguish the hematogenous process from secondary pulmonary tuberculosis, pathologists rely on four key criteria:

1. Strictly symmetrical involvement of the lung tissue on both sides.
2. Presence of a primary extrapulmonary focus from which the dissemination originated.
3. Pronounced tendency toward progressive perifocal fibrosis (formation of so-called "punched-out" foci and cavities).
4. Absence of "tiering" in the lesion (in secondary tuberculosis, the process always spreads apicocaudally, i.e., from top to bottom, which is not observed here).

Miliary tuberculosis

The syndrome derives its name from the Latin word miliarius—millet-like. It is a variant of a generalized process characterized by the formation of microscopic foci of productive inflammation.

• Morphology: Multiple yellowish-white tubercles the size of a millet grain appear in all parts of both lungs. Due to concomitant perifocal emphysema, the lungs appear distended and fluffy to the touch.
• Clinical presentation: The course is acute and progressive. Patients suffer from hectic fever, severe dyspnea, increasing respiratory failure, and pronounced intoxication syndrome.
• Radiology: Imaging reveals symmetrical bilateral microfocal dissemination across all lung fields.
• Important distinction: Unlike miliary generalization of primary tuberculosis, in the hematogenous (post-primary) form, the components of the primary tuberculous complex are already completely healed by the time the disease develops.

Large-focal (hematogenously disseminated) tuberculosis

This form, studied in detail by the Russian pathologist A.I. Strukov, typically affects adult patients over 35 years of age and has a chronic course.

• Formation of foci: Large tuberculous foci form symmetrically in both lungs, predominantly subpleurally. If the tissues in the center of these foci break down, specific "spectacle-shaped" cavities arise.
• Chronic changes: A prolonged course leads to scarring of the tubercles. Diffuse and reticular microfocal pneumosclerosis, as well as pulmonary emphysema, gradually develop.
• Complications and outcome: The pathological process often spreads to the pleura with the eruption of tubercles and the development of tuberculous pleurisy. Due to the sclerosis of the pulmonary vascular bed, the right ventricle undergoes compensatory hypertrophy, forming cor pulmonale. Ultimately, chronic cor pulmonale failure is the main cause of death in such patients.

Class and exam questions

What else to study on this topic

• Morphology of intrauterine parasitic infection and pseudocyst formation
• Hematogenous and aspiration genesis of congenital pneumonias
• Distinctive features of acquired pneumonia in newborns
• Pathological picture of fetal sepsis in intrauterine infection
• Manifestations of neonatal septicopyemia: meningitis and peritonitis

Other topics in the "Additional Topics" section

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.