Вторичный туберкулез развивается в организме человека, который уже ранее переносил первичную форму туберкулеза, в организме взрослого человека, который ранее уже переносил первичную форму туберкулеза, она обеспечила ему некий иммунитет, но не оградила его от повторного инфицирования.
Вторичный туберкулез считается самой частой формой этого заболевания.
Для вторичного туберкулеза характерно:
- избирательно легочная локация процесса;
- интраканулярное и контактное (желудочно — кишечный тракт, бронхиальное дерево) распространение;
- изменение клинико — морфологических форм;
Существует восемь форм вторичного туберкулеза, каждая его форма представляет собой последующие развитие предыдущей формы туберкулеза. Эти формы мы подробно опишем далее.
Острый очаговый туберкулез
Острый очаговый туберкулез определяется наличием одного или двух очагов ( очаги Абрикосова) в 1 и 2 сегментах, чаще всего правого легкого. Очаги состоят из эндобронхита, мезобронхита и консобронхита внезибридалькового бронха. Данный процесс по бронхам переходит на легочную перенхиму, после чего и развивается ациозная или лобулярная творожистая бронхопневмония. Если лечение проводится во время, то процесс может затихнуть, после очаги казеоза инкапсулируются и появятся очаги реинфекта.
Фиброзно — очаговый туберкулез
Фиброзно – очаговый туберкулез — фаза течения острого очагового туберкулеза, после периода затихания болезни процесс снова вспыхивает
Фиброзно — очаговый туберкулез — это фаза течения острого очагового туберкулеза. Характеризуется эта форма вторичного туберкулеза тем, что после того как болезнь затихла процесс снова вспыхивает. Во время заживления очагов Абрикосова возникают крупные инкапсулированные и не перефицированные очаги, этот процесс характеризуется появлениям лобулярных и ациозных очагов казеозной пневмонии, которые вновь инкапсулируются и нетрифируются. Сохраняя склонность к обострению. Этот процесс не выходит за пределы 1 и 2 сегментов.
Инфильтративный туберкулез
Инфильтративный туберкулез легких представляет собой участки туберкулезной бронхопневмонии, формирующиеся в пределах дольковой структуры легкого
Эта форма туберкулеза развивается во время прогрессирования острой очаговой формы туберкулеза, при этом экссудативные изменения никогда не выходят за пределы сегментов.
Инфильтративный туберкулез представляет из себя участки туберкулезной бронхопневмонии, размером до 1.5 см, которые формируются в дольковой структуре легкого. Относится он ко вторичному периоду туберкулеза, развивается, как правило, на фоне имеющихся заживших или свежих очагов воспаления.
Данный очаг имеет название, по имени двух ученных, которые впервые описали рентгенологическую картину заболевания, называют очаг — инфильтрат Ассманна — Редекера. Не специфическое перифокальное воспаление может рассосаться, и тогда в период заживления остаются несколько маленьких не рассосавшихся казеозных фокуса, которые в дальнейшем инкапсулируются.
Туберкулема
Туберкулема — это следующая фаза эволюции инфильтративного туберкулеза. Характеризуется рассасыванием перифокального воспаления, но не смотря на это очаг творожистого некроза, окруженный капсулой остается. Размер туберкулемы бывает от 2 до 5 см в диаметре, располагается туберкулема в 1 и 2 сегменте, чаще всего правого легкого.
Туберкулема легких составляет 10 — 15 % от заболевших туберкулезом легких. Чаще всего туберкулема возникает у мужчин от 20 до 40 лет или у людей с местной гиперергией и высокой сопротивляемостью организма, процесс выражается ограничением патологического процесса в легком от здоровой ткани фиброзной капсулой.
Существует 3 основных вида туберкулем:
- Инфильтративно – пневмонического типа;
- Казеомная пневмония;
- Псевдотуберкулема;
Инфильтративно – пневманическая туберкулема очень часто формируется из инфильтративного туберкулеза, крайне редко она формируется из диссеминированного или из очагового туберкулеза.
Псевдотуберкулема образуется из каверны.
Казеозная пневмония
Казеозная пневмония наблюдается при прогрессировании инфильтративного туберкулеза
Казеому можно считать настоящей туберкулемой, так как эта форма туберкулеза возникает без каких — либо предыдущих форм.
Казеозная пневмония имеет лобарный характер. Чаще всего она наблюдается при прогрессировании инфильтративного туберкулеза, в результате казеозные изменения начинают преобладать над перифокальными. Образуются сегментарные пневмонические очаги, которые могут сливаться в большие участки легких. При казеозной пневмонии легкое увеличено, на разрезе имеет желтую окраску, а на плевре фиброзные наложения.
Острый кавернозный туберкулез
Острый кавернозный туберкулез характеризуется быстрым образованием полости распада
Острый кавернозный туберкулез характеризуется очень быстрым образованием полости распада. Полость распада образуется в результате разжижения и гниения казеозных масс, далее они с микробактериями выделяются с мокротой. Это опасно тем, что бактерии попадают в окружающую среду. При этом каверна сообщается с просветом сегментарного бронха.
Фиброзно — кавернозный туберкулез
Каверна занимает один или оба сегмента, а вокруг появляются очаги, бронхоэктазы
Фиброзно – кавернозный туберкулез появляется из острого кавернозного туберкулеза, когда процесс уже перетекает в хроническую форму.
Пиогенный (нектотический) – внутрений слой каверны, богат распадающимися лейкоцитами, средний – слой туберкулезной грануляционной тканью, наружный – соединительной тканью. Каверна может находиться в одном или двух сегментах легкого. Вокруг нее расположены разнообразные очаги и бронхоэкстазы. Процесс медленно распространяется, опускается с верхних сегментов на нижние, как контактным путем так и по бронхам.
Цирротический туберкулез
При цирротическом туберкулезе в пораженных легких вокруг каверн происходит развитие соединительной ткани
Цирротический туберкулез— вариант развития фиброзно — каверного туберкулеза. Характеризуется развитием соединительной ткани в пораженных участках легких, на месте заживлений каверны образуется линейный рубец, появляются плевральные сращения, легкие деформируются, становятся плотными и малоподвижными, появляются многочисленные бронхо — экстазы.
При вторичном туберкулезе наибольшее число осложнений связано с каверной — кровотечения, разрыв содержимого каверны в плевральную полость, это всё приводит к пневмотраксу и гнойному плевриту (эмпиеме плевры).
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