BUKHARA STATE

MEDICAL INSTITUTE
NAME-Asharaf Ansari
Groupno:8

Topic-Tuberculosis
pleurisy and MENINGITIS

TUBERCULOSIS PLEURISY
• Tuberculous pleurisy is the most common form
of extra pulmonary tuberculosis.
• Tuberculous pleurisy presents a diagnostic and
therapeutic problem due to the limitations of
traditional diagnostic tools.
 HISTOLOGICAL STRUCTURE OF PLEURA:

• Mesothelium - cell layer

• Boundary membrane
• Superficial collagen layer
• Superficial elastic layer
• Deep elastic layer
• Deep collagenous cribriform layer

FUNCTION OF THE PLEURA:

• Negative pressure in the chambers leads to

suction of fluid into the pleural cavity - per
diapedes
• Through the lymphatic system, lymph enters
the lymph nodes located mediastinally and
around the aorta.

PHYSIOLOGY OF THE PLEURA:

• The volume of fluid is normally kept within 25-

30 ml
 • Suction "hatches" are located in the intercostal
spaces and the diaphragmatic part of the
pleura

PATHOGENESIS:

• Allergic
• Lymphogenic
• Hematogenous
• Perifocal

CLASSIFICATION:

Primary
●Secondary
By etiology:
●Tuberculous • Rheumatic
●Bacterial • Viral
●Fungal • Gangrenous
●Traumatic • Eosinophilic
●Oncological

BY LOCALIZATION:
 • Apical
●Costal
●mediastinal
●Diaphragmatic
●Interlobar
●Unilateral
●double sided

BY PATHOGENESIS:

Fibrinous (dry)
●Exudative
By the nature of the liquid:
●Serous • Serous-fibrinous
●Purulent • Eosinophilic
●Hillous • Cholesterol
●Mixed • Hemorrhagic
THE CLINICAL COURSE DEPENDS ON:

From the location of pleurisy

● The nature of the exudate
● Rates of exudate accumulation
● Individual reactivity of the organism

CLINICAL MANIFESTATIONS:
Pain
●Body temperature 37 - 37.5ºС
● Weakness
● Decrease in appetite
●Dry cough

●Rapid shallow breathing

●Forced position of the patient (on the sick,
healthy side)
●Lag of the affected side in the act of breathing

WITH DIAPHRAGMATIC PLEURISY:

Girdle pain
●Irradiation of pain in the trapezius and shoulder
muscles
●May resemble bouts of cholecystitis, appendicitis,
and other surgical conditions

OBJECTIVE METHODS:

Palpation - increased voice trembling

●Percussion - shortening of percussion sound
●Excursion of the lungs is limited
●Auscultatory - pleural friction rub and moist rales

DIAGNOSTIC METHODS:

Anamnesis
●Identification of the tuberculous process in the
lungs and other organs
●Laboratory diagnostics
●X-ray diagnostics
●Thoracocentesis

LABORATORY DATA-BLOOD ANALYSIS:

General blood analysis:

● leukocytosis 12,000-14,000
● lymphopenia
● eosinophilosis
● accelerated ESR
Mantoux test with 2 TUs of a normo-hyperergic
nature
● Mycobacterium tuberculosis is determined in the
pleural fluid in 25% of cases

TREATMENT:
anti-tuberculosis antibiotics
●pathogenetic
●symptomatic
●Thoracocentesis (medical)
●surgical

TUBERCULOSIS MENINGITIS

Specific lesion by tuberculosis of the meninges

(soft, arachnoid, less often hard) of the brain and
spinal cord
combined wit. a tuberculous process.
in the lungs or intrathoracic lymph nodes in
50% of cases,
●1/3 of them occur against the background of
disseminated TB

PATHOGENESIS:

Hematogenous
●Lymphogenic
●liquorogenic
PATHOLOGY:

The meninges are sharply thickened, muddy

● Exudate serous gray-yellow or yellow, jelly-like
Tubercles - along the olfactory tracts, in the area of
the intersection of the optic nerves, on the
contact surfaces of the frontal lobes.
●The ventricles are dilated, contain muddy
exudate
●On the ependyma of the ventricles there are
small tubercles.

BASILAR MENINGITIS:
PERIOD-1: Duration from 1 week to 4 weeks,
faituge, irritability, drowsiness, apathy, loss of
appetite.
PERIOD-2: The period of the peak of the disease,
increased symptoms of the prodromal period,
constant headaches, neck stiffness, chocking when
eating.
PERIOD-3: Terminal. Focal symptoms appear:
paralysis- lower monoparesis, development of
ischemic strokes
DIAGNOSTICS:

Analyze the development of the disease

●characterized by subacute development of the
disease
●Find out if there is tuberculosis in other organs
●Carry out a liquorological study
●Examine the Ocular fundus