Il ne faut pas dire toute la vérité, mais il ne faut dire que la vérité. You should not tell all the truth, but all you say should be true.
Jules Renard
7.1. ENT MANIFESTATIONS OF TUBERCULOSIS
The disease is caused by Mycobacterium tuberculosis (discovered by Robert Koch) which most often penetrates into the human body through the upper respiratory tract and less often through mucous membranes and damaged skin. The risk factors include the following:
► bad social and living conditions;
► close contact with people with active tuberculosis;
► immunosuppression (including AIDS, long-term glucocorticoids administration).
As a rule, in the beginning, the lungs or lymph nodes (in children) are affected by tuberculosis. A lesion of the mucous membrane of the upper respiratory tract often develops as a result of penetration of infectious sputum there (when people with active pulmonary tuberculosis expectorate sputum) and less often as a result of hematogenous or lymphogenic spread.
There are two pathomorphological types of lesions: infiltration and ulcer. Infiltration can be limited and/or diffuse, and, sometimes, it can be tumorlike. A tuberculous ulcer has irregular shape, uneven edges, and it is not deep; pale granulation tissue is seen on its bottom.
Upper Respiratory Tract Tuberculosis
Nose Tuberculosis
As a rule, in the beginning, tuberculosis of the nose is located in the anterior parts of the nasal cavity: in the vestibule, on the nasal septum, and on the mucous membrane of the nasal conchae. Nodular infiltration appears and
becomes ulcerated relatively quickly; perforation of the cartilaginous part of the nasal septum may often occur. At the moment of the infiltration break down and formation of ulcers, purulent discharge colored with blood is seen. Rhinoscopy shows an ulcer as a defect of the mucous membrane at the bottom of which there are inactive granulations.