11. Characteristics of clinical forms of tuberculosis. Diagnostic criteria. Differential diagnosis

It is characterized by a symptom complex of functional disorders and objective signs of intoxication during the turn of tuberculin tests or within a year after the turn. At the same time, clinical and radiological examination does not allow to identify local manifestations of tuberculosis (fig. 1). The frequency of the form is 11%.

Fig. 1. X-ray of the chest. Normal

Diagnostic criteria:

1. tuberculin test shift;
2. contact with a bacterioexcretor;
3. an increase in peripheral lymph nodes of more than 5–6 groups on both sides and other paraspecific reactions;
4. a syndrome of manifestation of tuberculosis intoxication in the form of subfibrillation in the evening, neurovegetative disorders, headaches, pallor, tachycardia;
5. X-ray examination without pathology, in-depth X-ray tomographic examination, possibly CT to exclude local lesions.

Differential diagnosis

Chronic tonsillitis:

1. exacerbation of intoxication is associated with tonsillitis;
2. long periods of remission;
3. children are less active, cheerful, there may be shortness of breath, general weakness;
4. temperature is poorly tolerated, unlike tuberculosis intoxication;
5. tonsil stones, bad breath, fusion of the tonsils with arches;
6. enlargement of regional lymph nodes to the pharynx.

Rheumatism:

1. against the background of erythema nodosum, pain in the heart, arthralgia;
2. muffled heart sounds, systolic murmur, etc.;
3. progressive damage to the cardiovascular system;
4. leukocytosis, monocytosis, ESR in the hemogram;
5. positive tests for rheumatism.

Hepatocholecystopathies:

1. pain on an empty stomach or with eating, dyspeptic phenomena. During abdominal pain, muscle tension in the hypochondrium, vomiting, liver enlargement (painful);
2. duodenal sounding, cholecystography.

Pyelonephritis:

1. changes in the urine in patients with tuberculous intoxication are absent or transient, moderate;
2. kidney function does not suffer;
3. urine culture for banal flora.

Hyperthyroidism:

1. in older children in the prepubertal period;
2. subfebrile monotonous temperature;
3. enlargement of the thyroid gland, eye symptoms, adynamia, asthenia;
4. the main metabolism is increased.

Worm infestations:

1. nausea, vomiting on an empty stomach, salivation;
2. normal temperature;
3. no symptoms of micropolyadenitis;
4. eosinophilia in the blood;
5. eosinophilic infiltrates in the lungs;
6. fecal scrapings.

Protracted subfebrile condition:

1. banal infections after vaccinations;
2. a tendency to allergic reactions;
3. stable subfebrile condition with small fluctuations during the day and an increase at 18–20 hours is atypical for tuberculosis;
4. exclusion of thermoneuroses.