PRIMARY TUBERCULOSIS IN CHILDHOOD WITH PARTICULAR EMPHASIS ON CHANGES AFFECTING THE TRACHEOBRONCHIAL TREE

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Abstract
Primary tuberculosis in children is still encountered frequently enough to be considered in the differential diagnosis of lung diseases or otherwise unexplained persistent respiratory disease. Most cases are detected by case finding methods or because of an illness unresponsive to antimicrobial chemotherapy. Symptoms are usually of a minor nature or absent. Most frequently encountered are fever, cough, and weight loss. Primary tuberculosis in children is characterized by pulmonary infiltrates with associated enlarged lymph nodes in the hilar and paratracheal areas and in the mediastinum, predominantly in the area of the bifurcation of the trachea. The infiltrations are most often homogeneous, ill-defined, and may involve an entire lobe. Narrowing of bronchi and/or indentation of the trachea by enlarged lymph nodes is a frequent finding. Atelectasis and obstructive emphysema are a consequence of the bronchial changes and occurred in 30 per cent of our cases. Atelectasis often develops during treatment and clears within 6 months. Clearing of the primary infiltrate and regression of lymph nodes takes place in from 9 to 12 months in the large proportion of cases. However, slow clearing up to 4 years can be seen in a few cases. Calcium is deposited in areas of caseation necrosis and was found after treatment as early as 3 months in the lung and 6 months in the lymph nodes.

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