Primary tuberculosis with miliary hematogenous generalization in old age

Abstract

Currently, the problems of the mechanisms of immune and inflammatory response aging, which determine the mechanisms of the development of the inflammatory process in the elderly, are being actively studied. A sectional observation of senile tuberculosis in a patient K., 78 years old, who had been treated for 4 months in the University Clinical Hospital No. 4 of the First Sechenov Moscow State Medical University in 2018 is presented. After autopsy, histological, histochemical and PCR examination, the following pathoanatomical diagnosis was made: primary (senile) tuberculosis with hematogenous and lympho-vascular generalization, with a focus of caseous pneumonia in the III segment of the right lung; caseous lymphadenitis of bifurcation, thoracic and abdominal paraaortic lymph nodes; miliary and large-focal generalization in the lungs, parietal and visceral pleura on the left, spleen and liver (acid fast stain; PCR study No. 18-5935 dated 08/13/2018 (Central Research Institute of Tuberculosis) detected DNA of mycobacterium tuberculosis complex). A feature of senile tuberculosis is the course of primary tuberculosis with hematogenic generalization and predominantly exudative-necrotic tissue reaction. Its pathogenesis is mainly due to the phenomenon of "aging immune system" (immunosenescence), as well as inflammaging — features of the inflammatory response in old age. Their main characteristics are the preactivated status of the immune system even before the recognition of the antigen, characterized by a basal level of circulating cytokines, as well as a sharp weakening of the adaptive immune response in the presence of an antigen associated with impaired functioning of the immune system with a large number of memory T cells lacking naive T-cells.