From Big Medical Encyclopedia

PRIMARY COMPLEX — combination of primary affect to lymphogenous distribution of pathological process to regional lymph nodes.

Primary affect (see. Affect primary ) can sometimes be very small or even hardly distinguishable, and in some cases is not defined kliniko-morphologically, and process is shown by defeat regional limf, nodes. It means that the activator got into an organism, without having caused development of noticeable inflammatory process in the field of infection atriums that is characteristic, e.g., of a bubonic form of plague, but can seldom be at tuberculosis and syphilis. Distribution of process of primary affect to regional limf, nodes usually is followed limfangiity (see), intensity to-rogo increases towards regional limf, nodes. At the same time in limf, nodes, as a rule, develops lymphadenitis (see) (usually through short term after development of primary affect), morphologically often having the lines characteristic of this infection. Process arises in one or several limf, nodes at once, and changes in them always have big expressiveness, than in primary affect.

The item to. plays a large role in a pathogeny of a disease. All elements P. to. biologically are the filter on the way of distribution of contagiums. Development after primary affect of regional lymphadenitis is manifestation of barrier function of lymphoid bodies. Hit of a contagium and its antigens in regional limf, nodes causes not only inflammatory, necrotic or sclerous processes, but also the proliferation and differentiation in them immunocompetent cells aimed at the development of an immune response — hypersensitivity of the slowed-down and immediate type. In the subsequent there is a stimulation of all immune system of an organism. Immune lymphocytes, being implemented into the struck fabric, increase activity of macrophages, reducing growth of bacteria, limiting their distribution and activity of an inflammation. At nek-ry infections, e.g. staphylococcal, the immune response and body resistance are connected preferential with development of antibodies already during the first hours and days after implementation of a contagium. A repeated exit of a contagium from P. to. strengthens an immune response. During the easing immunol, resistance and preservation of active inflammatory process elements P. to. can become the reason of decrease in an immune response, promote distribution of the activator and progressing of a disease.

The most expressed P. to. happens at tuberculosis, syphilis, is more rare to plague and others inf. diseases. At tuberculosis it usually develops as a result of aerogenic infection with mycobacteria of tuberculosis: in pulmonary fabric there is an alveolitis, exudative deskva-mativnaya pneumonia with perifocal inflammatory reaction and often caseous necrosis in the center (see. Tuberculosis of a respiratory organs ). In limf, vessels of interlobular partitions also note specific inflammatory process with the hypostasis, tubercular hillocks and even the centers forming as if a path to a root of a lung. In regional limf, nodes against the background of a hyperplasia of lymphocytes in various zones of proliferation of reticular macrophages and accumulations of macrophages quickly develop tubercular hillocks with the subsequent caseous necrosis almost everything limf. node. At alimentary infection with tuberculosis of P. to. usually develops in intestines, limf, vessels and regional limf, nodes of a mesentery — intestinal P. forms to. Very seldom at tuberculosis there is P. to. in connection with defeat of almonds, skin, a middle ear.

The item to. at syphilis (see) usually it consists of syphilitic primary affect — a hard ulcer — and lymphadenitis regional limf, nodes. At sexual infection with syphilis of P. to. it is localized in sexual orgayets and inguinal limf, nodes, in other cases — in a mucous membrane of a mouth and limf, nodes of a neck or on fingers of hands (e.g., at obstetricians) and in regional limf, nodes. In primary affect productive inflammatory process, typical for syphilis, with the subsequent necrosis and an ulceration, in regional limf develops. nodes — a hyperplasia of lymphoid follicles and desquamation of an endothelium of sine and limf, vessels with the subsequent sclerosis. At to plague (see) only at a skin form there are all elements P. to. — a chumny anthrax of skin on site penetrations of the causative agent of plague, and also defeat regional limf, nodes in the form of a plague bubo. The item to. at other forms of plague it is not typical since usually has no kliniko-morphological manifestations of primary affect. Typical P. to. develops also at tularemias (see) and nek-ry other infections.

Bibliography: Rabukhin A. E. Tuberculosis of a respiratory organs at adults, page 110, M., 1976; Strukov A. I. and Serov V. V. Pathological anatomy, page 384, etc. M., 1979; Strukov A. I. and Solovyova I. P. Morphology of tuberculosis in modern conditions, page 30, 95, M., 1976; Font l and N of JI. H. Immune responsiveness of lymphoid bodies and cells, JI., 1967, bibliogr.

M. M. Averbakh.