“I finally had a liver transplant, and tuberculosis was found not long after the operation…”
In the Pulmonary Department of Changsha Central Hospital (Changsha Central Hospital Affiliated to South China University) In the sixth ward of the hospital, 41-year-old Li Ming (pseudonym) is receiving anti-tuberculosis treatment. He just received a liver transplant five months ago. Three months after the operation, he was found to be infected with tuberculosis, which is undoubtedly a blow to him.
Li Ming is from Yueyang, Hunan, and is 41 years old this year. He was diagnosed with “hepatitis B” when he was a teenager and was not treated because he did not feel any discomfort at the time.
In August 2021, he was diagnosed with “decompensated liver cirrhosis, liver space-occupying lesions” when he was reexamined at the local hospital, and the doctor told him that only liver transplantation was the first line vitality.
At the end of September 2021, Li Ming was fortunate enough to wait for a donor and successfully completed the liver transplant.
After the operation, Li Ming cherished the hard-won new life very much and insisted on regular anti-rejection and anti-HBV treatment.
In December 2021, Li Ming began to have cough and expectoration. He thought it was a common cold. He bought some anti-inflammatory and cough medicines at the pharmacy, but the cough and expectoration did not improve. .
At the beginning of January this year, Li Ming coughed more frequently and developed fever, so he went to the local hospital for treatment.
The results of chest CT showed: bilateral pleural effusion, obvious left side, diffuse miliary nodular shadows in both lungs, compressive atelectasis in the left lower lung, and tuberculosis infection should be considered .
Therefore, Li Ming was referred from the local hospital to Changsha Central Hospital (Changsha Central Hospital affiliated to South China University) Pulmonary Hospital Sixth Ward for inpatient treatment.
After completing the relevant examinations, Li Ming was diagnosed as “subacute hematogenous disseminated pulmonary tuberculosis“, and the tuberculosis bacteria also spread to the pleura, brain, peritoneum, spleen, etc. Multiple organs, belonging to severe tuberculosis.
After the diagnosis was confirmed, the department gave Li Ming anti-tuberculosis and other symptomatic and supportive treatment in time, but during the treatment, Li Ming’s fever was still not controlled, and the bronchoalveolar lavage fluid mycobacteria rapid culture drug sensitivity report prompted “Multi-drug-resistant tuberculosis”, it was discovered that the reason for Li Ming’s poor anti-tuberculosis drug treatment was infection with drug-resistant tuberculosis.
“Drug-resistant tuberculosis refers to tuberculosis in which the infected Mycobacterium tuberculosis is resistant to one or more anti-tuberculosis drugs. Drug-resistant tuberculosis is different from ordinary tuberculosis in that the cure rate is low, The long treatment cycle, high treatment cost, and serious adverse drug reactions are difficult problems for tuberculosis in the world at present.”
Director Pei Yi of the Sixth Ward of the Pulmonary Hospital, Department of Economics During the discussion, an individualized drug resistance treatment plan was formulated for Li Ming, including the application of the current new anti-tuberculosis drug, bedaquiline.
After half a month of starting drug-resistant treatment, Li Ming’s condition was gradually controlled, and his cough and fever were relieved.
Why such severe drug-resistant tuberculosis occurs within a short period of time after liver transplantation?
Director Pei Yi explained: Organ transplantation requires long-term use of immunosuppressive agents, which not only leads to a decline in the patient’s immune function, but also easily leads to various infectious diseases, including tuberculosis, and infection. After tuberculosis, the positive rate of acid-fast bacilli in clinical specimens is high, the bacterial quantity is large, blood disseminated pulmonary tuberculosis and extrapulmonary tuberculosis are relatively common, and multiple pathogens are often combined at the same time.
With the development of medical science, the number of organ transplants is increasing year by year. So, what should people pay attention to in the prevention and early detection of tuberculosis after transplantation?
Director Pei Yi reminded that, first of all, pay attention to the screening of latent tuberculosis infection in recipients and donors before transplantation , fully assess whether there are indications for preventive anti-tuberculosis treatment, so as to avoid the occurrence of tuberculosis after transplantation.
During home recuperation after transplantation, reasonably increase nutrition, regularly ventilate the room, and wash, dry, and disinfect daily necessities frequently. Proper exercise to enhance resistance;
Try to avoid going to crowded and poorly ventilated places, wear a mask when going out;< /p>
If someone in the family has symptoms of cough, fever, and fatigue, they should take the initiative to wear a mask, seek medical examination in time, and avoid close contact with patients after transplantation;
If the diagnosis is confirmed after transplantation Complicated with tuberculosis, due to the low immune function of this group of people, the disease progresses rapidly, and multi-organ tuberculosis is prone to spread, so it is necessary to actively fight tuberculosis in strict accordance with the principle of “early stage, whole process, combination, appropriate amount, and regularity”
At the same time, it is necessary to be alert to drug-resistant tuberculosis infection, and conduct molecular drug resistance and drug susceptibility testing as soon as possible, so as to formulate drug resistance regimens as soon as possible and realize individualized and precise treatment.
(edited by Rainbow. Some pictures are from the Internet, invaded and deleted)
Special author of Hunan Medical Chat: Changsha Central Hospital (Changsha Central Hospital affiliated to South China University) He Fang Zhu Wenqing
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