Today (March 24)
It is World TB Day.
Mr. Wang, 39 years old, participated in the physical examination organized by the unit, and a chest CT examination showed a shadow in the upper lobe of his right lung. When the radiologist told him that it might be tuberculosis, Mr. Wang’s first reaction was: Didn’t the tuberculosis disappear long ago? How did I get this disease?
Don’t think TB is far from you
There may be many people like Mr. Wang who have the illusion that tuberculosis, like cholera and plague, has left us. In fact, among notifiable infectious diseases, tuberculosis is second only to viral hepatitis. Tuberculosis remains a serious public health problem. To be sure, TB won’t go away for quite some time.
Tuberculosis is a serious, chronic infectious disease caused by Mycobacterium tuberculosis infection. Tuberculosis can invade many organs of the human body, such as lungs, lymph nodes, pleura, bones and joints, skin, meninges, kidneys, etc., but it is mainly transmitted through the human respiratory tract. Therefore, pulmonary tuberculosis is the most common type of tuberculosis, accounting for 80% of all types of tuberculosis. %above.
According to the World Health Organization, 5% of the world’s 7 billion people have 1 in 4 harboring TB bacteria. ~10% are likely to develop active tuberculosis during their lifetime, representing a large pool of potential patients. China is a country with a high burden of tuberculosis, and tuberculosis control is still a long-term and arduous task.
TB does not necessarily cause coughing and sputum production
Mr. Wang came to our hospital for further diagnosis and treatment. After a blood test and combined with Mr. Wang’s chest CT findings, the doctor came to the same conclusion: the diagnostic criteria for pulmonary tuberculosis were met, and anti-tuberculosis treatment was recommended. Another question that confuses Mr. Wang is: doesn’t it mean that pulmonary tuberculosis will have cough and phlegm? Why am I not feeling any discomfort?
The doctor told him that the cough and phlegm of tuberculosis is the manifestation of tuberculosis damage to the lung tissue. In the process of damage and repair, the lungs produce inflammatory exudation, and the nervous system transmits signals to the cough center, which in turn transmits signals to the motor nerves, resulting in coughing and expectoration. But if the disease is mild, the inflammatory exudation is not obvious, and the nervous system does not report to the cough center, coughing and expectoration will not occur. Mr. Wang’s lung shadow was found through physical examination, and the lesions were relatively mild, so he did not have typical symptoms of tuberculosis.
What tests are needed to diagnose tuberculosis
The diagnosis of pulmonary tuberculosis depends on the TB test of sputum, but Mr. Wang has no sputum, so naturally he cannot conduct a sputum test. The doctor prescribed a blood interferon-gamma release test to Mr. Wang. If the test is positive, it indicates that you have been infected with TB bacteria, that is, a person with TB infection or a patient with TB. Since Mr. Wang’s chest CT has typical manifestations of pulmonary tuberculosis, he is naturally not a tuberculosis infection, and must be diagnosed as a tuberculosis patient. According to the classification of diagnostic criteria, it does not belong to the definite diagnosis of pulmonary tuberculosis, but belongs to the clinical diagnosis of pulmonary tuberculosis. In rare cases, the clinical diagnosis may be misdiagnosed. Therefore, during the treatment process, chest CT should be reviewed to evaluate the curative effect, and changes in the size of the lesions should be observed. Bronchoscopy and other examinations further confirmed the diagnosis.
Another important test for diagnosing tuberculosis is chest CT. Chest CT can make the lesions that cannot be found on chest X-ray nowhere to hide. Mr. Wang has a physical examination every year, but the previous lung examinations were all chest X-rays, so it is very likely that there were lung lesions during the previous physical examination, but the lesions were mild at that time, and the chest X-rays were not found until the examination. The lesions were discovered only after chest CT. Since Mr. Wang’s lung lesions have obvious characteristics of tuberculosis, the doctor directly targeted tuberculosis.
Some patients have small nodules or ground-glass opacities in the lungs, and neither blood tests, bronchoscopy, nor PET-CT can determine the nature of these lesions. Direct surgical resection may injure some benign lesions by mistake, and also bring harm to the body. At this time, the most rational and scientific method is to observe regularly under the guidance of professional doctors. In most cases, the lesions will remain unchanged for a long time. A small number of lesions will be operated immediately after they are found to be enlarged, and the treatment will not be affected by the delay of surgery. Effect.
Tuberculosis infection is conditional
Mr. Wang is very convinced by the explanation given by the doctor. Another question he is concerned about is whether his tuberculosis will spreadDyed to wife and children. Droplets produced by pulmonary tuberculosis patients after coughing are the most important route of transmission. Mr. Wang was found to have pulmonary tuberculosis in a physical examination. There are no symptoms such as coughing and sputum. Ignore. After the doctor’s analysis, Mr. Wang’s dangling heart was also put down.
It is impossible to find out when and where Mr. Wang was infected with TB. Perhaps it was because of the hard work and hard work during the school days, or because of the hard work and exhaustion after work, after inhaling the droplets coughed up by tuberculosis patients, unfortunately, he was “hit”. Maybe a few months, a few years, or a dozen years later, at a certain point in time, the immune balance between the body and bacteria was broken, and Mr. Wang changed from a TB-infected person to a TB patient.
Fortunately, Mr. Wang’s tuberculosis was detected earlier. After 6 months of treatment, most of the lesions were absorbed. Now Mr. Wang has returned to his intense and busy work. Attention young people like Mr. Wang: TB doesn’t shy away from you just because you’re young, it peeks by, baring its fangs when unnoticed. Therefore, ending tuberculosis still requires our joint efforts.
Source | Public Health Magazine
Author｜ Duan Hongfei, Beijing Chest Hospital Affiliated to Capital Medical University
Review｜Experts of National Health Science Expert Database
Li Liang, Beijing Chest Hospital Affiliated to Capital Medical University
Planning｜Wu Weihong and Tan Jia
Editing｜Luan Zhaolin