In March 2020, Xiao Liu Jingren, a 30-year-old young woman living in Tianshui, Gansu Province, was introduced to the Department of Respiratory and Critical Care Medicine of the Second Affiliated Hospital of Xi'an Jiaotong University to seek medical treatment, her situation was more complicated, repeated coughing for half a year, no matter what medicine she took, it did not work, but she did not have much phlegm and did not have a fever. But all the diseases that belong to chronic cough she did not have typical clinical features and were ruled out one by one. What was the cause of her lingering cough?
"There are many causes of chronic cough, but none of them have typical features... At that time, she was suggested to have a tracheoscopy, but her family did not agree, and the symptoms did not alleviate after taking the medicine for 2 weeks."
Professor Yang Shuying, director of the department who received the patient Xiao Liu, told us that the cough was more severe when the patient first came to the doctor, and its clinical manifestation was a chronic cough for more than 2 months. Chronic cough is more common diseases, such as: chronic bronchitis, COPD, gastroesophageal reflux, cough variant asthma, as well as upper airway syndrome (i.e., retronasal drip syndrome), eosinophilic bronchitis, etc... But the most common is bronchitis, which usually manifests as a chronic cough that persists for a long time.
At that time, the patient's cough symptoms were not very similar to the cough manifestations of typical bronchitis, and considering the long cough, it may be an infection, so we recommended that they do tracheoscopy to determine the cause. However, due to the invasive examination of tracheoscopy, the family is worried that the patient is unbearable and does not agree to the examination. Anti-inflammatory treatment had to be carried out first. Anti-inflammatory and sputum-reducing drugs were prescribed, and the patient returned to the clinic after about 2 weeks of taking it, and the cough still did not improve. At our strong recommendation, patients and their families reluctantly agreed to undergo a tracheoscopy, which resulted in a mycobacterium tuberculosis infection, commonly known as "tuberculosis (tuberculosis)".
What are the typical symptoms of tuberculosis?
Professor Yang replied to us, first of all, fever is the most common systemic symptom of tuberculosis. However, the clinical manifestations of tuberculosis are also different, and some patients infected with Mycobacterium tuberculosis do not have any clinical manifestations of tuberculosis at all. Moreover, inactive tuberculosis has no obvious symptoms and may only be detected during chest imaging examination. Active tuberculosis usually presents with cough, sputum production, hemoptysis, night sweats, chest pain, wasting, fatigue, and poor appetite. Because some patients can have no clinical manifestations, tuberculosis is sometimes difficult to diagnose in time. The patient is a young woman with cough, prolonged cough, sputum production, which cannot be ruled out as tuberculosis. At that time, although the patient's chronic cough caused by infection was taken into account, because there were no systemic symptoms such as the most common fever, and there were no symptoms such as weight loss, fatigue, and poor appetite, it was not immediately thought that it was mycobacterium tuberculosis infection.
Since fever is the most common constitutional symptom of tuberculosis, what are the chances of a patient having a fever?
Professor Yang replied that the fever in patients caused by Mycobacterium tuberculosis infection may account for less than two-thirds of the clinical situation. That is, one-third of infected people do not have fever. Therefore, tuberculosis cannot be completely excluded in patients with long-term chronic cough, although there is no fever, without the typical manifestations of tuberculosis. Endoscopy should be done as early as possible, and it is especially important to confirm the pathogen of infection through laboratory tests (laboratory tests, cultures, etc.). Because Mycobacterium tuberculosis is an infectious disease that can be transmitted by droplets, many people now think that the environment is getting better and better, public health conditions have been greatly improved than in the past, tuberculosis and other infectious diseases are fewer, not easy to infect, but in fact, it is not so, our country's tuberculosis is more than the number of tumors detected every year, especially coughing patients through droplets spread tuberculosis is the most common, these belong to open tuberculosis, that is, air (droplet) transmitted tuberculosis.
"Some patients may have recurrent symptoms of upper respiratory tract infection, different locations of lesions, different manifestations of cough and comorbid symptoms... Women with these three characteristics are easy to "stare" at tuberculosis."
Professor Yang told us that most of the onset of tuberculosis is slow, and with the progression of the lesion, patients can not only have symptoms such as cough, sputum production, blood in sputum or hemoptysis, but also some patients can have recurrent symptoms of upper respiratory tract infections. However, the location of the lesion varies, and the manifestations and symptoms of cough are different, such as:
1. Lesions occur in the trachea, bronchial mucosa, may have irritating cough, coughing up blood, chest pain and dyspnea and other symptoms;
2. Tuberculosis in children can also show developmental delay. Primary tuberculosis in children can compress the trachea or bronchi due to enlarged tracheal or parabronchial lymph nodes, or lymphadenopathy-bronchial fistula, often with symptoms such as wheezing;
3. Patients with tuberculosis can also have systemic symptoms, such as night sweats, fatigue, intermittent or persistent afternoon low fever, loss of appetite, weight loss, etc.; female patients may be accompanied by menstrual disorders or amenorrhea; a small number of patients have a sudden onset of illness, with moderate and high fever, and some with varying degrees of dyspnea.
Professor Yang also told us that there are a small number of patients who can be accompanied by tuberculous hypersensitivity syndrome, including: erythema nodosum; arthritis, etc. When patients have extrapulmonary tuberculosis, symptoms involving organs can also occur, such as: deformities and dysfunction of osteoarticular tuberculosis; headache and meningeal irritation signs of tuberculous meningitis; alternating diarrhea and local tenderness of digestive tuberculosis; painless hematuria and infertility of genitourinary tuberculosis.
But even if tuberculosis has so many distinguishable symptoms, there are not a few tuberculosis patients with symptoms like Xiao Liu who have atypical symptoms and almost no other manifestations except chronic cough. Reminds us, what kind of people or people with underlying diseases have chronic cough, and think that it may be tuberculosis?
Professor Yang told us that the first is that young people, especially young women, should not forget to suspect tuberculosis when they have a chronic cough; the second is diabetes. Although young women have less diabetes, don't forget that there are two types of diabetes, and type I is more likely to be young. Patients with type I and type II diabetes are prone to tuberculosis, relatively speaking, type II diabetic patients are older and find more tuberculosis; the third is long-term fatigue, malnutrition, staying up late, especially people with poor mood and depression, who are most likely to be infected with tuberculosis.
For example, Lin Daiyu, the typical character in the novel "Dream of the Red Chamber", is such a group of people, and depression will reduce human immunity. Tuberculosis infection has a lot to do with whether the human immunity is strong or not, because it exists in the air, if the body's immune function is strong and the resistance is strong, it is not easy to be infected. Therefore, remind us that maintaining a cheerful, sunny mood, adhering to appropriate physical exercise, not staying up late, and balanced nutrition help to improve the body's immunity and resist the invasion of tuberculosis.
