Today(March 24)
It is World TB Day.
Mr. Wang, 39, participated in the physical examination organized by the unit, and a chest CT examination showed that there was a shadow in the upper lobe of his right lung. When the imaging doctor told him that it might be tuberculosis, Mr. Wang's first reaction was: Isn't the tuberculosis long gone? How did I get this disease?
Don't think TB is far away 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 the notifiable infectious diseases, the number of tb patients is second only to viral hepatitis. Tuberculosis remains a serious public health problem. To be sure, TB will not go away for quite some time.
Tuberculosis is a chronic infectious disease that seriously endangers health caused by infection with Mycobacterium tuberculosis. Tuberculosis bacteria can invade many organs throughout the human body, such as lungs, lymph nodes, pleura, bone and joints, skin, meninges, kidneys, etc., but mainly through the human respiratory tract to spread, so tuberculosis is the most common tuberculosis, accounting for more than 80% of various types of tuberculosis.
According to the World Health Organization, on average, one in every 4 people in the world has tuberculosis bacteria lurking in their bodies, and 5% to 10% of them may develop active tuberculosis in their lifetime, which is a large potential patient pool. China is a country with a high burden of tuberculosis, and tuberculosis prevention and control is still a long-term and arduous task.
Tuberculosis does not necessarily require coughing and sputum production
Mr. Wang came to our hospital to continue his diagnosis and treatment. After a blood test, combined with Mr. Wang's chest CT performance, the doctor came to the same conclusion: it met the diagnostic criteria for tuberculosis and recommended anti-tuberculosis treatment. Another question that confuses Mr. Wang is: Doesn't it mean that tuberculosis will cough and cough up sputum? How come I don't have any discomfort?
Doctors told him that the cough and sputum of tuberculosis were manifestations of tuberculosis bacteria damaging lung tissue. The lungs produce inflammatory exudations in the process of injury and repair, and the nervous system transmits signals to the cough center, which in turn transmits the signal to the motor nerves, so cough and sputum cough occur. However, if the condition is mild, the inflammatory exudation is not obvious, and the nervous system does not report to the cough center, cough and sputum will not occur. Mr. Wang found a shadow of the lungs through a physical examination, and the lesions were still relatively mild, so he had not yet produced typical tuberculosis symptoms.
What tests are needed to confirm tuberculosis
The diagnosis of tuberculosis depends on the tuberculosis bacteria examination of sputum, but Mr. Wang has no sputum, so naturally he cannot perform sputum examination. The doctor prescribed Mr. Wang a γ-interferon release test for his blood. A positive test indicates infection with TB bacteria, which is either a TB-infected person or TB patient. Since Mr. Wang's chest CT has typical tuberculosis manifestations, he is naturally not a tuberculosis infected person and should be diagnosed as a tuberculosis patient. According to the classification of diagnostic criteria, it does not belong to the definitive diagnosis of tuberculosis, but to the clinically diagnosed tuberculosis. Clinical diagnosis may be misdiagnosed in rare cases, so during treatment, it is necessary to review the chest CT to assess the efficacy, observe the change in the size of the lesion, and once the lesion is found to be enlarged after anti-tuberculosis treatment, it is necessary to perform lung puncture or bronchoscopy to further clarify the diagnosis.
Another important test to diagnose tuberculosis is chest CT. Chest CT can make lesions that cannot be detected on chest x-rays nowhere to be seen. Mr. Wang does a physical examination every year, but the previous lung examination is to take chest X-ray, so it is likely that there were lung lesions during the previous physical examination, but at that time, the lesions were mild, and the chest x-ray was not found, until the lesions were not found after the chest CT was done. Because the characteristics of tuberculosis in Mr. Wang's lung lesions are more obvious, the doctor directly locks on tuberculosis.
Some patients have small nodules or ground glass shadows in the lungs, and neither blood tests, bronchoscopy, nor PET-CT can determine the nature of these lesions. Direct surgical removal may accidentally injure some benign lesions, and will also bring harm to the body. At this time, the most rational and scientific way is to observe regularly under the guidance of professional doctors, in most cases, this lesion remains unchanged for a long time, and a small number of lesions are operated immediately after the enlargement is found, and the treatment effect will not be affected by the delay of surgery.
Infection of tuberculosis is conditional
Mr. Wang was very convinced by the doctor's explanation, and another question he was concerned about was whether his tuberculosis would be transmitted to his wife and children. The droplets produced after coughing in tuberculosis patients are the most important route of transmission, and Mr. Wang is the tuberculosis found in the physical examination, there is no cough, coughing up sputum and other symptoms, and the risk of transmission to the family is almost negligible. After the doctor's analysis, Mr. Wang's hanging heart was also put down.
It is impossible to inquire when and where Mr. Wang was infected with tuberculosis bacteria. Perhaps because of the hard work of picking up lights and fighting at night and reading hard when I was a student, or maybe it was due to the hard work and tiredness after work, after inhaling the droplets coughed up by tuberculosis patients, I was unfortunately "caught". Perhaps a few months, a few years, a dozen years later, at a special point in time, the immune balance of the body and bacteria was broken, and Mr. Wang became a tuberculosis patient from a tuberculosis infected person.
Fortunately, Mr. Wang's tuberculosis was found relatively early, and after 6 months of treatment, most of the lesions were absorbed. Now Mr. Wang has long returned to a tense and busy work. Young people like Mr. Wang should also pay attention: tuberculosis does not retreat because you are young, it will peep from the side and show its fangs when it is not noticed. Therefore, to end tuberculosis, we still need to work together.
Source| Popular Health
The author | Duan Hongfei, Beijing Chest Hospital affiliated to Capital Medical University
Audit | expert of the National Health Science Popularization Expert Database
Li Liang, Beijing Chest Hospital affiliated to Capital Medical University
Planning | Wu Weihong Tan Jia
Edited | Luan Zhaolin