Be wary of Mycobacterium tuberculosis who "pretend to sleep"! It is often mistaken for a cold in the early stages of the disease

Experts interviewed: Gao Mengqiu, director of the Second Department of Tuberculosis, chief physician and professor of Beijing Chest Hospital

Global Times health client reporter Zhang Mian

"Pale, emaciated, heart-wrenching cough..." There was no shortage of such descriptions in novels and plays in the 19th century, and it was tuberculosis, or tuberculosis, or "tuberculosis", which was then called the "white plague". Today, TB remains one of the top 10 causes of death worldwide. This year, 24 March marks the 28th World TB Day, with the theme "You and I work together to end the TB epidemic". In 2014, the World Health Organization expressed a desire to reduce the incidence of tuberculosis to less than 1 in 10,000 by 2035. In 2015, the United Nations Sustainable Development Goals 2030 also called for ending the TB epidemic by 2030. But on current trends, we are still far from that goal.

Gao Mengqiu, director of the Second Department of Tuberculosis, chief physician and professor of Beijing Chest Hospital, said in an interview with the "Global Times Health Client" reporter that the "ten tuberculosis and nine deaths" mentioned by the old society have become history, but tuberculosis is still one of the major global public health challenges. According to the "2022 Global TB Report" released by the World Health Organization, in 2021, there were 10.6 million new TB patients in the world and 780,000 new TB patients in China. Among the 30 countries with a high burden of TB, the continent has the third highest estimated TB case.

The culprit behind tuberculosis is Mycobacterium tuberculosis, commonly known as Mycobacterium tuberculosis, which has no ability to exercise, and to achieve transmission must use "transportation" - droplet nuclei. When tuberculosis patients cough and sneeze, they can produce a large number of droplet nuclei, about 5 microns in diameter, floating in the air. When healthy people inhale such air, Mycobacterium tuberculosis will take the opportunity to enter the body. Most of the tuberculosis bacilli will be killed by the human immune system, but some can escape the "chase" of the immune system and survive in the body. In addition to hair and teeth, Mycobacterium tuberculosis can infect various organs of the human body and cause corresponding diseases, such as tuberculosis, bone tuberculosis, tuberculous pleurisy, tuberculous meningitis, renal tuberculosis and lymph node tuberculosis.

Whether Mycobacterium tuberculosis enters the human body and causes disease mainly depends on two factors: the virulence of Mycobacterium tuberculosis and the immunity of the human body. If the virulence of Mycobacterium tuberculosis is strong, and the person's immunity is weak, and Mycobacterium tuberculosis multiplies in large numbers in the body, people will have symptoms and get sick. When the virulence of Mycobacterium tuberculosis is weak, the person's immunity is strong, and the bacterium tuberculosis will be eliminated. There is also a third situation, when the body's immunity and the virulence of Mycobacterium tuberculosis are evenly matched, the intelligent Mycobacterium tuberculosis will "pretend to sleep", medically called dormant bacteria. This situation is the most worrisome, because once the body's immunity is weakened, such as when you have a serious illness, have an operation, and are extremely tired, dormant Mycobacterium tuberculosis will recover, multiply again, and develop into active tuberculosis. Therefore, six categories of people should pay special attention: 1. people who have recently been exposed to infectious tuberculosis patients, especially children under 5 years old; 2. HIV-infected people; 3. people who use biological agents; 4. organ transplant patients; 5. pneumoconiosis patients; 6. hemodialysis patients. In these people, those infected with Mycobacterium tuberculosis are recommended for preventive anti-tuberculosis therapy even if they do not have the disease. Of course, all cases of weakened immunity can lead to the onset of tuberculosis.

Gao Mengqiu said that as far as individuals are concerned, they should start from the four links of tuberculosis transmission to interrupt it.

First, BCG vaccination. At present, the first dose of vaccine for newborns in mainland China is BCG, which can allow newborns to obtain immunity against Mycobacterium tuberculosis and reduce the incidence of severe tuberculosis. It is generally not recommended for adults to be revaccinated, due to years of contact with the outside world, passive immunity has been formed, and a considerable part of antibodies have been formed in the body. To determine whether BCG has been injected, look for soybean-sized scars on the deltoid muscle of the arm.

Second, find symptoms and treat them in time. If cough or sputum production occurs for more than two weeks, especially if symptoms such as bloody sputum appear, you should see a doctor in time. The symptoms of elderly patients are sometimes not as typical as those of young people, so they are often mistaken for colds, if fever, cough for more than 2 weeks, after general anti-cold, upper respiratory tract infection treatment symptoms still not relieved, and accompanied by obvious fatigue, must be vigilant, timely medical attention. Once diagnosed, it should be actively treated and follow the cross policy: early, the earlier the drug, the better; Combination, a single drug is not possible, multiple drugs need to be used in combination; Regular, must take medicine regularly according to the doctor's advice; Throughout the process, tuberculosis needs to be treated throughout the course, at least 6 months, must be adhered to; Moderately, TB treatment is administered from person to person, and the treatment dose for each person is calculated according to body weight. As long as regular treatment is adhered to, the vast majority of patients can be cured.

Third, control potential sources of infection. Mycobacterium tuberculosis is very viable, can be transmitted by droplets, and has a wide spread and long harmful time. The mainland has promulgated the Law on the Prevention and Control of Infectious Diseases, allowing sterilization patients to receive treatment under scientific management. Patients with active tuberculosis themselves should also improve their sense of social responsibility, restrain their behavior during the expulsion period, and avoid going to public places; Actively wear a mask and dispose of it properly when you go home, such as burning it or wrapping it and throwing it in the trash; If you forget to wear a mask, take the initiative to keep a safe distance of more than 1 meter from people, and consciously cover your mouth and nose with the inside of your forearm when coughing or sneezing, and it is not recommended to cover it with your hands.

Fourth, healthy people should be consciously avoided. Actively wear masks in settings at high risk of TB transmission, such as when visiting hospitals or people with suspected TB. Develop good living habits, combine work and rest, exercise moderately, ensure nutrition, do not spit, and often open windows indoors to ventilate. ▲

Responsible editor: Pan Zihu

Editor-in-chief: Xu Wenting