1. Does tuberculosis still exist in the world and on the continent?
A: Tuberculosis persists not only on the mainland, but also around the world. To date, tuberculosis remains one of the top 10 causes of death worldwide. In the past five years, the mainland has ranked 2-3 in the world in the incidence of tuberculosis.
2. How do tuberculosis bacteria destroy people's health?
A: Tuberculosis is a chronic infectious disease caused by infection with the bacillus tuberculosis bacillus. Tuberculosis bacteria may invade various organs of the human body, but they mainly invade the lungs, which is what we usually call tuberculosis. Tuberculosis is mainly transmitted through droplets, and the usual sneezing and coughing of tuberculosis patients can release the tuberculosis bacteria in the lungs into the air in the form of droplets, or more professionally, aerosols, to spread and infect other people. When a healthy person inhales air containing a sufficient amount of tuberculosis bacteria, a part of the population will become ill, and some of these people will recover without treatment; Others have progressively worsening symptoms and need to be treated with medication to recover.
3. In which organs can tuberculosis occur?
A: Tuberculosis is a chronic infectious disease caused by infection with the bacterium Mycobacterium tuberculosis. Tuberculosis bacteria may invade various organs throughout the body, but mainly the lungs, which is called tuberculosis. In addition to pulmonary tuberculosis, there are also the more common tuberculous pleurisy, tuberculous meningitis, bone tuberculosis and lymph node tuberculosis.
4. Who is susceptible to TB?
A: Tuberculosis is mainly infected by people with reduced resistance, such as malnutrition (such as hypoproteinemia, anemia, etc.), smoking, irregular life, staying up late for a long time leading to sub-health of the body, and other diseases such as diabetes, AIDS, organ transplantation, depression, or patients with rheumatic immune system diseases that require long-term use of immune preparations.
5. What are the respiratory symptoms of tuberculosis?
Answer: (1) Cough and sputum: If the patient is infected by tuberculosis bacteria and infiltrates the lungs, the cough and sputum are mild, and may only manifest as dry cough or a small amount of mucus sputum. When cavities form, the amount of sputum increases. If secondary infection is present, the sputum is purulent. Cough is exacerbated with bronchial tuberculosis, and irritating choking may occur. Cough and sputum for more than 2 weeks, and do not improve after treatment, go to the hospital to be screened for tuberculosis. (2) Hemoptysis: Although destructive lesions are prone to hemoptysis (disease worsening stage), there are also healing lesion fibrosis and calcified lesions that directly or indirectly cause hemoptysis (disease improvement stage). (3) Chest pain: the location of the pain is uncertain, often dull pain, which is caused by nerve reflex. sometimes pinprick pain in a fixed position, worse with breathing, and less pain in the decubitus position on the affected side, suggests pleural involvement; When the diaphragm is irritated, pain can be reflected to the shoulder or upper abdomen.
6. Why do some tuberculosis patients have no cough and sputum symptoms?
A: Some people with TB may have no respiratory symptoms but can present with systemic symptoms. (1) Fever: Fever is the most common symptom of systemic toxicity of tuberculosis. Most of them present with a long-term low-grade fever, which usually begins in the early afternoon or evening and decreases to normal in the early hours of the next morning. May be accompanied by lethargy, fatigue, night sweats, or no apparent discomfort. Patients with high fever of tuberculosis, although they may not improve due to the lack of timely diagnosis and treatment, are in relatively good general condition, which is different from the extreme debilitation and debilitation of other infectious diseases. (2) Others: Other systemic symptoms include loss of appetite, weight loss, and female patients may be accompanied by menstrual disorders or amenorrhea.
7. How can new drug resistance be detected?
A: First of all, all tuberculosis patients should undergo a drug susceptibility test for tuberculosis bacteria at the early stage of diagnosis, that is, whether the tuberculosis bacteria in the body are sensitive to or resistant to each drug. For some patients who have received unreasonable treatment regimens, such as insufficient drug selection, unreasonable drug regimen combination, or insufficient therapeutic dose of drugs, or a long period of discontinuation in the treatment process, we need to perform drug sensitivity again to find out whether there is new drug resistance. For example, after anti-tuberculosis treatment, the chest CT scan shows that the lesions in the lungs are not shrinking, but are getting worse, and the drug susceptibility test should be performed again to understand whether drug resistance has emerged, resulting in an unreasonable current treatment plan.
8. What laboratory tests can be used for drug resistance testing?
A: At present, the more commonly used methods of detecting drug resistance, including the traditional detection of drug resistance through Roche culture, usually take 3 months to produce results; There is also a shorter time for drug resistance testing through liquid media, which takes 1-2 months to get results; At present, more advanced molecular biology techniques can detect drug resistance by rapidly detecting gene fragments of tuberculosis bacteria in the body, and it only takes 1-2 days to find drug-resistant tuberculosis bacteria.
02 Treatment and medication of tuberculosis
9. What are the "treatment principles" for tuberculosis that patients should follow with their doctors?
A: The principles of chemotherapy for tuberculosis are: early, regular, whole, appropriate amount, and combination. This is the current internationally recognized principle of chemotherapy, and it is also the "cross policy" that doctors must abide by in the process of treatment. Specifically, it refers to the fact that a reasonable and formal chemotherapy regimen for anti-tuberculosis treatment requires high-efficiency antiseptics, sufficient and reasonable dosages, scientific administration methods, adequate treatment courses, and regular and early medication to achieve a cure for tuberculosis. However, due to the long course of treatment and the variety of medications to be taken, the patient's full understanding and active cooperation are also inseparable from the final treatment effect. Therefore, it can be said that this is a "cross policy" that needs to be followed by both tuberculosis patients and doctors.
10. How to follow up and re-examine tuberculosis patients during the period of continuous treatment after discharge?
A: Discharged patients should come to the hospital for follow-up within 1-2 weeks after discharge to know whether there are any adverse drug reactions during the treatment. Please consult the physician in charge of the patient at the time of admission in the outpatient or inpatient ward. Please note that you need to register at the outpatient clinic on the day of the follow-up visit; If you need a blood test for a follow-up, please come to the hospital on an empty stomach on the day of your visit.
11. What tests are needed during treatment for TB patients?
Answer: Discharged patients should be rechecked every month after discharge to understand the effect of treatment. If there are special circumstances, it needs to be reviewed at any time. Discharged patients should have chest CT re-examined every 2-3 months after discharge to understand the effect of treatment. If there are special circumstances, it needs to be reviewed at any time.
12. How is susceptible tuberculosis treated?
A: Different tuberculosis diseases have different drug choices and treatment durations. Sensitive tuberculosis is a relatively easy type to treat, most of these patients are infected with tuberculosis for the first time, and the choice of treatment drugs is relatively simple, usually 3-4 anti-tuberculosis drugs are taken together; The course of treatment is also relatively short, and most patients can complete the treatment in 6-9 months; For some patients with extrapulmonary TB, the course of treatment may need to be extended to 1 year or more; The response to treatment is also usually good.
13. What are the common adverse reactions during the treatment of sensitive tuberculosis?
A: The adverse drug reactions of sensitive tuberculosis are milder than those of drug-resistant tuberculosis, and most of them are uneasiness, fatigue, abnormal liver function, etc.
14. How is drug-resistant TB treated?
A: Another type of tuberculosis is drug-resistant tuberculosis, which requires more drug treatment, usually requiring 5-7 drugs at the same time, including some infusion drugs; The course of treatment is also longer, requiring at least 20 months of medication; The price of drugs is also high, the cost of a drug can reach thousands of yuan or even tens of thousands of yuan a month, and 5-7 drugs need to be taken at the same time; However, despite this, the cure rate of these drug-resistant tuberculosis patients is also low, partly because the drug-resistant bacteria themselves are more difficult to control, and partly because of the long course of drug-resistant tuberculosis treatment, high cost and many adverse reactions, so many patients are difficult to complete the entire course of treatment, resulting in an increase in the number of patients who fail treatment.
15. What are the new drugs for the treatment of drug-resistant tuberculosis?
A: Refers to other anti-tuberculosis drugs other than first-line drugs. Adverse effects are usually more common. Second-line drugs can also be divided into two types according to different modes of administration: second-line injectable drugs (amikacin, kanamycin, capreomycin); Second-line oral antituberculosis drugs (fluoroquinolones such as levofloxacin and moxifloxacin, cycloserine, propylthionamide, sodium p-aminosalicylate, isoniazid, clofazimine, linezolid, bedaquiline, etc.). Bedaquiline and delamani are new anti-tuberculosis drugs after 2020, bringing hope to this type of tuberculosis patients. At present, there are two new drugs in class 1.1 independently developed by the mainland: suldapyridine and pifazimine, which will bring more options for the treatment of drug-resistant tuberculosis in the future.
16. What are the common adverse reactions in the treatment of drug-resistant tuberculosis?
A: There are also many adverse reactions of drugs in the treatment of drug-resistant tuberculosis, such as some drugs may cause discomfort in appetite, abnormal liver function, abnormal kidney function, abnormal thyroid function, abnormal hematopoietic system (such as anemia, low platelets, etc.), and neurological abnormalities (such as leg numbness, blurred vision, etc.).
17. What are the precautions during the treatment and medication?
Answer: Take the drug on time, do not stop the drug or increase or decrease the dose by yourself, otherwise it is easy to cause the risk of poor treatment effect, recurrence, secondary drug resistance and so on. If there is an infusion or intramuscular drug in the tuberculosis regimen, it should not be stopped after discharge, and if there are difficulties, please adjust it under the guidance of a doctor.
03How can we prevent and treat tuberculosis?
18. How can people with TB reduce transmission to others during their illness?
Answer: Patients with bacterial positive, please consciously isolate from others and avoid going to public places or crowded places; or strictly wear N95 masks to prevent infecting others; Please refrain from spitting or discarding phlegm. Please keep the room well ventilated, and keep the items in the sun regularly.
19. How can I improve my immunity and nutritional status in my own life?
A: Make sure you get enough rest and sleep, and avoid staying up late; Ensure a balanced diet and high-quality protein intake, such as milk, eggs, lean meat, etc.; Maintain an optimistic attitude; frequent sun exposure; Pay attention to keeping warm clothes to avoid catching a cold.
20. How to disinfect the living environment and materials of tuberculosis patients?
Answer: The tableware used by the patient can be boiled and sterilized, and the tuberculosis bacteria can be killed by boiling for 10 minutes. The patient's clothes and bedding can be exposed to the sun for 2-4 hours to achieve the purpose of disinfection. The room should be ventilated with open windows, the living room can be disinfected with ultraviolet radiation and ozone, and the ground can be sprayed with chlorine-containing disinfectant.
21. How to deal with the sputum of tuberculosis patients?
A: Tuberculosis is mainly transmitted through the respiratory tract, so don't cough or sneeze into others. Cover your mouth and nose when coughing or sneezing, and wear a disposable mask if your condition allows you to breathe. Prepare a spittoon with a lid, put disinfectant in it, such as 84 disinfectant solution and chlorogen, spit the sputum into the spittoon, and clean the spittoon every day. If you accidentally spit sputum on the ground, you can disinfect it with 84 disinfectant solution and then wipe it.
22. How do tuberculosis patients exercise?
Answer: Proper physical exercise for tuberculosis patients can enhance respiratory and circulatory functions, promote gas exchange and gastrointestinal peristalsis, increase the secretion of digestive juices, increase appetite, improve sleep, and enhance body resistance, which is good for lesion absorption and improving drug efficacy. Physical exercise should not be strenuous and should be suitable for walking, tai chi and other items. Patients with acute symptoms, such as high fever, chest tightness, breath-holding, hemoptysis, pneumothorax and other comorbidities, should rest or stay in bed absolutely, and should not participate in physical exercise.
23. How can family members protect themselves when accompanying tuberculosis patients?
A: Ensure adequate nutrition and eat high-calorie, high-quality protein, vitamins and minerals. Arrange rest and sleep reasonably, and ensure that you sleep for at least 6 hours a day to ensure sufficient physical strength. Hands should be washed promptly when touching the excreta of sick people. Hand sanitizer should be used to disinfect hands when touching patient drains. The utensils of the escort should be used separately from the patient, and the toiletries should be used exclusively to avoid transmission to the digestive tract. Bedding and clothes are always kept dry and dried in the sun. Appropriate physical exercise to enhance the body's immunity.
24. Will TB patients always be contagious?
A: Tuberculosis is the most contagious before treatment, and the contagiousness will decrease rapidly after treatment, it is best if you can live separately, if you can't live separately, try not to live in one room. Because TB is mainly transmitted through the respiratory tract, try not to have too much intimate contact with people around you, especially not to talk face-to-face. Usually, after 1 to 2 months after receiving an adequate amount of effective anti-tuberculosis regimen, the infectivity of TB patients decreases significantly, and if the sputum test is persistently negative, there is no obvious evidence of infection.
25. How to choose a mask?
A: The most common mask we have in life is a blue or white disposable non-woven mask or a cotton mask that can be disinfected multiple times. This mask is fine for patients to avoid transmission to others, but N95 medical masks are required if you need to prevent infection from a sick person. In hospitals and tuberculosis laboratories, the most commonly used masks are medical N95 masks, the so-called N95 is tested with 0.3 micron sodium chloride particles, and the blocking rate must reach more than 95%. This type of mask usually has a metal compression on the bridge of the nose, and pressing the metal pressing sheet by hand until it fits tightly with the bridge of the nose and face, and adjusting the rest of the mask to fit the face, can usually shield and filter most of the tuberculosis bacteria in the air, and play a role in tuberculosis prevention. Therefore, if you need to come into contact with a tuberculosis patient or enter an infected area, you also need to choose a professional-grade N95 mask for prophylaxis.