I. Misconceptions about diagnosis and treatment
1. Cough symptoms are mistaken for cold or bronchitis
The most common symptom of TB is coughing, which happens to be a symptom of a cold. Some patients have chronic bronchitis or smoke and often cough, so they take coughing for granted and consider it “normal”, not knowing that TB or even lung cancer has sneaked up on them. Many people choose to take anti-inflammatory drugs for colds or go to medical units that do not have the means to detect tuberculosis for symptomatic treatment, which delays the early detection and treatment of tuberculosis. Therefore, if you cough and sputum for more than 3 weeks or if your original cough is aggravated, you should visit a regular medical institution to rule out the possibility of tuberculosis.
2. Mistaken for old tuberculosis
If there is any abnormality in the chest X-ray, you should go to a pulmonary hospital for further detailed examination, and do not jump to the conclusion that it is “old tuberculosis”. A series of tests, such as PPD skin test, blood sedimentation, sputum tuberculosis, chest CT, etc., combined with medical history, are required to determine whether the disease is “old”.
3.X-ray examination is more important than sputum examination in the diagnosis and treatment of tuberculosis
In the traditional concept, the main way to diagnose TB and judge the efficacy is to conduct X-ray examination, which is actually a wrong view. First of all, the rate of misdiagnosis in the diagnosis of pulmonary tuberculosis relying solely on X-ray images is quite high, and foreign experts have done studies in which the inconsistency rate of the same chest film diagnosed between different specialists and diagnosed at different times by one specialist is about 30%. At present, sputum examination is considered to be the golden indicator for the diagnosis of tuberculosis. In addition, chemotherapy for tuberculosis is now a bactericidal treatment, and after the patient takes the drug, the tuberculosis bacilli in the body are rapidly killed. This is why we often observe that the lesions continue to absorb after the patient has completed the course of treatment and stopped taking the medication. Therefore, sputum TB examination is much more important than X-ray examination in the diagnosis and treatment of TB.
4.Tuberculosis patients must be hospitalized
Most TB patients can be cured without hospitalization, and the threat of social and family transmission in home treatment is not greater than that of those who are hospitalized, therefore, only a few patients with critical and severe TB, difficult patients, TB patients with serious comorbidities or complications, and patients who are allergic to anti-TB drugs or have serious adverse reactions can be hospitalized. After discharge, patients should be transferred to a tuberculosis prevention institution to continue to implement strict treatment management until the end of the course of treatment.
5.Intravenous drip is more effective than oral drug delivery
Many patients have the misconception that “intravenous drip is better than oral administration”, but in fact, the first choice of medication for TB patients should be oral medication. Oral treatment has the advantages of convenience, economy, effectiveness and less adverse reactions, and the in vivo blood concentration of oral anti-tuberculosis drugs can fully meet the requirements of treatment, except for streptomycin, kanamycin and capreomycin, which must be injected intramuscularly and patients who cannot take drugs orally, all can take drugs orally.
6, new drugs, high-priced drugs than the old drugs, cheap drugs good
Since the discovery of streptomycin effective for tuberculosis treatment in the 1940s, a series of anti-tuberculosis drugs have been discovered one after another, bringing tuberculosis treatment into the era of chemotherapy. Since people have come to the notion through the use of other antimicrobials that the newer and more expensive drugs are the better ones. In fact, this is not exactly the case in the treatment of tuberculosis. In the WHO Guidelines for Planning and Management of Drug-Resistant Tuberculosis published in 2008, anti-tuberculosis drugs are divided into five groups, and the priority required remains the first group of first-line oral anti-tuberculosis drugs, including isoniazid, rifampin, ethambutol and pyrazinamide. Because first-line oral antituberculosis drugs remain the most potent and best tolerated of all antituberculosis drugs, they should be used unless resistance to one of the first-line drugs has been demonstrated by drug sensitivity testing. The arbitrary addition of second-line drugs in the absence of drug sensitivity results is not only an added financial burden to patients, but also tends to develop new drug resistance. Therefore, in the treatment of tuberculosis is not “new drugs, high-priced drugs than old drugs, cheaper drugs”, depending on the specific situation, to develop a scientific and reasonable chemotherapy program, not related to the old and new price.
7.The drugs issued for free are not good drugs
Tuberculosis, as a statutory infectious disease, is not only a public health problem is also a serious social problem. In order to effectively control tuberculosis, our government currently provides free and uniform anti-tuberculosis drugs for patients with active tuberculosis. However, many people, including some medical professionals, have the idea that there is no free lunch and that “cheap is not good enough”, and have doubts about the effectiveness of free drugs for TB treatment, leading some patients to pay for their own treatment even if they are not financially well off. In this case, many patients give up the whole treatment due to financial problems, which makes the prevention and control of tuberculosis even more difficult. In fact, the treatment plan of free treatment implemented by the government is formulated by medical experts, and the drugs provided are procured through government bidding, with strict factory inspection procedures and supervision mechanisms, and are managed and distributed by TB control institutions at all levels, so the quality and effectiveness of the drugs are guaranteed.
8. Daily medication is better than every other day medication
It should be said that alternate day dosing, that is, intermittent dosing, has the same effect as daily dosing. This interval is called the delayed growth period. During the delayed growth period, any anti-tuberculosis drug is ineffective, and even daily dosing does not increase the efficacy. Therefore, taking drugs on alternate days, avoiding the delayed growth period, can achieve the same therapeutic effect as taking drugs daily and has been proven in clinical studies. The advantage of alternate day dosing is to reduce the number of doses, to facilitate the patient’s regular use of drugs, and generally speaking, the side effects are close to those of daily dosing.
9, anti-tuberculosis drugs in several doses is better than the effect of a dose
The dose of anti-tuberculosis drugs is concentrated in one dose a day, and the dose of anti-tuberculosis drugs is divided into several doses a day, as the name suggests. Studies have shown that the bactericidal effect of anti-tuberculosis drugs depends on the peak blood concentration of the drug within a short period of time. The higher the peak blood concentration, the longer the exposure time, the better the bactericidal or antibacterial effect. If a one-day dose is taken at once, the peak blood concentration can be reached, while a divided dose only maintains a lower blood concentration. Moreover, in addition to improving the efficacy, the dosing method also has the advantages of reducing the number of doses and low incidence of adverse reactions, which can play a role in promoting the patient’s adherence to regular medication.
10, no symptoms with drug control is the same as a cure, you can stop the drug.
Some patients take anti-tuberculosis drugs for 1-2 months, cough and sputum and other symptoms relief or alleviate, at this time, patients are most likely to take it lightly, paralysis, mistakenly believe that the cure and irregular use of drugs, or even stop, thus causing repeated tuberculosis, resulting in tuberculosis treatment, difficult to treat.
In fact, tuberculosis bacteria are very stubborn and difficult to kill, taking 1-2 months of medicine only kills most of them, and tuberculosis bacteria are quite stubborn. Then the TB specialist will assess whether to stop the drug or extend the course of treatment (severe cases need to be extended) according to the patient’s disease, sputum TB examination, radiological examination, etc., in order to achieve a cure and reduce recurrence.
11. In the course of anti-tuberculosis treatment, if side effects occur, the drug should be stopped or changed immediately.
Once the doctor has determined the treatment plan for the patient, the patient himself should not easily interrupt the treatment or change the treatment plan, otherwise it may lead to treatment failure and may also increase the emergence of drug-resistant tuberculosis. Patients who experience certain adverse reactions during treatment should seek help from their physician. The doctor will help the patient determine whether these adverse reactions are side effects of the antituberculosis drugs. If they are side effects of the drug, they should determine whether the relevant indicators meet the criteria for discontinuation. If they do not meet the criteria for discontinuation, only symptomatic treatment is required. If the side effects continue to worsen after the above symptomatic treatment or have reached the discontinuation criteria, only then should the drug be stopped or changed.
12.Tuberculosis patients will adhere to their own medication without management
The course of tuberculosis treatment is long, requiring at least 6 months for first-time patients and at least 8 months for repeat patients. In such a long period of time, most patients’ symptoms will be significantly reduced or disappear after a period of medication, so some patients think they are cured and stop taking the medication, while others will have adverse reactions to anti-tuberculosis drugs and stop taking the medication because they cannot stick to it. Therefore, the World Health Organization has proposed a modern tuberculosis control strategy (DOTS), the core of which is to supervise and manage patients throughout the whole process, i.e., each dose of medication must be taken under the supervision of a doctor or family supervisor.
13, tuberculosis to “taboo”
Many patients, and even some medical staff, believe that TB patients should “avoid” eating seafood, rooster, carp, milk, eggs and beef. Patients often ask their doctors: What should I eat and what should I not eat? In fact, apart from avoiding stimulating foods (such as too spicy and salty dishes) and abstaining from smoking and alcohol to avoid aggravating the cough, TB patients do not need to “avoid” too many foods, such as chicken, duck, fish, meat, eggs, seafood, vegetables and fruits. Of course, there are some diets that do have a negative effect on TB patients. For example, eating hot or tonic drugs or foods, so if a patient really wants to take them, he or she must consult a Chinese medicine doctor and ask what he or she can eat.
14. Believe in prescriptions to cure TB quickly and stop using anti-TB drugs
Many patients, especially those in rural areas, have been prescribed anti-tuberculosis drugs in specialized hospitals or disease control departments, and after taking them for 1-2 months or even a few days, they feel that their symptoms have not improved much or that some patients have more serious pulmonary symptoms and serious side effects of taking the drugs. This approach is also wrong, some folk remedies do have certain efficacy in the treatment of tuberculosis, but it is impossible to achieve the effect of curing tuberculosis within a short period of time.
15, once the TB disease has relapsed, you only need to take the last treatment drugs.
Some people have a relapse of tuberculosis, so they go to the pharmacy and buy some of the drugs they used to take. This approach is wrong. After treatment, the tuberculosis bacteria in the patient’s lesion may have developed resistance to the drugs used, so taking the previous drugs again will greatly reduce the effectiveness of treatment. Therefore, after a relapse of tuberculosis, the patient should visit a tuberculosis specialist, who will determine a new treatment plan for the patient after a comprehensive analysis and, if necessary, choose a treatment plan based on drug sensitivity results.
16.After recovering from tuberculosis, the patient will not get tuberculosis again
Many people believe that after recovering from tuberculosis, a patient has lifelong immunity and will never get tuberculosis again. This view is also incorrect. After a person with TB disease stops taking the medication after regular treatment, there may still be a very small amount of so-called dormant or persistent bacteria lurking in the body, and the person may be exposed to new strains of TB again. Once the body’s immunity is significantly or chronically reduced, these bacteria will “recover” and slowly grow and multiply, and when the amount of bacteria increases to a certain amount, TB disease will recur. Therefore, after recovering from tuberculosis, it is crucial to maintain a healthy lifestyle, eat properly, exercise and avoid getting cold to prevent the recurrence of tuberculosis.
Second, cognitive misconceptions
1.Optimistic type
(1) Tuberculosis is curable and not life-threatening
The most common form of tuberculosis is pulmonary tuberculosis, also known as “consumption” in the past. In the middle of this century, antibiotics were widely used to curb the clutches of tuberculosis and greatly reduce the mortality rate of tuberculosis patients, so that people breathed a sigh of relief and no longer talked about “consumption”. As a result, the impression was created in people’s consciousness that “tuberculosis is curable”. When some young patients learn of their condition, their first reaction is to ask, “Now that medicine has evolved, TB should not be life-threatening, right?”
Tuberculosis is a chronic infectious disease, and most patients with tuberculosis can be cured after six months of treatment. However, some patients with severe TB or drug-resistant TB are still difficult to treat and can be life-threatening in severe cases.
Since the 1980s, the misuse of antibiotics and irregular treatment have led to the development of drug resistance in a large number of patients with tuberculosis. It is still difficult to treat patients with drug-resistant and multi-drug-resistant TB. According to statistics, drug-resistant tuberculosis patients account for about 28%-41% of the total number of people on first treatment. This is a wake-up call. This is a very worrisome situation.
In recent years, WHO has identified the phenomenon of “super drug resistance,” in which patients develop resistance to quinolones and aminoglycosides on top of multi-drug resistance. In that year, South Africa reported 53 cases of “super-resistant” people, 52 died within 25 days. The WHO estimates that 180,000 of the world’s 9 million patients may be super-resistant.
(2) “Poor people” have the disease, and tuberculosis is rare in modern society.
In the past, it was widely believed that tuberculosis was a disease of the poor, occurring only in poor rural areas. The vast majority of people and even many government officials and medical personnel blindly believe that TB has become history, TB is far away from our society, and even if you have TB, there are measures to prevent and treat it.
In the past decade, the number of urban tuberculosis patients has increased dramatically, mainly due to the deteriorating quality of the environment, the water, air and food necessary for people’s daily life are subject to industrial pollution, people’s resistance has decreased, the airborne tuberculosis has a resurgence of the trend. In some areas, there is even a perverse phenomenon that urban tuberculosis spreads faster than rural areas. Secondly, as the incidence of urban hepatitis and AIDS, the number of drug carriers has risen sharply, hepatitis concurrent with TB, AIDS concurrent with TB has become a new mode of infection, but also to the onset of tuberculosis can be carried by the smooth car.
(3) If you had BCG vaccination as a child, you will not be afraid of TB in your life
Some people think that if they had BCG vaccination as a child, they are resistant to TB. In fact, the BCG vaccine was invented in the 1920s, and after decades, the genes of the germs have mutated and the “defense” of BCG is now weak. It is still effective in preventing childhood tuberculosis meningitis and blood-borne transmission, and can reduce the severity of tuberculosis, but the protection rate for vaccinated children is only 80% after exposure to sputum-positive patients, and the BCG vaccine is not effective in protecting adults, and the medical community is working on developing a new alternative vaccine. Therefore, having BCG vaccination is not the same as being in a “safe”.
2.Pessimistic type
(1) Tuberculosis is an infectious disease and is contagious, so if you come into contact with a person with tuberculosis, you will get tuberculosis.
People generally believe that TB is an infectious disease and is contagious, but this view is rather one-sided. Since TB bacilli are mainly spread by air through the respiratory tract, only patients with bacillary TB are infectious, and patients with extrapulmonary TB (such as bone TB and lymphatic TB) are not infectious. Even in patients with detoxified TB, after receiving anti-tuberculosis treatment for 2-4 weeks, the TB bacilli in the sputum are rapidly reduced and the viability of the bacteria is diminished, and they are basically not contagious to the surrounding population. TB disease does not necessarily occur in healthy people who are infected with TB bacteria, and whether or not TB disease occurs is mainly influenced by the number and virulence of the infected TB bacteria and the level of body resistance. The lifetime chance of developing TB disease in people infected with TB bacilli is 5-10%. Those who are in close contact with infectious TB patients can be preventatively medicated or observed, and it is not necessary to be overly frightened to develop and maintain good hygiene habits.
(2) Tuberculosis can be inherited
Tuberculosis is a chronic infectious disease, not a hereditary disease. Some families have several or several generations of TB patients at the same time, and many people think that TB can be hereditary, but in fact it is mainly the result of mutual transmission of infectious TB patients in the family, not heredity.
(3) Students with tuberculosis must be suspended from school for treatment
It is not necessary to suspend students from school after they have tuberculosis, but it is determined by the specific circumstances of the patient. In this regard, the Ministry of Health and the Ministry of Education have clear regulations, namely, “Patients diagnosed with infectious tuberculosis should be suspended from school and treated in isolation at home, and the local tuberculosis control institution should be responsible for the treatment and management of the patients. Non-infectious patients can continue to attend school during the treatment period, but their treatment is the responsibility of the local tuberculosis control institution or, under the guidance of the local tuberculosis control institution, the school nurse, who performs the supervision of chemotherapy and ensures the regular use of drugs. Of course, students who are seriously ill or in poor physical condition with complications should be suspended from school for treatment, even if they are not infectious.
(4) Treating tuberculosis as an incurable disease
Many people cannot treat tuberculosis correctly, and once they or their family members suffer from it, they will talk about “consumption” and become pessimistic, and many people even choose to commit suicide because they cannot bear the psychological problems caused by their own and society’s lack of knowledge about tuberculosis. In fact, as long as you cooperate well with your doctor and adhere to regular medication, more than 90% of TB patients can be cured unless they are drug-resistant or cannot tolerate the side effects of the drugs, but 50% of those with smear-positive TB die within 5 years without treatment.
(5) Positive tuberculin skin test is tuberculosis
The tuberculin test (PPD skin test) is mainly used for epidemiological investigation of tuberculosis infection, auxiliary diagnosis of tuberculosis, and testing the success of BCG vaccination. Many people mistakenly believe that a positive PPD skin test means that they have tuberculosis. In fact, a positive PPD skin test can occur in the following four situations.
(1) They have been infected with tuberculosis bacteria but have not developed the disease.
(2) Have had tuberculosis before.
(iii) Have received BCG vaccination.
④Currently suffering from tuberculosis. The specific case needs to be carefully identified by a medical professional.