In my clinical work, I often hear patients ask all sorts of questions about TB. If I was in the ward, I would take the time to answer the patient’s questions in as much detail as possible, but I can’t do this in the outpatient clinic. In such a short time, the doctor has to ask the patient about the onset of the disease, symptoms, and may have to read a lot of labs and tests, especially for lung disease, which requires a chest X-ray or chest CT, all of which take a lot of time. If a patient asks three questions or gives a wrong answer, the doctor needs more time to understand the patient’s condition, to think quickly, to analyze and judge the condition, and then to tell the patient the condition and the next step, such as issuing a lab order, prescription or hospitalization certificate, etc. It is already a bit hard to do all these things in 5-10 minutes, but some patients also want to ask a lot of general questions. If the doctor answers, it will take more time, and the patients behind will curse and cuss, and they won’t finish until the end of the day; if the doctor doesn’t answer, the patients will think the doctor has poor attitude and poor medical ethics, and even complain. If the doctor does not answer, the patient will think that the doctor’s attitude and medical ethics are poor, and even complain. I have also encountered, feel full of injustice, than the sinus more injustice.
I often think: it is normal and good for patients to want to know about their diseases, and a better understanding will help them better cooperate with doctors and achieve better results. But our outpatient clinics cannot meet the needs of our patients in this regard; the wards are a little better, but still not enough. I hope to find a better way to help more patients, not just those who come to me, as long as they are willing to learn more about medical science and are literate.
1. What is tuberculosis?
Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis that can occur anywhere in the body, mostly in the lungs (more than 80%).
2. In what way is tuberculosis transmitted?
Tuberculosis is transmitted through the respiratory tract. When TB patients cough, sneeze, talk loudly or laugh, droplets containing Mycobacterium tuberculosis are discharged into the air; or when patients spit, the Mycobacterium tuberculosis in sputum flies into the air and healthy people inhale the lungs and become infected. Transmission by other means such as the digestive tract and skin is rare.
3. Is there much tuberculosis? Isn’t it almost eradicated?
According to the Fifth National Tuberculosis Epidemiological Sample Survey in 2010, the prevalence of active tuberculosis among people aged 15 and above was 459/100,000, and the prevalence of smear-positive tuberculosis was 66/100,000. Each year, 1.5 million new cases of tuberculosis occur in China, and 130,000 people die from tuberculosis. Tuberculosis is the infectious disease that causes the highest number of deaths worldwide.
Tuberculosis is a common disease in China, and TB is a common disease in respiratory medicine. Patients with cough or sputum for more than 2 weeks, or with blood in the sputum, need to be on high alert for TB; half of the patients with pleural fluid are suffering from TB pleurisy.
4.Do you have to catch TB after contact with TB patients?
No. Ninety percent of people infected with TB bacilli destroy the bacilli with their own resistance and do not develop the disease; a small number of infected people (about 10%) develop the disease due to weak resistance.
5.I was found out by physical examination, and I have no symptoms, so how can I have TB?
About 20% of active TB is asymptomatic or has mild symptoms.
6.What are the typical symptoms of tuberculosis?
(1) Respiratory symptoms: cough and sputum for more than 2 weeks, may be accompanied by hemoptysis, chest pain, dyspnea, etc.
(2) Systemic tuberculosis symptoms: fever (often low fever in the afternoon), may be accompanied by night sweats, fatigue, reduced appetite, weight loss, menstrual disorders.
However, not every patient is sick by the book, and the symptoms can be atypical and can have only one or two of them, such as only a mild cough.
7.What should be considered as possible tuberculosis? What tests are needed to confirm the diagnosis?
(1) A chest radiograph taken during physical examination reveals a lung heterogeneity consistent with the imaging features of tuberculosis.
(2) Cough and sputum for more than 2 weeks.
(3) Sputum blood.
(4) “Pneumonia” in which repeated anti-inflammatory measures have failed.
The first and most important things are chest X-ray or chest CT, sputum TB, bronchoscopy, blood T-SPOT TB, and so on. Other things are not explained.
8.What is the reason for the doctor to diagnose me with TB when no TB bacilli are found in my sputum?
The sputum positivity rate of TB is very low, only about 1/4, which means that only about 1/4 of the patients who are finally diagnosed with TB find TB bacilli in their sputum, and most TB patients do not find TB bacilli in their sputum, so you cannot rely only on sputum positivity to diagnose TB, otherwise most TB patients will delay their disease.
Not finding TB bacilli in the sputum is not the same as not having TB bacilli in the lungs, just like having fish in a pond and not catching them with a fishing net.
Most of the TB is bacillus negative TB, and its diagnosis is complicated. CT of the chest is an important basis for diagnosing TB, and there are also blood tests and bronchoscopy, etc. The doctor will synthesize all the information (medical history, physical examination, laboratory tests and test results) to make the diagnosis.
9. If you have negative sputum bacteria, you are not infectious. Is that correct?
No, it is not. Sputum-positive cases are highly contagious, 100%; sputum-negative cases are less contagious, about 30%. If you only have extrapulmonary tuberculosis but not pulmonary tuberculosis, you are not infectious.
10.Is a positive sputum smear (+) a diagnosis of tuberculosis?
No, it is not. According to the Fifth National Tuberculosis Epidemiological Survey in 2010, 22.9% of the specimens with positive cultures of Mycobacterium avium were non-tuberculous Mycobacterium avium. Patients with pre-existing bronchiectasis have a higher percentage of non-tuberculous mycobacterial lung disease than the norm. Identification depends on mycobacterial culture and mycotype identification, or genetic testing. Treatment is usually based on tuberculosis until it is determined.
11.What is the outcome of tuberculosis without anti-tuberculosis western medicine?
(1) In the days when there were no western anti-tuberculosis drugs, 1/2 of sputum smear-positive TB patients died 2 to 4 years after the onset of the disease, nearly 1/4 became chronic infectious agents, and only 1/4 were cured (self-healed).
(2) Even if the patient is self-healed, the relapse rate is high, with a reported 5-year relapse rate of 36.5%.
(3) Each case of the source of infection can infect an average of about 10 people per year, and each case of tuberculosis death can infect 30 to 50 people.
12. Can tuberculosis be cured? Is it easy to recur?
The majority (more than 90 percent) of primary tuberculosis can be cured with regular anti-tuberculosis treatment. Early detection, early diagnosis and early treatment are the keys to cure of tuberculosis. You should cooperate with your doctor to undergo tuberculosis tests, and once diagnosed, you should follow the doctor’s instructions to take regular medication and review the whole process. The treatment course for new TB usually takes 6-8 months, and medication should not be missed or interrupted in the middle. The recurrence rate is about 10%.
The cure rate of relapsed TB is much lower than the initial treatment, and the rate of multidrug-resistant TB is even lower.
13.I heard that western medicine for TB is very toxic, especially for the liver, can I not use it?
No, you can’t. TB is far more harmful than the anti-TB drugs are to the human body. “The lesser of two evils”.
Toxic side effects of drugs do not occur in everyone, the incidence is generally in the tenth percentile, and the vast majority of timely treatment by doctors will not cause serious consequences, and only less than one percent are really very serious. Tuberculosis, on the other hand, causes up to 75 percent of the adverse effects.
14.How is tuberculosis treated?
The principles of anti-tuberculosis treatment: early, combined, moderate, regular and full.
Anti-tuberculosis treatment should be started as soon as tuberculosis is diagnosed, or when tuberculosis is highly suspected and diagnostic anti-tuberculosis is decided. The first 2 months of initial TB treatment is the intensive period, and the standard regimen is a combination of 4 drugs: isoniazid, rifampin, pyrazinamide, and ethambutol (or streptomycin either), with the dosage of each drug determined by body weight and taken daily; the second 4 months is the consolidation period, with isoniazid and rifampin. The regimen can be adjusted appropriately according to the severity of the disease and the severity of drug reactions. The regimen is different when serious adverse drug reactions occur; the regimen is different for retreatment and drug resistance.
15.How long does it take to cure tuberculosis?
Course of anti-tuberculosis treatment.
For common mild tuberculosis, the initial treatment course is half a year, and the retreatment is at least 8 months.
Severe tuberculosis: 9 months to 1 year.
Tuberculosis combined with diabetes mellitus, pneumoconiosis, etc.: 1 year.
Ordinary extra-pulmonary TB (tuberculous pleurisy, bronchial TB, lymph node TB, renal TB, intestinal TB, etc.): 1 year.
Tuberculous meningitis: 1.5 years.
Multidrug-resistant tuberculosis: 21 months to 2 years.
16. What happens if TB is not treated properly?
Some patients feel that their lungs are not affected by normal life, so they do not check and treat their lungs; some patients stop taking their medication or intermittent medication after receiving short-term regular treatment and their symptoms are reduced; some patients are worried about adverse drug reactions and do not take their medication according to the prescribed regimen or reduce the dosage of medication on their own. These wrong practices can lead to poorly treated and easily relapsed tuberculosis, which can develop into multidrug-resistant tuberculosis that is difficult to treat, takes a long time, uses many different kinds of drugs, has more severe side effects, and is more expensive to treat, but has a much lower efficiency. And infecting others with multidrug-resistant TB can eventually lead to death of oneself and others.
17. What should TB patients pay attention to?
(1) Adequate rest and do not stay up late.
(2) Comprehensive and balanced nutrition.
(3) No strenuous exercise.
(4) Do not spit anywhere, use a covered cup with disinfectant to spit and pour it into the toilet after disinfection.
(5) It is better to wear a mask when touching people;
(6) Do not cough or talk loudly to people.
(7) Open windows frequently for ventilation.
(8) Do not go to crowded places with dirty air during the acute period. For example, supermarkets, large shopping malls, subways, mahjong rooms, Internet cafes, movie theaters, etc.
(9) Avoid catching cold and flu, because the immune system decreases when you catch a cold, which may aggravate tuberculosis or complicate inflammation of the lungs.
(10) Actively treat comorbidities, common ones: diabetes, chronic bronchitis, heart disease, hypertension, etc. Especially, diabetes must be actively treated.
18.What should TB patients eat? What should not be eaten?
Chinese medicine has a lot of taboos, but Western medicine does not recognize them and has no basis.
(1) You should pay attention to the nutrition and matching of food, various kinds of meat (including poultry, livestock, fish), eggs, vegetables, fruits, staple foods, milk, soybean products, all kinds of food can be reasonably matched.
(2) Do not smoke and drink. Smoking hurts the lungs and alcohol hurts the liver, which can add to the problem.
(3) Patients with hemoptysis have taboos: don’t eat hot or big tonic drugs or foods, such as ginseng, dog meat, mutton, gum, lychee, cinnamon, too spicy and stimulating foods, very hot foods: such as hot pot.
(4) Some people will experience elevated uric acid in the blood and joint pain after taking pyrazinamide. At this time, we should eat less seafood, animal offal, soy products. Generally pyrazinamide is taken for 2 months, and after stopping pyrazinamide, there is no need to avoid eating.
19.What should the family members and close contacts of TB patients pay attention to?
(1) Once a patient is diagnosed with TB, all family members and close contacts should go for a chest X-ray. If there is any problem, further examination and treatment; if there is no problem, it is better to take chest X-ray again every six months because TB has an incubation period and may develop after 1-2 years.
(2) Pay attention to protection because it is difficult to prevent tuberculosis because it is transmitted through the air. Patients or family members should wear masks and open windows frequently for ventilation.
(3) Exercise to improve the immune system.
20.What should I pay attention to in anti-tuberculosis treatment?
(1) Take medication every day as prescribed by the doctor, and never miss a dose or stop taking medication without a valid reason. Pay attention to rest and nutrition, especially not to stay up late. (2) If there is no discomfort, go to the hospital regularly to review and dispense medication.
(2) If you feel uncomfortable, go to the hospital immediately. The doctor will decide whether to stop or change the medication. If the reaction is very serious and you stop the medicine first, you should also go to the doctor as soon as possible.
21.What are the symptoms that require immediate medical attention?
Poor appetite, nausea, vomiting, right abdominal distension or vague discomfort, yellowing of the face or eyes, appearance of rash, bleeding spots on the skin, fever, severe insomnia, excitement, depression, irritability, joint pain, blurred vision, reduced vision, reduced or absent visual field, tinnitus, altered or decreased hearing, dizziness, vertigo, balance disorder, back pain, soy sauce-colored urine etc.
22.What about adverse reactions?
Some minor adverse reactions do not stop, some require adjustment of anti-TB drugs, and some must be discontinued. Incorrect handling can lead to serious consequences. Some reactions can lead to serious damage if they are ignored and the drug is continued, while some can lead to untreated TB and develop into intractable chronic TB if the drug is stopped inappropriately or with too weak a regimen. Note: Not all doctors are able to correctly recognize and manage adverse reactions to anti-TB drugs, so they must be handled by an experienced doctor in a professional institution.
23. After a year of TB treatment, why does the chest CT film still show a bad lesion?
Most patients with TB undergo anti-TB treatment and the lung lesions that can be absorbed in the first 1-3 months are absorbed. This is a normal phenomenon of tuberculosis. As long as the regular treatment lasts long enough, the symptoms disappear, the sputum bacteria turn negative, and the lesions remain stable and do not increase, it is judged that the tuberculosis is cured and the drug can be stopped.
24.What are the circumstances under which the drug can be stopped?
There are only two cases in which it is reasonable to stop medication, but all others are not valid reasons.
(1) The course of anti-tuberculosis treatment has been completed, and the doctor says that the tuberculosis has been cured, so the drug can be stopped.
(2) Some adverse reactions to anti-tuberculosis drugs occur, and the doctor says that some or all of the drugs have to be stopped, but when the situation improves, the program needs to be adjusted and the drugs used again as soon as possible.
25.How can TB patients be treated and seen after they are discharged from the hospital?
(1) When you are discharged from the hospital, you usually bring a month’s worth of medication, and you need to go to the outpatient clinic to review and dispense medication after discharge.
(2) During the intensive period (the first 2-3 months of treatment), the liver function, uric acid and blood routine are reviewed once every half month, and if streptomycin or amikacin is used, the kidney function and urine routine are increased. During the consolidation period, the above items will be reviewed once a month. You should also tell your doctor if you have any discomfort. If there is obvious discomfort, see the clinic immediately, regardless of whether the half-month period is up or not.
(3) The medication can only be dispensed in advance and not later. Never stop the medication for a few days because the medication is finished and you did not have time to dispense it.
(4) If you can’t make an appointment with a specialist, you should review and fill the medication in the general outpatient clinic. You should never stop the medication or delay the treatment if you have a serious reaction because you are out of medication because you are waiting for a specialist.
(5) In our clinic, after registering, go to the consultation room and ask the doctor to issue a laboratory test for review (you must tell the doctor the items), then go to the blood test, and then wait in line to see the doctor. Do not wait in line to the number and then open the lab order, it will be too late to read the report.
(6) Review sputum bacteria at the end of 2, 5 and 6 months for anti-TB. The chest CT will be reviewed in 1-2 months for anti-TB, and then once every 1-3 months depending on the condition.
(7) There are many different kinds of anti-TB drugs, so patients must clarify the names, dosage and usage of the drugs, and must not make mistakes. If you are not sure, you can ask the doctor carefully, and you can record the drugs on paper or take pictures on your cell phone to show the doctor. Be careful never to use poor quality drugs, which have poor efficacy and toxic side effects. Recognize a good manufacturer.
(8) Go to the medical history room to copy TB culture and drug sensitivity results 2 months after discharge, if (+) need to see the clinic and show to the doctor.
(9) Chest films, CT films and various medical records should be kept well, and the films should not be folded or rolled. You need to bring them to the clinic and don’t throw them away when you are well, as you will need to compare them for future follow-ups.