Overview
Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis, which can affect many organs. Humans are infected mainly through inhalation of bacterial droplets (emitted by coughing and sneezing of TB patients). TB bacteria that invade the respiratory tract are engulfed by alveolar macrophages.
Symptoms
1. Pay attention to the inquiry
①Whether there is fever, night sweats and weakness, loss of appetite, weight loss, cough, coughing, bloody sputum or hemoptysis, chest pain, dyspnea and other symptoms. Female patients have menstrual disorders or amenorrhea.
②Inquire about the length of illness, onset time, X-ray lesions, sputum bacterium examination, diagnosis, treatment medication and program, course of treatment, efficacy, and drug side effects.
2. Physical examination was noted for any enlargement of superficial lymph nodes and any BCG scar on the left upper arm. Any abnormal findings in the chest and signs of complications of tuberculosis in other systems.
3, classification of pulmonary tuberculosis disease pulmonary tuberculosis is divided into five large: primary pulmonary tuberculosis (type 1); hematogenous disseminated pulmonary tuberculosis (type II); infiltrative pulmonary tuberculosis (type III); chronic fibro-cavernous pulmonary tuberculosis (type IV); tuberculous pleurisy (type V). Activity and regression of pulmonary tuberculosis: divided into three stages, namely, progressive, improving, and stable.
Etiology
Mycobacterium tuberculosis belongs to the genus Mycobacterium of the order Actinomycetes, family Mycobacterium, and is a pathogenic acid-resistant bacterium. It is mainly divided into human, bovine, bird and mouse types. The main pathogenic to human is human type bacteria, bovine type bacteria rarely infected. Drug resistance of tuberculosis bacteria to drugs can be formed by the development of innate drug-resistant bacteria in the flora, or it can be acquired due to the use of an anti-tuberculosis drug in humans alone and resistance to the drug develops relatively quickly. Drug-resistant bacteria can cause therapeutic difficulties and affect outcomes.
Diagnosis
1. Ask for a history of exposure or previous exposure to pleurisy, anal fistula, enlarged cervical lymph nodes, diabetes mellitus and BCG.
2. Have symptoms of tuberculosis toxicity, such as low-grade fever, general malaise, malaise, night sweats, decreased appetite, and flushed cheeks. Cornular tuberculosis and caseous pneumonia are often accompanied by high fever, some may be accompanied by arthralgia, and women may have menstrual disorders.
3. Early dry cough, mucopurulent or purulent sputum when cavity formation is combined with infection, hemoptysis, chest pain, and respiratory distress in severe cases.
Differential diagnosis
The clinical and X-ray manifestations of pulmonary tuberculosis are often similar to those of many non-tuberculous lung diseases, which are easily misdiagnosed.
I. Lung cancer
Central type lung cancer often has blood in sputum and shadow near the hilum, which is similar to hilum lymph node tuberculosis, while peripheral type lung cancer may appear as spherical or lobulated mass shadow, which needs to be distinguished from tuberculosis ball, and lung cancer is mostly seen in smoke-loving men over 40 years old who often have no obvious toxic symptoms, irritating cough, chest pain and progressive wasting. CT scan of the chest is often helpful to distinguish the two. CT scan of central lung cancer shows soft tissue density shadow attached to thickened bronchial wall on one side, irregular contour of the mass, irregular narrowing of bronchus in lung segments and lobes, enlarged mediastinal lymph nodes, etc. Combined with sputum tuberculosis, exfoliative cell examination and through fibrinoscopy and biopsy, it can often be distinguished in time. If it is difficult to completely exclude lung cancer clinically, in combination with the specific situation, dissection of the chest can be considered when necessary to avoid delaying the treatment.
II. Pneumonia
It is not difficult to distinguish typical pneumococcal pneumonia from infiltrative tuberculosis, but infiltrative tuberculosis with rapid progression of disease, expanding to the entire lobe of the lung and forming caseous pneumonia, is easily misdiagnosed as pneumococcal pneumonia. Yellow mucus sputum, X-ray lesions are mostly located in the right upper lobe and can spread to the apical and posterior segments of the right upper lobe, with cloudy flocculence, uneven density, and worm-like cavities.
Mycoplasma pneumonia, viral pneumonia or allergic pneumonia (eosinophilic pulmonary infiltrates) with mild cough and low fever show signs of inflammation on X-rays similar to those of early infiltrative tuberculosis. granulocytosis.
Lung abscess
Pulmonary abscess cavities are mostly found in the lower lobe of the lung, the inflammatory infiltrate around the abscess is more serious, and there are often fluid planes in the cavity, while tuberculosis cavities occur mostly in the upper lobe of the lung, the cavity wall is thinner, and there are few fluid planes in the cavity. Tuberculosis co-infection is easily confused with chronic lung abscess, which is sputum negative for tuberculosis.
IV. Bronchiectasis
The history of chronic cough, sputum and recurrent hemoptysis needs to be distinguished from chronic fibrous cavity type tuberculosis, but the sputum of bronchiectasis is negative for tuberculosis attack, and the X-ray chest radiograph is mostly without abnormal findings or only localized thickened lung texture or curly hair shadows.
V. Chronic bronchitis
The symptoms of chronic bronchiectasis in the elderly resemble chronic fibro-cavernous tuberculosis, and the incidence of tuberculosis in the elderly has increased in recent years.
VI. Other febrile diseases
Typhoid fever, sepsis, leukemia, mediastinal lymphoma and nodular disease have many similarities with tuberculosis. Bronchial lymphatic tuberculosis in adults often presents with fever and enlarged hilar lymph nodes, which should be differentiated from nodular disease and mediastinal lymphoma, etc. Patients with tuberculosis have a positive nodulin test and anti-tuberculosis treatment is often effective while lymphoma develops rapidly. Tuberculosis patients with positive nodulin test and effective anti-tuberculosis treatment, while lymphoma develops rapidly, often with enlarged liver, spleen and superficial lymph nodes, and the diagnosis often depends on biopsy.
The above examples are only a few of the major common diseases. In the specific identification, it is necessary to comprehensively grasp and analyze the diagnostic basis of tuberculosis that the patient has, but also to be familiar with the characteristics of such easily confused diseases, and to try to make the examination both targeted and careful dynamic observation and strict comparison and judgment.
Treatment
1.Inquire about the history of exposure or previous history of pleurisy, anal fistula, cervical lymph node enlargement, diabetes mellitus and BCG exposure.
2. Have symptoms of tuberculosis toxicity, such as low-grade fever, general malaise, malaise, night sweats, decreased appetite, and flushed cheeks. Cornular tuberculosis and caseous pneumonia are often accompanied by high fever, some may be accompanied by arthralgia, and women may have menstrual disorders.
3. Early dry cough, mucopurulent or purulent sputum when cavity formation is combined with infection, hemoptysis, chest pain, and respiratory distress in severe cases.