Tuberculosis seriously affects people’s health and is one of the key diseases to be prevented and treated in China. Timely and accurate diagnosis and complete cure of tuberculosis is not only to restore the health of patients, but also the most important measure to eliminate the source of infection and control the epidemic of tuberculosis.
With the progress of diagnostic techniques in bacteriology, imaging, immunology, etc., the widespread use of short-course chemotherapy and the increase in the number of elderly patients, drug-resistant patients, combined diabetes, immune damage and other tuberculosis patients, the diagnosis and treatment of tuberculosis are becoming increasingly complex. It is necessary to establish standardized diagnostic procedures and treatment guidelines so that tuberculosis physicians and other relevant medical and health institutions can reach a consensus, correctly master diagnostic techniques, reasonably use chemotherapy protocols, and improve the diagnosis and management of tuberculosis.
I. Clinical manifestations of pulmonary tuberculosis
The following manifestations should be considered as possible pulmonary tuberculosis, and further sputum and chest X-ray should be done. It should be noted that about 20% of patients with active tuberculosis can also be asymptomatic or have only mild symptoms.
1. Cough and sputum for three weeks or more, which may be accompanied by hemoptysis, chest pain, dyspnea, etc.
2, fever (often low fever in the afternoon), may be accompanied by night sweats, fatigue, reduced appetite, weight loss, menstrual disorders.
Allergic manifestations caused by tuberculosis metaplasia: erythema nodosum, vesicular conjunctivitis and tuberculosis rheumatism (Poncet’s disease), etc.
4, tuberculin (PPD C5TU) skin test: China is a highly endemic country for tuberculosis, children are commonly vaccinated with BCG, a positive test is not significant for the diagnosis of tuberculosis, but for children who have not been vaccinated with BCG, it indicates that they are infected with Mycobacterium tuberculosis or have active tuberculosis in their bodies. When the test is strongly positive, it indicates that the body is in a state of hypersensitivity and has a high chance of developing tuberculosis, which can be used as a reference indication for clinical diagnosis of tuberculosis.
5. When tuberculosis is present, the pulmonary signs are often not obvious. When the lung lesion is more extensive, there can be corresponding signs, and small and medium-sized blister sounds can be heard when there is obvious cavitation or complication of bronchial dilatation. The narrowing of the Cornish isthmus suggests a lesion in the lung apex.
Imaging diagnosis of pulmonary tuberculosis
Bacteriological examination is the definitive basis for the diagnosis of pulmonary tuberculosis, but not all pulmonary tuberculosis can be confirmed bacteriologically. Chest X-ray is also often important. However, there are no characteristic changes in the chest X-ray of tuberculosis, and attention should be paid to differentiate it from other lung diseases.
Generally speaking, the chest X-ray of tuberculosis can have the following characteristics:
1, mostly occurring in the posterior segment of the upper lobe of the lung, the dorsal segment of the lower lobe of the lung, and the posterior basal segment.
The lesions can be limited or invaded by multiple lung segments.
3, X-ray images may be polymorphic (i.e., exudative, proliferative, fibrous and caseous lesions), and may also be accompanied by calcification.
4. Easily combined with cavitation.
5.It may be accompanied by bronchial dissemination foci.
6.It may be accompanied by pleural effusion, pleural thickening and adhesions.
7.Spherical lesions (tuberculosis spheres) are mostly within 3 cm in diameter, surrounded by satellite lesions, and may have draining bronchial signs at the medial end.
8.Low absorption of lesions (less change within one month).