Tuberculosis is a chronic infectious disease and a systemic disease that can affect all organs of the body. However, the organs that suffer more from TB are the lungs, kidneys, liver, stomach, brain, intestines, bladder, skin, testes, bones, etc. The most common one is pulmonary TB. Due to the difference in human resistance, the size of bacterial virulence, and the difference in treatment after the discovery of TB, there can be many clinical types of TB, and the symptoms reflected in patients of various clinical types are different, but in any case, the symptoms of TB have common aspects in all patients.
I. Common symptoms that occur after tuberculosis infection in the lungs
(A) Systemic symptoms
Generally speaking, tuberculosis is a chronic infectious disease. At the beginning, the symptoms are mild and the patient feels no discomfort, so they are generally not noticed. Only when the disease progresses do symptoms appear, but some people have poor resistance, and if they are infected with a large amount of tuberculosis bacteria and strong virulence, then the symptoms will be very obvious. General discomfort, fever, weakness, easy fatigue, distraction, poor appetite, weight loss over time, and sometimes abnormal menstruation for lesbians.
1. Fever: Fever is one of the common symptoms that can occur in many diseases. Tuberculosis is no exception. However, fever in tuberculosis has its own characteristics: (1) prolonged hypothermia, which usually appears in the late afternoon and evening. (3) When the disease deteriorates and progresses, fever is obvious, especially in the case of other bacterial infections in the lungs, high fever can occur, sometimes at 39℃ to 40℃, and the tuberculosis bacteria may spread throughout the body when the body resistance is extremely low, and then continuous chills and high fever can occur; (4) Lesbians can have fever through blood flow before and after menstruation, and when they have tuberculosis, fever does not return to normal immediately after menstruation is clean. .
2, night sweats: the so-called night sweats, that is, the patient sweats all over the body when falling asleep or waking up, usually occurs in children with weak constitution (sometimes normal children may also have this phenomenon). Patients with heavy lung lesions have more night sweats, and in severe cases, the clothes and quilt can be soaked through, and the patient feels exhausted and weak.
(B) Local symptoms
1. Cough: It is the most common local symptom of tuberculosis. In the early stage, the cough can be very mild, often mono-cough, or as we say, half cough, dry cough without sputum, and it does not affect the working life to a significant extent. When the lesion progresses, the cough can be aggravated; when accompanied by endobronchial tuberculosis, the cough can be intensified, and sometimes choking can occur. In patients who have been ill for a long time, if the bronchus is displaced, the trachea is pulled due to the adhesion of the lesion, or the bronchus is deformed due to compression by the surrounding lymph nodes, an irritating cough can occur due to poor ventilation.
2. Coughing sputum: The coughing sputum is not obvious at the beginning of the disease, or there is a small amount of white mucus sputum, but the sputum volume increases when the lesion expands or even when there is a cavity in the lung. When there is other pathogenic bacteria infection, the amount of sputum will also increase, and yellow pus sputum may appear, and it may also be accompanied by systemic symptoms such as fever and chills.
Chest pain: Chest pain is also the main local symptom of tuberculosis, but generally the lesion must affect the pleura, especially the wall pleura, when the chest pain can occur. The wall pleura is the front of the thorax and lung tuberculosis Figure 2, 3 is shown in the wall pleura. Sometimes there is vague pain in a variable location, which is due to nerve reflexes and is not affected during pulmonary respiratory movements. If the site is fixed with stabbing pain and worsens with breathing and coughing, this indicates that the inflammation stimulates the pleura. Some patients often feel pain in the shoulder or upper abdomen, which is probably due to the inflammation stimulating the diaphragm through nerve reflexes.
4. Hemoptysis: We often find that many patients do not know that they are suffering from tuberculosis beforehand, and usually do not care about some coughs or fever, but when they cough, they find blood in their sputum, blood clots, or even a mouth full of blood, before they go to the hospital to see a doctor. Hemoptysis can occur in more than 1/3 of patients, and not in any patient. Blood comes from the blood vessels, so it can only occur when the lesion affects the permeability of the blood vessel wall or directly damages the blood vessels, and the amount of bleeding depends on the degree of damage to the blood vessels. We believe that the number of lung lesions is not proportional to the amount of bleeding. In some patients, the lesions are small but damage the blood vessels, then bleeding can occur. On the contrary, many lesions but no damage to blood vessels can bleed little or no bleeding, but of course with many lesions, there is more chance of damage to blood vessels and more chance of bleeding.
5, other: the structure of the lungs has been described in more detail earlier, precisely because the compensatory function of the lungs is large, the reserve potential is large, so mild lesions will not cause pulmonary respiratory dysfunction. The lung is the main organ of oxygen exchange between our body and the natural environment, and oxygen exchange is mainly accomplished by alveolar tissue in the lung tissue. Long-term chronic hypoxia will cause a bulge-like change in the end phalanges, which we call pestle-like fingers. All organs and tissues of the body will have different degrees of function changes due to systemic hypoxia. For example, the digestive system will suffer from indigestion and malnutrition due to lack of oxygen, the brain will suffer from drowsiness and even coma due to lack of oxygen, and the heart will suffer from angina pectoris due to lack of oxygen.
Second, the clinical manifestations of pulmonary tuberculosis
Tuberculosis is often asymptomatic or mildly symptomatic in the early stages or with mild lesions, and is easily ignored by patients, etc. The general symptoms, compared with many other respiratory tract infections, are generally rarely characteristic, except for being more prolonged.
(A) Systemic symptoms
1, fever: seen in the progressive stage of the disease, showing afternoon low fever (probably after a day of physical activity, increased absorption of products of tissue destruction into the blood caused by) severe patients have irregular high fever or even auditory DD consumption fever, fever often represents the activity of tuberculosis.
2, night sweats: when sleeping or waking up, sweating all over the body, underwear all wet.
3, fatigue, depression, weight loss, loss of appetite, rapid heartbeat (consistent with body temperature), and menstrual disorders.
(II) Local symptoms
1.Cough, coughing sputum
As the disease progresses, coughing worsens and the amount of sputum increases. Mucus sputum, mucus sputum mixed with small yellow-white purulent lumps.
2.Hemoptysis
(1) Blood in sputum, inflammatory lesions, increased capillary permeability.
(2) Moderate hemoptysis, small blood vessel injury.
(3) large amount of hemoptysis, cavernous type A rupture.
3. Chest pain
If the pain is pinprick-like and increases with respiratory movement, it indicates that the pleura is involved. If the apical pleura is involved, the chest pain may radiate to the shoulder.
4.Difficulty in breathing
The compensatory function of the lung is so great that mild or moderate lesions do not cause dyspnea.
Recently, there is an increasing trend of pulmonary tuberculosis patients over 60 years of age in China, with blood-borne disseminated type and slow fibrous hollow being more common, and young people in Chongqing with rising tuberculosis and pleurisy being more common. Many diseases and factors have an adverse effect on tuberculosis, diabetes is one of them, tuberculosis bacteria in the case of increased blood sugar and ketone bodies, easy to multiply. In diabetes mellitus combined with pulmonary tuberculosis, if urinary sugar is not controlled, the lesions progress rapidly and often show caseous necrosis and bronchial spread. Pregnancy plays an adverse effect on tuberculosis, active tuberculosis, to abort. With adequate protection of anti-tuberculosis drugs, delivery does not cause recurrence of lesions.
III. What is tuberculosis?
Tuberculosis is a chronic infectious disease caused by the invasion of Mycobacterium tuberculosis into the human body. For a long time, people have had a strong fear of tuberculosis because there is no effective drug treatment and it is highly contagious. With the progress of science and technology, scientists have developed more than a dozen effective anti-tuberculosis drugs since the 1950s, and as long as early detection and regular treatment are available, it is completely curable. Mycobacterium tuberculosis can invade any organ of the body, which means that tuberculosis can occur in all organs of the body.
What is bone and joint tuberculosis?
Bone and joint tuberculosis is one of the tuberculosis diseases. It is most common in children and adolescents. The disease has a slow onset, long course and many comorbidities. Clinical manifestations include local pain, limited joint movement, muscle spasm, cold abscess or fistula formation, and may be accompanied by systemic symptoms of tuberculosis toxicity, such as low-grade fever, night sweats, and wasting. At present, the main treatment methods are non-surgical intervention and local puncture and pus aspiration and drug injection treatment. Early diagnosis and early treatment can stop the development of lesions in time, shorten the course of disease and protect the function of joints.
V. What are the symptoms of pulmonary tuberculosis?
Early stage or mild tuberculosis can be ignored because of no symptoms or mild symptoms, but if the lesion is in the active progress stage, the following symptoms can appear.
1, fever: manifested as a low fever in the afternoon, mostly in the afternoon 4-8 pm body temperature rises, generally between 37-38 ℃. At this time, the patient is often accompanied by general weakness or wasting, night sweats, and women may suffer from menstrual irregularities or menopause.
2. Coughing and sputum: It is the most common early symptom of tuberculosis, but it is also the most likely to be mistaken by patients or doctors as “cold” or “bronchitis” and lead to misdiagnosis.
3. Blood in sputum: Sputum with blood or small blood clots, most of the blood in sputum is caused by tuberculosis.
VI. What should I do if I suspect I have tuberculosis?
Once you understand what tuberculosis is all about and know what the symptoms of tuberculosis are, then if you have the aforementioned symptoms and suspect that you have tuberculosis, especially if you cough and sputum with blood in the sputum for more than two weeks, you should immediately go to your local tuberculosis control institution for early diagnosis, regular treatment and early recovery. In addition, relatives (close contacts) of patients with bacillary TB should also have a health check in a timely manner.
7. How do I give my medical history to the doctor?
There are usually two aspects of medical history to be given to the doctor during outpatient visits to the tuberculosis clinic.
1. When TB is suspected.
(1) Time of onset, symptoms and evolution of the disease.
(2) Diagnosis and treatment prior to the current visit.
(3) Whether other diseases are combined, especially rheumatism and diabetes mellitus.
(4) History of close contact with bacillary tuberculosis or other conditions, such as occupation, working conditions and living conditions.
2. Patients with known pulmonary tuberculosis.
(1) Describe the history of the disease to the physician voluntarily.
(2) What kind of examination has been done, especially chest X-ray and sputum examination.
(3) Describe in detail the treatment, including the name of the drug, dosage, usage, efficacy and side effects. Because this can help the doctor understand the past disease, estimate the efficacy and prognosis, select reasonable drugs and develop effective chemotherapy program.
Why should I have sputum examination?
If your doctor finds abnormal shadows in your lungs, he or she will give you a sputum examination. Sputum examination is a microscopic search for Mycobacterium tuberculosis. Once the bacilli are found in the sputum, the diagnosis of tuberculosis can be confirmed. In addition, the patient’s doctor will ask you to check sputum regularly during the treatment to evaluate and assess the effect of treatment. At the end of the treatment course, three consecutive negative sputum checks are considered to be a cure for tuberculosis in sputum-positive patients.
9.How to take sputum specimens properly?
Sputum examination is so important that patients should also master the correct method of sputum retention, otherwise it will directly affect the sputum test results. The correct method of sputum retention is to rinse the mouth with water several times before sputum retention to remove food residues and some miscellaneous bacteria from the mouth. The sputum retained should be the sputum coughed out from the trachea after coughing hard, and then it should be put in the sputum box for examination. Do not spit saliva or nasal mucus into the sputum box to avoid affecting the results of sputum examination.
For those who need to check sputum for the first time, the doctor requires three sputum specimens to be sent: 1.
1. immediate sputum: the sputum coughed up at the time of the visit.
2. nocturnal sputum: sputum coughed up in the evening of the previous day.
3. Early morning sputum: the sputum coughed up deeply after waking up, among which the sputum coughed up for the first time in the early morning is the most effective.
X. What does a positive tuberculin test mean?
Mycobacterium tuberculosis is a biological product made from the culture filtrate of tuberculosis bacillus, which contains only the protein of tuberculosis bacillus and no tuberculosis body. At present, the tuberculin commonly used in China is a pure protein derivative of Mycobacterium tuberculosis, referred to as PPD. The result is judged as follows: within 24-72 hours after PPD injection, measure the straight warp of skin hard nodes. 5mm or less is negative (-), 5-9mm is weakly positive (+), 10-19mm is positive (++), greater than 20Mmm or less than 20mm but blistering and necrosis is strongly positive (++++). If you are positive for tuberculin, it only means that you have been infected with tuberculosis bacteria. Whether you have tuberculosis or not, your doctor should analyze your clinical manifestations, sputum bacteriological test and x-ray examination to make a final judgment. If it is negative, it does not negate the TB infection, because the initial infection immune response has not yet been established, the body’s immune function is suppressed, such as tumors, severe TB, severe malnutrition and the application of immunosuppressive drugs can be negative.
XI. What are the commonly used anti-tuberculosis drugs?
1.Isoniazid (INH): It has a strong killing effect on tuberculosis bacilli, and it is inexpensive and essential for the treatment of tuberculosis.
2.Streptomycin (SM): It is one of the drugs in the chemotherapy program for the intensive period (the beginning of two months) of primary treatment of tuberculosis, and has obvious bactericidal effect on Mycobacterium tuberculosis. The drug has damage to the cranial nerves and can cause vertigo and tinnitus, hearing loss and even deafness, and numbness of the lips and mouth.
Rifampicin (RFP): It has a strong killing effect on tuberculosis bacteria, and is the most effective anti-tuberculosis drug after isoniazid foot, and is also an indispensable component of the primary tuberculosis treatment program.
4.Ethylenebutanol (EMB): It has an inhibitory effect on TB bacilli, especially on TB bacilli that have been resistant to isoniazid and streptomycin, and should pay attention to the change of vision during the medication.
5.Pyrazinamide (PZA): It has a special killing effect on intracellular or resting state of Mycobacterium tuberculosis. The above five drugs are the most commonly used or effective drugs for the treatment of tuberculosis at present. Doctors can make up a reasonable chemotherapy regimen for the treatment according to the changes in the patient’s condition and the use of drugs.
12. What are the principles of treating tuberculosis?
1.Early: Treatment of confirmed bacillary tuberculosis should be carried out as early as possible, so as to facilitate lesion repair and, more importantly, to reduce the transmission to relatives and surrounding healthy people.
2, combination: choose two or more anti-tuberculosis drugs to form a chemotherapy regimen, combined treatment can ensure the effectiveness of treatment, and delay and prevent the development of resistance to tuberculosis bacteria and lead to chemotherapy failure.
3, the right amount: too small a dose of drugs can not kill the bacteria and easy to produce drug resistance, but too large a dose is prone to toxic side effects and interrupt treatment. Therefore, we must adhere to the prescribed dose of drugs in order to complete the scheduled course of treatment and ensure the effectiveness of treatment.
4.Regulation: strictly follow the chemotherapy regimen within the prescribed course of treatment and take the drugs at the same intervals as prescribed by the chemotherapy regimen to avoid missing or interrupting the dosing.
5.Whole course: Complete the prescribed course of treatment as required. If the course of treatment is not completed and the drug is stopped, it will make the treatment fail or cause relapse. But more than the course of indefinite use of drugs, not only can not improve the efficacy, and easy to produce toxic side effects and increase the unnecessary economic burden.
XIII. What is primary treatment of tuberculosis?
Primary TB is defined as patients who are found for the first time and have not received any anti-tuberculosis drug treatment, or patients who have been treated with irregular and unreasonable anti-tuberculosis treatment after the discovery of TB, but the course of treatment does not exceed one month. However, as long as the patient actively cooperates with the anti-TB doctor and insists on effective, reasonable and complete chemotherapy, the infectiousness can disappear quickly within 2-4 weeks and the cure rate can be over 95%. The key is to comply with medical advice, obey management, complete the course of treatment, and strive for a complete cure.
What is retreatment of tuberculosis?
Retreatment of tuberculosis refers to the relapse of a patient who has failed initial treatment or treatment. Or those who have received irregular and unreasonable chemotherapy for more than one month after detection of tuberculosis. In clinical practice, the condition of relapsed TB is mostly complicated, often characterized by heavy disease and poor health, and mostly caused by irregular or unreasonable chemotherapy (not adhering to treatment as required by doctors or treatment in non-tuberculosis specialized institutions, or even wild medicine, as well as the purchase of drugs from irregular pharmacies, etc.). At this time, the tuberculosis bacilli have developed drug resistance, so treatment is much more difficult than for first-treatment tuberculosis. The key to the treatment of tuberculosis is to establish confidence in overcoming the disease, actively cooperate with the doctor, choose the chemotherapy program consisting of anti-tuberculosis drugs according to the drug sensitivity test, and insist on completing the treatment.
What should patients pay attention to after starting treatment for tuberculosis?
1.Establish the correct scientific view and confidence: Due to the influence of traditional concepts that tuberculosis is incurable, especially in rural areas, suffering from tuberculosis will carry a heavy ideological burden, and even taboo the disease, refusing examination and treatment, and taking an uncooperative attitude, the result of which is to delay the treatment and lose the opportunity to cure.
2.Follow the doctor’s advice: take the medicine strictly according to the doctor’s requirements. Some people take tuberculosis lightly, do not follow medical advice, do not take medication on time, do not insist on completing the full course of treatment, stop taking medication prematurely, so that the disease is sometimes good and sometimes bad, can not be completely treated into a chronic source of infection that can not be cured. Some people think that the greater the amount of medicine, the disease will be faster to increase the dose, resulting in toxic reactions forced to stop the drug, and some people are afraid of drug side effects and reduce the dose, the result is insufficient to affect the effectiveness of the drug. Familiar with the method of medication, such as anti-tuberculosis drugs require a single dose to increase the concentration of bactericidal in the blood, and then rifampin should be taken on an empty stomach one hour before breakfast, otherwise it will affect the efficacy. In addition, if adverse reactions occur after taking the drug, do not stop the drug on your own, but promptly report to the doctor.
3, adhere to the medication, regular review: adhere to the medication, complete the course of treatment is the key to cure tuberculosis. At the same time, patients should also be required to regularly re-examine in order to enable doctors to grasp the efficacy of drugs, lesion repair and other conditions.
4, the patient’s family should actively cooperate with the treatment: family members are in close contact with the patient and know the patient best, and their care and understanding of the patient will have a positive impact. Children, the elderly or illiterate people should help them to take medication, know the medication and keep it, and play the role of a voluntary supervisor.
5, it is best to do the whole supervision of chemotherapy: that is, in the treatment process of each patient medication are under the direct supervision of medical staff, to do: send the drug to the hand, see served to the mouth, swallowed and then go”.
Sixteen, why BCG vaccination?
BCG vaccine is actually a kind of attenuated live Mycobacterium tuberculosis, which is bovine Mycobacterium tuberculosis in artificial medium after 13 years and 230 successive transplantation and transmission culture, so that it loses its pathogenicity to human body, but can make the body produce immunity. After BCG vaccination, the human body is artificially infected with a mild primary infection without the risk of disease, which stimulates the body to develop specific immunity, and this acquired immunity can prevent the human body from developing disease when infected with the tuberculosis bacillus again. After decades of research and practical observation, BCG vaccine has indeed become an effective weapon for human prevention of tuberculosis, especially for children and adolescents with obvious protective effects.
XVII. What should be noted in the diet of TB patients?
Tuberculosis patients should be given foods high in protein and calories. Any symptoms of tuberculosis will cause serious depletion of tissue protein and caloric energy, so the supply of food protein and caloric energy should be higher than normal. The daily supply of protein is 1.5-2.0g/kg, with milk, eggs, animal offal, fish and shrimp, lean meat, soybean products and other foods as the source of protein. Milk is rich in casein and calcium, which is the ideal nutritional food for TB patients. The amount of caloric energy supply is based on the principle of maintaining the patient’s normal body weight, and can be supplied at 40-50 kcal per kilogram of body weight, and carbohydrate staple foods can be supplied according to the diet without restriction, but fat should not be eaten more, mainly vegetable oil. Vitamins and inorganic salts have a great role in promoting recovery from tuberculosis. Among them, vitamin A has the role of enhancing the body’s ability to resist disease; vitamins B and C can improve the metabolic process in the body, enhance appetite, and improve the function of lungs and blood vessels and other tissues; patients with recurrent hemoptysis should also increase the supply of iron and eat more green leafy vegetables, fruits and grains, which can supplement a variety of vitamins and minerals.
Patients with tuberculosis have a particularly bad appetite. To increase appetite, work on cooking to achieve variety, good color, aroma, taste and shape. If possible, in addition to three meals a day, two additional snacks can be added. Should avoid eating irritating foods and pungent and phlegm-producing substances. Because tuberculosis is a chronic infectious disease, while using medicine and diet, attention should be paid to adequate rest and appropriate outdoor activities, and to the hygiene of the environment and eating utensils.
18. How should tuberculosis patients be disinfected and isolated at home?
Patients with tuberculosis should not spit anywhere, but should spit in a paper or spittoon, and then burn or disinfect it and pour it away. Do not talk, cough or sneeze loudly to your family. It is best to wear a mask, which should be boiled and washed daily.
It is better to have a separate bedroom with sufficient light and good energy wind, the room should be disinfected frequently , you can light the moxa or put rice vinegar on the stove to fumigate at 1-2 tablespoons per cubic meter of space, close the windows and doors for 1-2 hours and then open the windows for ventilation. The easiest way to disinfect heat-resistant objects such as utensils and appliances used by patients is to boil them, such as eating utensils, clothes, etc. The boiling time is 10-15 hours. The boiling time is 10-15 minutes.
Patients’ used clothes should be washed frequently and exposed to the sun to kill Mycobacterium tuberculosis.
Microwave disinfection: Microwaves can penetrate glass, plastic film, and paper. However, the disinfection of microwave ovens varies with the power of the microwave oven. General household microwave oven power of 700 watts or more, time 4-7 minutes can achieve the disinfection effect. Attention.
① Microwaves do not penetrate metal, so disinfection items should not be placed inside metal utensils.
② microwaves are most easily absorbed in the water molecules, so it is best to put a glass of water in the oven when disinfecting, so that the disinfection effect is better.