Patient: Description of condition (onset, main symptoms, hospital visited, etc.): Age 32, female, with a three-year-old child. I had tuberculosis nine years ago, and I have been coughing in winter for the last two years, and I am not in good health. The medication is not obvious, but there is also improvement. On February 16, I returned home from work at 5:00 p.m. and felt sick, and I had a fever at about 8:00 p.m. I didn’t take my temperature. 17, I was fine and continued to work, but on the afternoon of February 18, I had a low fever and didn’t take my temperature, and I was sick with a heavy head, so I went to the doctor that afternoon and was advised to take a film. I told the doctor that I had tuberculosis 9 years ago, the doctor said he knew, and said I still had some problems with my right lung. On the 20th, I took the film to a doctor specializing in chronic diseases in Panyu, and said that there was a possibility of recurrence, but I could not be sure, and I needed anti-inflammatory treatment before taking the film. There is pus sputum, shortness of breath and no other discomfort Every time I have a cold and cough with pus sputum, it is treated as bronchitis, the effect is not obvious, but the cough is not strong, but always a little sputum, sometimes with pus sputum and sometimes with clear sputum. I’m worried… I’d like to know if the prognosis is not good if the TB does come back. Is there a possibility of pneumonia infection on the original healed scar? I am anxious to get your analysis… Thank you very much! Wen Wenpei, Department of Tuberculosis, Guangdong Tuberculosis Control Center
Wen Wenpei, Department of Tuberculosis, Guangzhou Chest Hospital: Don’t be in a hurry. As you said, it is very likely that inflammatory infection can occur on the old scars of the original cured tuberculosis. To diagnose recurrent tuberculosis, the chest X-ray taken nine years ago when the disease was cured is an important control. If there is really an increase in shadows, the diagnosis must be made after careful anti-infection treatment and exclusion of coccidioides, mycoplasma and other infections, combined with sputum smear results. The diagnosis of recurrent smear-negative tuberculosis should never be made hastily in the presence of a negative smear. The rate of misdiagnosis is very high. Clinically, some patients who are cured of mycoplasma pneumonia are diagnosed with smear-negative tuberculosis (cephalosporin does not work on mycoplasma) because they are not inflammatory after treatment with cephalosporin is ineffective, and secondly, a positive sputum smear is the most important diagnostic basis for recurrent tuberculosis.
Patient: Dr. Wen: I’m very touched that you replied to my message so quickly, I’m very relieved! My coughing sputum today seems to be slightly better than yesterday, but yellow. I also have more dry cough, and I feel that I am not short of breath to cough it out, and then I feel that my face is slightly puffier than usual. The second sputum test yesterday was still negative Add: I think I started to notice some swelling on my face yesterday, and I got up this morning, so should I have a blood test or other test or something? As you said, what about ruling out mycoplasma/coccus/viral infection? I hope to visit you sometime!
Wen Wenpei, Department of Tuberculosis, Guangzhou Chest Hospital.
You’re welcome! After completing the current anti-infection treatment plan developed by your primary care physician, see what the diagnosis is. You can see me during my clinic hours if you need to.