Overview: Mycobacterium tuberculosis is an infectious disease caused by infection of the lungs.
Mycobacterium tuberculosis infection of the lungs is an infectious disease characterized by cough, sputum, low afternoon fever, hemoptysis, night sweats, and unexplained weight loss. Mycobacterium tuberculosis infection of the lungs in humans is treated with chemotherapy as the core treatment, and with symptomatic and surgical treatments when necessary.
Definition
Tuberculosis is a chronic respiratory infectious disease caused by infection of the lungs with Mycobacterium tuberculosis and is the most common form of tuberculosis in clinical practice. It is the most common form of tuberculosis in clinical practice. In Chinese medicine, it is called “consumption”.
Tuberculosis is an infectious disease caused by infection with Mycobacterium tuberculosis. In addition to the lungs, the plasma membrane, lymph nodes, genitourinary system, intestines, liver, skin, bones and joints can be infected with Mycobacterium tuberculosis and cause tuberculosis.
According to the Law of the People’s Republic of China on Prevention and Control of Infectious Diseases, tuberculosis belongs to Class B infectious diseases.
Clinically, TB is categorized into progressive stage, improving stage and stable stage.
Classification
Active tuberculosis
Active tuberculosis: there are clinical symptoms and signs related to tuberculosis, and there is evidence of active tuberculosis in mycobacterium tuberculosis pathogenesis, pathology, imaging and other examinations.
It is usually highly contagious, and the contagiousness will usually decrease dramatically after anti-tuberculosis treatment.
Classification according to lesion site
Primary tuberculosis (type I): including primary syndrome and intrathoracic lymph node tuberculosis.
Hematogenously disseminated tuberculosis (Type II): including acute, subacute and chronic hematogenously disseminated tuberculosis.
Secondary tuberculosis (type III): including infiltrative tuberculosis, tuberculosis ball, caseous pneumonia, chronic fibro-cavitary tuberculosis and destroyed lung.
Tuberculous pleurisy (type IV): including dry, exudative pleurisy and tuberculous pyothorax.
Tracheal and bronchial tuberculosis: including tuberculosis of the mucosa and submucosa of the trachea and bronchus.
Categorized by drug-resistant status
Non-drug-resistant tuberculosis: no resistance to the antituberculosis drugs used has been found in vitro.
Drug-resistant tuberculosis
Monoresistant TB: Mycobacterium tuberculosis is resistant to one first-line antituberculosis drug.
Multidrug-resistant TB: Mycobacterium tuberculosis is resistant to more than one first-line antituberculosis drug, excluding isoniazid and rifampicin, which are both resistant.
Multidrug-resistant TB: Mycobacterium tuberculosis is resistant to at least two or more first-line antituberculosis drugs, including isoniazid and rifampicin at the same time.
Extensively drug-resistant TB: Mycobacterium tuberculosis is resistant to at least one of the second-line antituberculosis drugs, fluoroquinolone antibiotics, and at least one of the three injectable drugs, in addition to being resistant to both the first-line antituberculosis drugs isoniazid and rifampicin.
Rifampicin-resistant TB: Mycobacterium tuberculosis is resistant to rifampicin, whether or not it is resistant to other anti-tuberculosis drugs.
Classification according to treatment history
Primary tuberculosis: one of the following conditions is met.
Those who have never been treated with anti-tuberculosis drugs for tuberculosis.
Those who are on a standard chemotherapy regimen with less than a full course of regular medication.
Those who have been on irregular chemotherapy for less than 1 month.
Resumption of tuberculosis treatment: one of the following conditions.
Those who have been unreasonably or irregularly treated with anti-tuberculosis drugs for ≥ 1 month for tuberculosis.
Those who failed the initial treatment and relapsed.
Classification according to the results of pathogenetic examination
Smear-positive tuberculosis: positive sputum antacid-stained smear.
Smear-negative tuberculosis: negative sputum smear with antacid staining.
Culture-positive tuberculosis: positive sputum culture for Mycobacterium tuberculosis.
Culture-negative tuberculosis: negative sputum Mycobacterium tuberculosis culture.
Molecular biology positive TB: positive nucleic acid test for Mycobacterium tuberculosis.
No sputum test for tuberculosis: the patient did not undergo sputum antacid-stained smear, sputum Mycobacterium tuberculosis culture and molecular biology.
Inactive tuberculosis
Inactive tuberculosis can be diagnosed by the absence of clinically relevant signs and symptoms associated with active tuberculosis, negative bacteriologic tests, and imaging studies that meet one or more of the following manifestations and exclude other causes of imaging changes in the lungs.
Calcified lesions (isolated or multiple).
Cordate lesions.
Cavities.
Pleural thickening, adhesions or with calcification.
Morbidity
According to the Global Tuberculosis Report 2021 published by the World Health Organization (WHO), in 2020, there will be 9.87 million new cases of tuberculosis globally, with an incidence rate of 127 per 100,000, and the global population of latent tuberculosis infections is approaching 2 billion.
Causes
Causes
Infection of the lungs with Mycobacterium tuberculosis is the underlying cause of tuberculosis.
Infection of the body with Mycobacterium tuberculosis does not necessarily lead to disease, but may cause clinical disease when the body’s resistance is lowered and Mycobacterium tuberculosis is present in sufficient numbers or virulence.
Source of infection
Mainly tuberculosis patients (sputum direct smear positive), mainly through coughing, sneezing and other ways to discharge droplets containing Mycobacterium tuberculosis, infection occurs after contact.
Cattle with tuberculosis can also transmit the disease through infected milk.
Transmission route
Mainly through droplets and dust; drinking infected milk can also be infected through the digestive tract, but it is less common.
Susceptible people
People are generally susceptible, but whether or not tuberculosis occurs after infection with Mycobacterium tuberculosis depends on two things.
The number and virulence of the infected Mycobacterium tuberculosis.
The specific and non-specific immunity of the human body to Mycobacterium tuberculosis, and the susceptibility to the disease when immunity is low.
High risk factors
Many factors increase the risk of developing TB, as listed below.
Close contacts with patients with active TB.
Elderly people, infants and young children, and pregnant women who are close to giving birth.
People who are infected with human immunodeficiency virus (HIV), chronically ill, undergoing chemotherapy, or malnourished.
People who live in crowded places with poor sanitary conditions.
People who live or work in environments where there are more TB patients, increasing the likelihood of infection, such as doctors and nurses who diagnose and treat TB, as well as related caregivers and healthcare providers.
Residents or travelers in areas where TB is highly prevalent.
Use of immunosuppressive drugs, such as infliximab.
Smoking.
Alcohol and drug abuse.
People who do not have access to good medical care, e.g., the poor, the homeless, etc.
Pathogenesis
Mycobacterium tuberculosis first inhaled into the lungs may be killed by phagocytosis in the alveoli. It is only when Mycobacterium tuberculosis is abundant and virulent that it survives and multiplies inside and outside the phagocytes, leading to inflammatory lesions in part of the lung tissue and the formation of primary foci of tuberculosis.
Mycobacterium tuberculosis in the primary lesion reaches the hilar lymph nodes along the draining lymphatic vessels in the lungs, causing enlargement of the lymph nodes. The primary lesion continues to expand or spreads to neighboring tissues and organs, and tuberculosis occurs.
When Mycobacterium tuberculosis first invades the human body and begins to multiply, in most cases the body can produce specific immunity against Mycobacterium tuberculosis through cell-mediated immune response, causing it to stop multiplying, the inflammation in the primary lesion is absorbed, and Mycobacterium tuberculosis disseminated throughout the body is eliminated.
A small number of uneradicated Mycobacterium tuberculosis can remain dormant for a long time, which is called latent infection. When the body’s resistance drops, the latently infected Mycobacterium tuberculosis can become active again and develop into active tuberculosis.
Symptoms
TB can have different symptoms depending on the stage of development.
Latent infection
There are no obvious signs, and it is only detected during chest imaging.
Inactive TB
No obvious symptoms, only abnormalities in the lungs can be detected during imaging tests.
Active tuberculosis
Symptoms are obvious and the main manifestations are as follows.
Cough and sputum: The cough is mild, may be dry or accompanied by mucus or purulent sputum, and may last for more than 2 weeks.
Hemoptysis: about 1/3 of the patients will have varying degrees of hemoptysis, most of them have a small amount of hemoptysis.
Fever: the most common symptom, mostly afternoon hot flashes, i.e., the temperature starts to rise in the afternoon and returns to normal the next morning.
Shortness of breath and chest pain: Individuals may experience shortness of breath and chest pain.
Other symptoms: Fatigue, loss of appetite, weight loss, night sweats, etc. may also be seen, and women of childbearing age may experience menstrual disorders.
Consultation
Department of Medicine
Department of Infectious Diseases
If tuberculosis is highly suspected on physical examination, or if symptoms such as low afternoon fever, night sweats, cough and sputum appear after contact with a patient with tuberculosis, it is recommended to consult an infectious disease department or a tuberculosis hospital promptly.
Respiratory medicine
When symptoms such as low-grade fever, cough, sputum, blood in sputum or hemoptysis occur, it is also advisable to consult the Department of Respiratory Medicine, and then transfer to the Department of Infection or the Tuberculosis Hospital for further treatment after confirmation of the diagnosis.
Emergency Department
In case of emergency, such as massive hemoptysis, high fever, or difficulty in breathing, it is recommended to go to the Emergency Department immediately.
Preparation for medical treatment
Preparing for medical treatment: registration, preparation of documents, and common problems.
Tips for seeking medical treatment
Chest auscultation and chest CT examination are often required. It is recommended to wear clothes that are easy to put on and take off, avoid wearing clothes made of metal, and inform the doctor if you are pregnant or planning to become pregnant.
Avoid contact with people around you, wear a mask and gloves, cover your nose and mouth when sneezing, and take non-public transportation to the hospital.
Avoid taking fever-reducing medication or antibiotics on your own, as this may affect the doctor’s judgment of your condition. For patients with high fever, physical cooling can be done first, such as applying cold compresses to the forehead, and wiping hands, feet and armpits with warm water.
Preparation Checklist for Doctor’s Visit
Symptom Checklist
Especially focus on the time of onset of symptoms, special manifestations, etc.
Is there fever? What is the highest degree? Is there a pattern?
Is there night sweating, weakness, chest pain during sleep?
Is there coughing and sputum? Is there blood in the sputum?
Is there hemoptysis?
How long have these symptoms been present?
List of medical history
Has there been any contact with a person with tuberculosis?
Are there any diseases such as diabetes, autoimmune deficiency diseases, tumors, etc.?
Are immunosuppressive drugs being used?
Has BCG vaccination been administered?
Checklist
Test results of the last six months, which can be brought to the doctor’s office
Laboratory tests: routine blood test, blood sedimentation, tuberculin test, sputum mycobacterium tuberculosis test, mycobacterium tuberculosis nucleic acid test, specific antigen and antibody test.
Imaging tests: chest X-ray, chest CT, bronchoscopy.
Biopsy: biopsy of puncture material.
List of medications used
Medications used in the last 3 months, if available in boxes or packages, carry them to the doctor’s office
Antipyretic and analgesic drugs: ibuprofen, acetaminophen.
Antituberculosis medications: isoniazid, rifampin, pyrazinamide, ethambutol, etc.
Diagnosis
Diagnosis is based on
Medical history
There may be a history of extrapulmonary tuberculosis or close contact with patients with tuberculosis.
Clinical manifestations
May be asymptomatic or have the following symptoms.
Systemic symptoms such as low afternoon fever, lethargy, malaise and night sweats.
Respiratory symptoms such as cough and sputum for more than 2 weeks.
Laboratory tests
Tuberculin test
OBJECTIVE: To find out if there is Mycobacterium tuberculosis infection.
Significance: It is informative for the diagnosis of tuberculosis in children, adolescents and young people.
Precautions
It takes 4-8 weeks for Mycobacterium tuberculosis to enter the body and for a metamorphic reaction to occur, before which the tuberculin test can be negative.
Tuberculin test results are mostly negative or weakly positive in cases of malnutrition, HIV infection, measles, chickenpox, cancer, and severe bacterial infections including severe tuberculosis (e.g., blood-borne tuberculosis and tuberculous meningitis, etc.).
Sputum Mycobacterium tuberculosis test
Purpose: To find out whether there is Mycobacterium tuberculosis infection.
Significance: the main method of confirming the diagnosis of tuberculosis, and also the main basis for the formulation of chemotherapy program and judging the effect of treatment.
Methods
Smear method: simple, fast, easy and reliable. Positive sputum suggests the presence of antacid bacilli, and it cannot distinguish between Mycobacterium tuberculosis and non-tuberculous mycobacteria. Since non-tuberculous mycobacteria have a very low chance of causing disease, detection of antacid bacilli in sputum is of great significance to the diagnosis of pulmonary tuberculosis.
Culture method: the sensitivity is higher than that of smear method, which is often used as the “gold standard” for diagnosis. It can also provide strains for antimicrobial susceptibility test (referred to as drug sensitivity test) and strain identification, which usually takes 2-8 weeks.
Note: The excretion of bacteria in patients with tuberculosis is intermittent and uneven, so it is necessary to take sputum at different times (e.g., early morning sputum, night sputum and immediate sputum), and check the sputum several times.
Drug sensitivity test
Purpose: To find out which antimicrobial drug is more effective in the treatment of tuberculosis in patients and to target the drug.
Significance: It is mainly used for patients who have failed the initial treatment, relapse and other retreatment, and provides a basis for the diagnosis of drug-resistant cases, the formulation of a reasonable chemotherapy program and epidemiological monitoring.
Precautions: It is better to collect sputum specimen before applying antimicrobial drugs.
Others
Such as γ-interferon release test, bacterial specific component detection (such as polymerase chain reaction, nucleic acid probe detection of specific DNA fragments, etc., specific antigen and antibody detection, etc.).
Imaging
Chest X-ray
Purpose: Initial screening for tuberculosis.
Significance: Routine preferred method for the diagnosis of tuberculosis.
It can detect tuberculosis lesions, determine the scope, location, morphology, density, relationship with surrounding tissues, and accompanying images of lesion shadows.
Determine the nature of the lesion, the presence or absence of activity, the presence or absence of cavities, the size of the cavity and the characteristics of the cavity wall.
Frontal and lateral chest films can often show clearly the lesions obscured by the heart shadow, pulmonary hilum, blood vessels and mediastinum, as well as the lesions in the middle lobe and lingual lobe of the lungs.
Imaging characteristics: lesions mostly occur in the apical posterior segment of the upper lobe, the dorsal segment of the lower lobe and the posterior basal segment, polymorphism, i.e., infiltrating, proliferative, caseous, and fibrocalcified lesions may coexist, with inhomogeneous density, clearer margins, and slower change of the lesions, which are prone to form cavities and disseminated foci.
Precautions
Special groups, such as infants, young children, pregnant women, should be cautious of X-ray examination.
Remove metal objects from the chest before the examination, such as necklaces around the neck and underwear with metal brackets.
Lung CT
Purpose: Evaluation of subtle features of lesions and reduction of overlapping images.
Significance: Commonly used for the diagnosis of tuberculosis and differential diagnosis with other chest diseases.
It can clearly show the characteristics and nature of each type of tuberculosis lesion, its relationship with the bronchial tubes, the presence or absence of cavities, as well as changes in progression and absorption.
It can accurately show whether the mediastinal lymph nodes are enlarged or not.
It is easy to find hidden chest and tracheal and endobronchial lesions, early detection of corn-like shadows in the lungs, and reduce the leakage of tiny lesions.
Precautions: Generally, no fasting is required, but for enhanced scanning and abdominal plain scanning only, fasting for at least 4 hours before the examination.
Bronchoscopy
Purpose: to understand the trachea, bronchial lesions.
Significance: commonly used in the diagnosis of bronchial tuberculosis.
Bronchial tuberculosis is characterized by mucosal congestion, ulceration, erosion, tissue hyperplasia, scarring and bronchial stenosis; biopsies are taken from the lesions for pathological examination and culture of Mycobacterium tuberculosis.
For intrapulmonary tuberculosis foci, specimens of secretions or flushing fluid can be collected for pathogenetic examination, and specimens can also be obtained via bronchopulmonary biopsy for examination.
Precautions
In case of transoral insertion, the denture should be removed in advance if there is a denture.
Fasting should be performed for 2 hours after the operation, and food should be taken only after the anesthesia has worn off to prevent aspiration.
Pathologic examination
Purpose: To understand the pathological changes of the lesion site.
Significance: By observing the pathological changes, it can assist the clinical diagnosis. Tuberculosis nodules and granulomas containing epithelioid cells and Langerhans cells, and/or positive for Mycobacterium tuberculosis may be seen.
Precautions: For specimens obtained by bronchoscopy, the same precautions apply as for bronchoscopy.
Differential Diagnosis
Pneumonia
Similarities: fever, cough, sputum.
Differences
Tuberculosis is mostly characterized by low fever in the afternoon, night sweats, fatigue and hemoptysis.
Pneumonia is generally more acute in onset, with chills and high fever. Symptoms can be relieved quickly with antibacterial treatment. Chest X-ray and tuberculin test can be used to differentiate.
Chronic Obstructive Pulmonary Disease (COPD)
Similarities: Both may have chronic cough, sputum and hemoptysis.
Differences: COPD is characterized by the following.
Typical symptoms are shortness of breath and dyspnea, aggravated by activity. Cough is usually obvious in the morning, mostly white mucous sputum or plasma foamy sputum.
Pulmonary function tests may show obstructive ventilation dysfunction.
Bronchiectasis
Similarity: both can have chronic recurrent cough, cough sputum, often repeated hemoptysis.
Differences: Bronchiectasis is characterized by the following.
The main symptoms are chronic cough, coughing up a large amount of purulent sputum and/or recurrent hemoptysis; sputum can be stratified after collection, with foam in the upper layer, turbid mucus in the middle layer, purulent components in the lower layer, and necrotic tissue in the lowest layer.
In mild cases, there is no abnormality on chest X-ray or only thickening of lung texture is seen, and curly hair-like changes are seen in typical cases; high-resolution CT (HRCT) can clearly show the enlargement of bronchial lumen, which can be differentiated.
Lung cancer
Similarity: both may have symptoms such as cough, blood in sputum, chest pain and emaciation.
Differences: Lung cancer and tuberculosis have similar clinical symptoms and X-ray signs, and can be differentiated by repeated sputum exfoliative cell and Mycobacterium tuberculosis examinations and pathological examinations.
Lung abscess
Similarity: Both may have fever and coughing up sputum.
Differences: Lung abscesses are characterized as follows.
Typical features are high fever, cough, coughing up a large amount of thick smelly sputum, and a history of oral surgery, foreign body aspiration, and coma and vomiting.
Chest X-ray shows a cavity with a fluid plane with dense surrounding inflammatory shadows; blood leukocytes and neutrophils are elevated.
Typhoid fever
Similarities: There are clinical manifestations such as high fever, decreased white blood cell count and hepatosplenomegaly, which can be easily confused with acute hematogenous tuberculosis.
Differences: Typhoid fever is characterized as follows.
It is often characterized by an episodic fever (persistent temperature of 39-40°C) and a rose rash on the skin.
Culture tests of blood, urine, feces and fattening test can differentiate it.
Leukemia
Similarities: Acute hematogenous tuberculosis may occasionally have a leukemia-like reaction, and both leukemia and acute tuberculosis may have a significant increase in peripheral blood leukocytes and/or the presence of naïve blood cells.
Differences: Leukemia has a tendency to bleed, and bone marrow smears and dynamic X-ray chest radiographs are helpful in differentiating it from other forms of leukemia.
Treatment
Tuberculosis is centered on chemotherapy, combined with symptomatic and surgical treatment.
Chemotherapy
Chemotherapy is the most basic treatment for tuberculosis, and its main function is to kill bacteria, prevent the production of drug-resistant bacteria and sterilization, which can shorten the infectious period, reduce the death rate, infection rate and prevalence rate, and eradicate Mycobacterium tuberculosis.
Principles: early, regular, whole course, appropriate amount, and combination.
Treatment program: two phases: intensive and consolidation.
Commonly used anti-tuberculosis drugs
First-line anti-tuberculosis drugs: isoniazid, rifampicin, pyrazinamide, ethambutol, streptomycin and five other drugs.
Second-line anti-tuberculosis drugs: p-amino acid sodium salicylate, colistin, kanamycin, propylthioisonicotinamide, levofloxacin and rifapentine.
Common adverse reactions to anti-tuberculosis drugs: there may be unsteady gait, heartburn (heartburn), vomiting, loss of appetite, blurred vision as well as convulsions, headache, etc., which can be referred to the doctor promptly for management.
Treatment regimen for primary active tuberculosis (including smear-positive and smear-negative)
Daily medication regimen
Intensive phase: isoniazid (H), rifampicin (R), pyrazinamide (Z) and ethambutol (E) once daily for 2 months.
Consolidation phase: isoniazid, rifampicin, once daily for 4 months.
Abbreviation: 2HRZE/4HR.
Intermittent dosing regimen
Intensive phase: isoniazid, rifampicin, pyrazinamide, and ethambutol, every other day or 3 times weekly for 2 months.
Consolidation phase: isoniazid, rifampicin, every other day or 3 times per week for 4 months.
Abbreviation: 2H3R3Z3E3/4H3R3.
Treatment regimen for relapsed smear-positive TB
Drug sensitivity testing is strongly recommended for patients with relapsed smear-positive TB. Sensitive patients are treated according to the following regimen, and drug-resistant patients are included in the drug-resistant regimen.
Sensitive drug regimen for retreatment of Mouvement positive TB
Intensive phase: isoniazid, rifampicin, pyrazinamide, streptomycin and ethambutol once daily for 2 months.
Consolidation phase: isoniazid, rifampicin and ethambutol once daily for 6 to 10 months. When sputum Mycobacterium tuberculosis tests are not negative at 4 months of treatment in the consolidation phase, the treatment period may be continued for an additional 6 to 10 months.
Abbreviation: 2HRZSE/6 to 10HRE.
Intermittent drug regimen
Intensive phase: isoniazid, rifampicin, pyrazinamide, streptomycin, and ethambutol every other day or 3 times weekly for 2 months.
Consolidation phase: isoniazid, rifampicin and ethambutol every other day or 3 times weekly for 6 months.
Abbreviation: 2H3R3Z3S3E3/6 to 10H3R3E3.
Multidrug-resistant TB/extensively drug-resistant TB treatment
Get detailed information about the patient’s medication history, commonly used antituberculosis drugs in the area and the prevalence of drug resistance; try to do drug sensitivity testing.
Strictly avoid choosing only one new drug to add to the original failed regimen.
WHO recommends the use of new generation fluoroquinolones whenever possible.
Do not use cross-resistant drugs.
Treatment regimens contain at least 4 second-line sensitizing drugs.
This includes at least pyrazinamide, fluoroquinolones, injectable kanamycin or amikacin, ethylthioisonicotinic acid hydrazide or propylthioisonicotinic acid hydrazide, and para-aminosalicylic acid (PAS) or cycloserine.
Drug dosage is determined by body weight.
The intensification period should be 9 to 12 months, with a total treatment period of 20 months or longer, as determined by treatment efficacy.
Monitoring of treatment efficacy is best based on sputum cultures.
Symptomatic treatment
Hemoptysis
Drugs to stop hemoptysis
Commonly used drugs: aminocaproic acid, tranexamic acid, phenolsulfonamide, carbachol, etc.
Posterior pituitary hormone: applicable to hemoptysis, can constrict small arteries, reduce the volume of blood in the pulmonary circulation and stop bleeding. Contraindicated in patients with hypertension, coronary heart disease, heart failure and pregnant women.
Bronchial artery embolization: bronchial artery destruction caused by hemoptysis can be used bronchial artery embolization.
Fever
Non-steroidal antipyretics
After effective anti-tuberculosis treatment, most of the fever caused by tuberculosis subsides within 1 week, and a few patients with unresolved fever can apply small doses of non-steroidal antipyretics.
Commonly used drugs: Ibuprofen.
Glucocorticoid
Suitable for acute hematogenous tuberculosis, or accompanied by severe toxic symptoms such as high fever, or high fever persists.
Commonly used drugs: Prednisone.
Precautions: Must be used under the premise of adequate and effective anti-tuberculosis drug therapy.
Airway stenosis due to tracheobronchial tuberculosis
When tracheobronchial tuberculosis leads to obvious narrowing of lobe and above lobe bronchial tubes, it often affects the respiratory function of the patient, and in severe cases, there is respiratory failure.
The patient should be treated with systemic anti-tuberculosis chemotherapy and airway interventions such as cryotherapy and balloon dilatation at the same time.
Immunotherapy
For multidrug-resistant and extensively drug-resistant patients who have experienced long-term irregular drug taking or poor long-term treatment effect and chronic bacterial excretion, immune-assisted therapy can be added on the basis of conventional chemotherapy as appropriate.
It is necessary to strictly grasp the indications, comprehensively consider the condition and economic situation to choose.
Currently used immunotherapy and immune preparations include: injection of Mycobacterium henselae, cytokines (IL-2, γ-interferon), thymus active extracts (thymus peptide or thymus pentapeptide) and so on.
Traditional Chinese Medicine (TCM) treatment
It is necessary to receive treatment in a qualified institution and do not trust some folk remedies to avoid delaying the condition.
When using Chinese medicine treatment, western medicine treatment can be carried out in conjunction with the doctor’s advice to realize the complementary advantages.
Commonly used medicines
Chinese medicine tablets: Momordica charantia, Cordyceps sinensis, Colla Corii Asini, Astragalus Membranaceus, etc.
Proprietary Chinese medicines: Astragalus A Lung Capsules, Baibai Anti-Tuberculosis Granules, Anti-Tuberculosis Capsules, Mealybugs Pills for Treating Tuberculosis, etc.
Surgery
Surgery can be used for patients with tuberculosis who have indications for surgery, but it is less commonly used.
Before and after surgery, patients also need to apply anti-tuberculosis drugs.
Indications
Indications for surgery for cavitary tuberculosis
Patients with no significant change or enlargement of cavities after initial and repeated rule therapy with anti-tuberculosis drugs (about 18 months), and positive sputum Mycobacterium tuberculosis test, especially Mycobacterium tuberculosis drug-resistant patients.
Those who have recurrent hemoptysis, secondary infections (including fungal infections), etc., and drug treatment is ineffective.
Those who cannot exclude cancerous cavities.
Those who have poor results of chemotherapy for pulmonary cavities caused by atypical mycobacterial infection.
Indications for tuberculosis ball surgery
Those whose tuberculosis ball is still positive for Mycobacterium tuberculosis in sputum after 18 months of regular anti-tuberculosis treatment or those who have hemoptysis.
Tuberculosis ball can not be excluded from lung cancer.
Tuberculosis ball diameter >3 cm, no change under regular chemotherapy, is a relative indication for surgery.
Indications for lung destruction surgery
Those who still have drainage, hemoptysis and secondary infection after regular anti-tuberculosis treatment.
Indications for surgery for hilar mediastinal lymphatic tuberculosis
The lesion is enlarged after regular anti-tuberculosis treatment.
The lesion compresses the trachea and bronchus and causes serious respiratory difficulties.
The lesion penetrates the trachea and bronchial tube, causing pulmonary atelectasis and caseous pneumonia, and the internal medicine treatment is ineffective.
Those who cannot exclude mediastinal tumor.
Indications for emergency surgery for hemoptysis
The hemoptysis volume is >600 ml in 24 hours, and the internal medicine treatment is ineffective.
The site of hemoptysis is clear.
Cardiopulmonary function and general condition are still good.
Repeated hemoptysis, who have had asphyxia, aura of asphyxia or hypotension, shock.
Indications for spontaneous pneumothorax surgery
Those with multiple episodes of pneumothorax (more than 2-3 times).
Those who continue to leak air despite closed chest drainage for more than 2 weeks.
Those with fluid pneumothorax with early signs of infection.
Those who have hemopneumothorax with no lung reopening after closed chest drainage.
Pneumothorax side combined with obvious pulmonary blisters.
Those with a history of pneumothorax on one side and the opposite side should be operated early.
Contraindication
Poor general condition or obvious cardiac, pulmonary, hepatic or renal insufficiency.
Prognosis
Cure
A small number of patients with strong immunity and occult Mycobacterium tuberculosis infection have the possibility of self-healing.
Tuberculosis will be cured after rationalization of treatment and adherence to the principles of early, regular, whole course, appropriate dosage and combination of medication.
According to the difference of tuberculosis infection, usually the cure rate of first-time patients can reach 98% and the recurrence rate is less than 2% if they are treated according to the principle of medication standardization.
Harmfulness
Patients with active TB can die due to progression of the disease or complications such as hemoptysis, spontaneous pneumothorax, pulmonary heart disease or extrapulmonary tuberculosis.
Patients with TB are prone to develop drug-resistant TB if they are not treated regularly. Once the patient is drug resistant, the cure rate will be reduced.
Daily
Daily management
Hygiene management
When coughing or sneezing, avoid others and cover your mouth and nose.
Do not spit. Spit in a covered spittoon with disinfectant solution or disinfectant wet tissue or sealed sputum bag.
Dietary management
Consume more high quality protein as appropriate to improve body immunity, such as milk, white meat, seafood and soy products.
Consume more fresh vegetables and fruits as appropriate, especially dark green leafy vegetables (e.g. spinach, rape), yellow and red vegetables and fruits (e.g. pumpkin, colorful peppers, carrots, yellow peaches, tomatoes, grapefruit, watermelon).
Avoid or eat less fried food such as doughnuts and potato sticks and indigestible food such as rice cakes and dumplings.
Prohibit drinking alcohol, which may cause vasodilation and aggravate coughing and hemoptysis.
Work and rest management
Regular work and rest.
Combine work and rest, ensure enough sleep time, avoid staying up late.
Others
Prohibit smoking.
Try not to go to crowded public places, if you have to go, you should wear a mask.
For home treatment, try to live in a separate room with other people, keep the room ventilated and wear a mask to avoid family members being infected.
Keep in a good mood and have confidence in the treatment.
Disease monitoring
In daily life, it is necessary to pay attention to the monitoring of the disease, if the treatment effect is not good or adverse drug reactions, it is necessary to consult the doctor in time.
Follow-up and review
The full course of treatment for TB lasts 6 to 8 months, and the full course of treatment for drug-resistant TB lasts 18 to 24 months, and regular follow-ups are required as prescribed by the doctor.
Prevention
Stay away from infectious sources
Avoid contact with TB patients and wear a mask when going to crowded places.
BCG Vaccination
For children, an effective measure to prevent tuberculosis is BCG vaccination, but the preventive effect on adults is not very effective. The BCG vaccine is effective in preventing tuberculous meningitis and granulomatous tuberculosis, which often occur in children.
After BCG vaccination of newborns, care must still be taken to isolate them from patients with tuberculosis.
Preventive Chemotherapy
Applicable people
Mainly used for high-risk groups of tuberculosis, including HIV-infected patients, close contacts of smear-positive tuberculosis patients, untreated pulmonary sclerosing fibrotic foci (inactive), silicosis, diabetes mellitus, long-term use of glucocorticoids or immunosuppressants, drug addicts, malnourished, children and adolescents with tuberculin test sclerosis ≥ 15 mm in diameter.
Usage
Commonly used isoniazid, once daily for 6 to 9 months, children according to body weight.
Or rifampicin and isoniazid once daily for 3 months.
Or rifapentine and isoniazid, 3 times weekly for 3 months.