Tuberculous pleurisy is an inflammatory and metaplastic reaction of the pleura caused by invasion of the pleura by tuberculosis bacteria. It is mostly seen in adolescents. It can be divided into two types: dry and wet pleurisy.
1.What symptoms indicate that I may have tuberculous pleurisy
The onset of the disease can be acute or slow, but more acute. The onset of the disease resembles a cold, with moderate to high fever, night sweats, malaise, and general malaise. Local symptoms may include chest pain, dry cough, shortness of breath, chest tightness, terminal breathing and cyanosis when there is a large amount of pleural effusion.
2.What tests can be done to confirm that I have pleurisy (pleural effusion)?
(1) X-ray chest film: dry pleurisy only the affected side of the rib diaphragm angle become toned, exudative pleurisy above a medium amount of fluid can be seen in a large uniform dense shadow, the upper edge of which is arched from the outside up to the inside down, the rib diaphragm angle disappears, the diaphragm shadow and heart shadow is unclear. In case of large amount of effusion, the mediastinum is shifted to the healthy side, the rib space is widened, and the diaphragm decreases.
(2) Ultrasonic examination: It can understand the amount of pleural fluid, determine the site of thoracic puncture, and identify pleural effusion and pleural hypertrophy.
3.After finding pleural effusion, what other tests are needed to further confirm the diagnosis?
(1) Routine examination: blood routine, blood sedimentation, liver function, blood sugar, five TB-AB of hepatitis B.
(2) Bacteriology: sputum smear, pleural fluid collection, culture or TB-DNA of pleural fluid for TB bacilli.
(3) pleural fluid: routine, biochemistry, pleural fluid and blood LDH and protein ratio, ADA.
(4) X-ray, chest frontal and lateral radiographs or CT examination.
(5) Ultrasonography: thoracic ultrasonography to measure the amount and localization of fluid.
(6) Tuberculin test.
(7) pulmonary function tests.
(8) pleural biopsy: for negative bacteriological examination
(9) Thoracoscopy: for those whose diagnosis cannot be confirmed by the above tests.
4.How to treat tuberculous pleurisy?
Principle: Anti-tuberculosis treatment, alleviate systemic and pleural reactions, active fluid extraction should be performed above medium amount of effusion to alleviate toxic symptoms, relieve compression on lung and cardiovascular to reopen the lung, reset the mediastinum, extract pleural fluid to prevent and reduce pleural adhesions, and protect lung function.
(1) Rest: bed rest should be taken during the acute period to enhance nutrition. Body temperature of 38 ℃ or more can be bed rest, general patients can get up and move appropriately. The total rest time should last about 2 to 3 months after the body temperature returns to normal and the pleural fluid disappears.
(2) Application of anti-tuberculosis drugs.
(3) Pleural puncture and aspiration: Because of the high protein content and fibrin content of the pleural fluid in tuberculous pleurisy, it is easy to cause pleural adhesions, so in principle, the pleural fluid should be aspirated as soon as possible. Pumping 2-3 times a week until the effusion is very little and not easily extracted, and each pumping usually does not exceed 1000ml.
(4) Hormone application: Routine use of glucocorticoids is not advocated for tuberculous pleurisy because there are many side effects. Glucocorticoids have the functions of anti-inflammatory, anti-allergic, reducing organism sensitivity, reducing pleural fluid exudation, promoting absorption to prevent pleural adhesions and reducing toxic symptoms, etc. They can be applied on the basis of effective anti-tuberculosis drug application when there is acute exudation, obvious symptoms and large amount of fluid accumulation. When the symptoms disappear and the pleural fluid is reduced, the dosage can be gradually reduced to stop.
(5)Symptomatic treatment
(6) Surgical treatment: severe pleural thickening and encapsulated effusion can be done by pleural exfoliation.
5.Is tuberculous pleurisy contagious?
If it is only simple tuberculous pleurisy, it is usually not contagious. Generally speaking, since the chest cavity is airtight and does not communicate with the trachea and bronchi, bacteria in the chest cavity of patients with simple tuberculous pleurisy will not be coughed out through the lungs and bronchi or exhaled out of the body, so it is not contagious. However, if the patient has tuberculosis pleurisy caused by direct spread of tuberculosis, the tuberculosis foci in the lungs are in the active stage. Since the tuberculosis bacteria in the lungs can destroy the lung tissues and be discharged out of the body along the bronchi and trachea with sputum, this kind of tuberculosis combined with tuberculosis pleurisy is contagious, so appropriate disinfection and isolation should be performed in the home. If no tuberculosis foci are found in the lung X-ray and no orange nucleus is found in the sputum examination, it will not be contagious.
6.How to regulate the diet of tuberculous pleurisy? Is there any contraindication?
Because tuberculosis is a chronic and consumptive disease, special attention should be paid to nutritional supplementation, which requires a reasonable mix of nutrients and good absorption. Fruits, vegetables, fresh milk, eggs, fish and lean meat as well as easily digestible staple foods are necessary to ensure the intake of multivitamins and other trace elements. But also be careful not to eat spicy, stimulating things. Strengthen nutrition, pay attention to exercise, strengthen resistance.