What Is Atypical Tuberculosis?

Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis, which can affect many organs, with pulmonary tuberculosis being the most common. Bacteria are its important source of infection. It is not necessary for humans to become infected after being infected with tuberculosis. When the resistance is reduced or the cell-mediated allergies are increased, it may cause clinical disease. If it can be diagnosed promptly and treated reasonably, most of them will be cured.

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Why does tuberculosis take up to six months? 2017-11-20 23:11

In the past three decades, with the promotion of short-course chemotherapy for tuberculosis, the prevalence of infectious tuberculosis in China has dropped by three-quarters, and the mortality rate of tuberculosis has fallen by more than four-fifths. Scientists are currently working on shorter treatment options. It can be expected that in the near future, it is expected to cure this chronic disease that harms human health in a shorter time. ... more

Basic Information

English name: pulmonary tuberculosis
Visiting department: Department of Infectious Diseases, Respiratory Medicine
Multiple groups: Elderly, chronic respiratory disease, diabetic, non-vaccinated BCG vaccine

Common causes: Lungs infected with tuberculosis bacteria cause tuberculosis
Common symptoms: May have low fever (significant in the afternoon), night sweats, fatigue, wasting, etc.
Contagious: Have
way for spreading: Droplet spread

Causes of tuberculosis

Mycobacterium tuberculosis belongs to the genus Mycobacterium of the family Actinomycetes, and is a pathogenic acid-resistant bacteria. Mainly divided into human, cattle, bird, rat and other types. Those who are pathogenic to humans are mainly human-type bacteria, and bovine-type bacteria are rarely infected. The resistance of TB bacteria to drugs can be formed by the development of congenital drug-resistant bacteria in the flora. It can also be caused by the use of an anti-TB drug alone in the human body, which can quickly develop resistance to the drug, that is, obtain resistance. bacteria. Drug-resistant bacteria can cause difficulties in treatment and affect efficacy.

Clinical manifestations of tuberculosis

Symptoms

Has a close history of tuberculosis exposure, and the onset can be acute and slow, mostly low fever (as in the afternoon), night sweats, fatigue, anorexia, weight loss, menstrual disorders in women, etc .; respiratory symptoms include cough, expectoration, hemoptysis, chest pain, Chest tightness or difficulty breathing in varying degrees.

2. Signs

Pulmonary signs vary according to the severity of the disease and the extent of the lesion. Positive signs are not easy to detect in early and small-scale tuberculosis. Those with a wider range of lesions have dullness, increased speech tremor, low alveolar breath sounds, and wet rales. Fibrosis develops in advanced tuberculosis, and local contraction causes pleural collapse and mediastinal displacement. In the early stage of tuberculous pleurisy, there are pleural friction sounds, when a large amount of pleural effusion is formed, the chest wall is full, the percussion is solid, speech tremor and respiratory sounds are reduced or disappeared.

3. Typing and staging of tuberculosis

(1) Classification of tuberculosis Primary type of pulmonary tuberculosis (type ) Dumbbell-shaped primary syndrome with intrapulmonary exudation, lymphangitis, and hilar lymphadenopathy, more common in children, or only manifested as hilum And mediastinal lymph nodes. Hematogenous disseminated tuberculosis (type II) includes acute miliary tuberculosis and chronic or subacute hematogenous disseminated tuberculosis. Acute miliary tuberculosis: miliary-sized shadows scattered between the two lungs, uniform in size and density, uniformly distributed miliary shadows, which can merge with each other as the disease progresses; chronic or subacute hematogenous disseminated pulmonary tuberculosis: the size of the two lungs varies. First, the old and new lesions are different, the distribution is uneven, the edges are fuzzy or sharp nodules and cable shadows. Follow-up type tuberculosis (type III) This type includes a variety of changes with lesions predominantly proliferative, invasive lesions predominant, caseous lesions, or hollow. Infiltrative pulmonary tuberculosis: X-rays are usually cloud-like or small patches of infiltrating shadows, with blurred edges (exudative) or nodules, cord-like (proliferative) lesions, large areas of consolidation or spherical lesions (cheese-visible cavity ) Or calcification; chronic fibrous cavitary tuberculosis: mostly in the upper part of the two lungs, but also unilateral, with a large number of fibroproliferation, in which cavities are formed, cotton-wool-like, lung tissue is contracted, the hilar is lifted, and the hilar shadow is "willow Changes, pleural hypertrophy, thoracic collapse, local compensatory emphysema. Tuberculous pleurisy (type ) pleural effusion on the diseased side, a small amount of shallower costosacral angle, more than moderate amount of effusion is a dense shadow, the upper edge is curved.

(2) Stages Progressive stage Newly discovered active pulmonary tuberculosis. During follow-up, the lesions increase and enlarge, the cavity appears or enlarges, the sputum examination becomes positive, and clinical symptoms such as fever increase. Period of improvement During the follow-up period , the lesion absorption improved, the cavity became smaller or disappeared, the sputum became negative, and the clinical symptoms improved. Stability period The cavity disappeared, the lesion was stable, and the sputum bacteria continued to turn negative (once a month) for more than 6 months; or the cavity remained, and the sputum bacteria became negative for more than 1 year.

Tuberculosis examination

White blood cell count

Normal or mildly increased, ESR increased rapidly.

2. Sputum tuberculosis

Using smear and bacteria collection method, the positive of acid-fast staining has diagnostic significance. Tuberculosis culture and animal inoculation are also feasible, but the time is long. The positive of polymerase chain reaction (PCR) of tuberculosis bacteria is helpful for diagnosis.

3. Tuberculin test

Old tuberculin (OT) or purified protein derivative (PPD) skin tests. Strong positives can help diagnosis.

4. Specific antibody determination

Enzyme-linked adsorption test, anti-PPD-IgG positive in blood is of reference value for diagnosis.

5. Examination of pleural effusion

Increased adenosine deaminase (ADA) content is helpful for diagnosis and is of significance when distinguishing from cancerous pleural effusion.

6. Imaging examination

Chest X-ray examination is an indispensable means for diagnosing tuberculosis, and it can be an important method to determine the location, scope, nature of the disease, disease progression, treatment response, and efficacy.

Tuberculosis diagnosis

Diagnosis can be made based on etiology, clinical manifestations, laboratory tests, and imaging studies.

Differential diagnosis of tuberculosis

1. Primary syndrome should be distinguished from lymphoma, intrathoracic sarcoidosis, central lung cancer, and metastatic cancer.

2. Acute hematogenous disseminated pulmonary tuberculosis should be distinguished from typhoid fever, meningitis, sepsis, pneumoconiosis, alveolar cell carcinoma, and hemosiderin.

3. Infiltrative pulmonary tuberculosis should be distinguished from various types of pneumonia, pulmonary abscess, pulmonary fungal disease, lung cancer, lung metastatic cancer, pulmonary cysts and other benign lung lesions.

Tuberculosis treatment

Drug treatment

The main effect of drug treatment is to shorten the period of infection, reduce mortality, infection rate and morbidity. For each specific patient, in order to achieve the main clinical and biological cure, rationalized treatment refers to the principle of early, combined, appropriate amount, regular and full use of sensitive drugs for active tuberculosis.

(1) Early treatment: Once treatment is found and diagnosed immediately,

(2) Combined use According to the condition and the characteristics of antituberculosis drugs, combine two or more drugs to enhance and ensure the efficacy;

(3) Appropriate amount of different doses according to different conditions and different individuals;

(4) Regularity Patients must strictly follow the medication method prescribed in the treatment plan and adhere to the treatment regularly. Do not change the plan at random or stop the drug at will without reason.

(5) Full course It means that the patient must adhere to the full course of treatment in accordance with the course of treatment prescribed by the plan, and the short course is usually 6 to 9 months. Generally speaking, newly treated patients are treated in accordance with the above principles, and the curative effect is as high as 98%, and the recurrence rate is less than 2%.

2. Surgical treatment

Surgery has been less used in the treatment of tuberculosis. When it is difficult to distinguish tuberculosis globules larger than 3 cm from lung cancer, retreated unilateral fibrous thick-walled cavities, long-term medical treatment that fails to make sputum negative, or unilateral damage to the lung with bronchiectasis, loss of function and Repeated hemoptysis or secondary infection can be used for lung lobe or pneumonectomy. When tuberculous empyema and / or bronchopleural fistula are ineffective in medical treatment and are accompanied by active pulmonary tuberculosis on the ipsilateral side, lobectomy is recommended. Contraindications for surgical treatment include: active bronchial mucosal tuberculosis, but those who are not within the scope of resection have poor general conditions or have significant heart, lung, liver, and renal insufficiency. Surgery is considered only if drug treatment fails. Before and after surgery, patients should be treated with anti-TB drugs without exception. At the 1993 symposium on indications for tuberculosis and lung cancer surgery in China's thoracic surgery, the indications for tuberculosis surgery were proposed as follows:

(1) Indications for cavity tuberculosis surgery After the initial treatment and retreatment of antituberculosis drugs (approximately 18 months), there is no obvious change or increase in cavity, and those with positive sputum bacteria, especially those with tuberculosis resistance; If repeated hemoptysis, secondary infections (including fungal infections), etc., drug treatment is not effective; Can not exclude cancerous cavity; Atypical Mycobacterium, poor results or high degree of pulmonary cavity chemotherapy.

(2) Indications for tuberculosis surgery Tuberculosis tuberculosis is positive for 18 months, sputum bacteria are positive, and hemoptysis; Tuberculosis tuberculosis cannot exclude lung cancer; Tuberculosis diameter> 3 cm, no change under regular chemotherapy. Relative surgical indications.

(3) Indications for damaging lung surgery After regular antituberculosis treatment, there are still patients who have discharged bacteria, hemoptysis, and secondary infection.

(4) Indications for hilar mediastinal lymph tuberculosis surgery Those who have enlarged lesions after regular antituberculosis treatment; Those who have severe breathing difficulties caused by compression of the trachea and bronchus; Pulmonary atelectasis caused by puncture of the trachea and bronchus, caseous pneumonia, Those who failed medical treatment; Cannot exclude those with mediastinal tumors.

(5) Indications for emergency surgery for massive hemoptysis 24 hours of hemoptysis> 600 ml, ineffective in medical treatment; bleeding site is clear; cardiopulmonary function and systemic conditions allow; repeated massive hemoptysis, apnea or low asphyxia Blood pressure, shock.

(6) Indications for spontaneous pneumothorax surgery Patients with multiple episodes of pneumothorax (more than 2 to 3 times); Patients with closed chest drainage who continue to leak for more than 2 weeks; Pneumothorax with early signs of infection; Pneumothorax Those with unrestricted lungs after closed thoracic drainage; Pneumothorax with obvious bullae; Peoplethoracic history on one side and contralateral side should be operated as soon as possible.