Tuberculosis, also known as "phthisis", is caused byMycobacterium tuberculosisInfectious respiratory disease caused by infection.The disease is mainly in lung tissuetrachea、a bronchial tubeandpleuraThe lesion is formed at the site.Tuberculosis is one of the top ten causes of death in the world, with a high mortality rate. The World Health Organization reports that 1.7 billion people are latent infected with Mycobacterium tuberculosis, and tuberculosis patients are mainly concentrated in 30 countries with the heaviest burden, accounting for 87% of the world.The susceptible population includes the elderly with low immunity, people infected with HIVdiabetesPatientspneumoconiosisPatients, immunosuppressant users, etc.
Common symptoms of pulmonary tuberculosis include persistent cough, expectorationhemoptysis、afternoon fever , night sweats, irregular menstruation or amenorrhea, etc.However, infected people do not necessarily get sick. Most infected people will enter the lungs to sleep after the immune system has eliminated most of the Mycobacterium tuberculosis.The main mode of transmission of tuberculosis is droplets in the air, and inhalation of droplets with Mycobacterium tuberculosis will cause infection.
The treatment method for pulmonary tuberculosis is mainly drug treatment. Usually, after at least two weeks of appropriate drug treatment, most patients can no longer be infectious.However, due to the infectivity of tuberculosis, patients should be regularly checked for tuberculosis to prevent the disease from worsening.The methods to prevent tuberculosis mainly include maintaining a good living environment, improving sanitary conditions, moderate drinking, and preventing drug abuse.
The incidence and mortality of pulmonary tuberculosis are decreasing year by year. According to the data of China's national tuberculosis report, the incidence of pulmonary tuberculosis has decreased from 63.4 per 100000 in 2015 to 55.6 per 100000 in 2019.For doctors, nurses, social workers or medical care providers working in the medical field, preventive measures should be taken to reduce the risk of tuberculosis.
TCM disease name
pulmonary tuberculosis
Alias
Phthisis
Visiting department
Respiratory Department, Infection Department, Tuberculosis Department
The classification of tuberculosis (including pulmonary tuberculosis) is very important for its diagnosis, treatment and prevention.At present, China implements the TB Classification (WS 196-2017), which is divided into patients with latent infection of Mycobacterium tuberculosis, active tuberculosis and inactive tuberculosis.
Tuberculosis can be divided into the following three categories.
Latent infection of Mycobacterium tuberculosis
Inside the body (lung tissuetrachea、a bronchial tubeandpleura）InfectedMycobacterium tuberculosisHowever, there is no clinical tuberculosis, and there is no evidence of active tuberculosis in clinical bacteriology or imaging.
Active pulmonary tuberculosis
There are clinical symptoms and signs related to pulmonary tuberculosis, and there is evidence of active tuberculosis in mycobacterium tuberculosis etiology, pathology, imaging and other examinations.
Classification by lesion location, disease progression, etc
Non active pulmonary tuberculosis can be diagnosed if there are no clinical symptoms and signs related to active pulmonary tuberculosis, the bacteriological examination is negative, the imaging examination conforms to one or more of the following manifestations, and the pulmonary imaging changes caused by other reasons are excluded:
Calcified lesions (solitary or multiple);
Cord like lesions (with clear edges);
Induration focus;
Purification cavity;
Pleural thickening, adhesion or calcification.
Route of transmission
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The main route of transmission of tuberculosis is through respiratory droplets.
When a patient with pulmonary tuberculosis coughs, sneezes, laughs, talks and sings, the droplets containing Mycobacterium tuberculosis can be spread from the respiratory tract to the air, and can stay for several hours. If inhaled by others, it can cause infection.
Other routes, such as infection through digestive tract by drinking milk with bacteria, transmission between mother and infant by placenta of pregnant women with disease, transmission through skin wound infection and direct inoculation of upper respiratory tract, are rare.
pathogeny
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Tuberculosis can be caused by mycobacterium tuberculosis infecting the lungs, but those infected with mycobacterium tuberculosis may not necessarily infect others.
The main source of infection of pulmonary tuberculosis is the pulmonary tuberculosis patients with bacteria in sputum. Therefore, the latent infection of Mycobacterium tuberculosis and inactive pulmonary tuberculosis patients are generally not infectious, while active pulmonary tuberculosis patients are usually highly infectious.
In addition, factors such as low immune function, drug abuse and alcohol abuse can increase the risk of tuberculosis.
Pathogenesis
Human infection with Mycobacterium tuberculosis is the main cause of pulmonary tuberculosis.When healthy people inhale the droplets with Mycobacterium tuberculosis, they may become infected and may further develop into pulmonary tuberculosis. Whether they become infected or ill depends on human immunity, the number and virulence of Mycobacterium tuberculosis and other factors.
Generally speaking, after most people are infected with Mycobacterium tuberculosis, the immune system can eliminate most of the Mycobacterium tuberculosis, but there is still a small amount of Mycobacterium tuberculosis that has not been eliminated and is in a dormant period for a long time. At this time, the infected person does not get sick and is in a latent infection state of Mycobacterium tuberculosis.
After a few people (including those susceptible to pulmonary tuberculosis) are infected with Mycobacterium tuberculosis, because the immune system cannot effectively eliminate or inhibit bacteria, bacteria proliferate in the body to cause inflammation and other diseases, and cough, expectoration, blood in sputum or hemoptysis and other clinical symptoms occur, the condition will progress to active pulmonary tuberculosis.
Tuberculosis is generally infectious（Tuberculous pleurisyExcept), pulmonary tuberculosis patients (those with positive sputum smear) are the main source of infection of pulmonary tuberculosis in the population.
It should be noted that people infected with Mycobacterium tuberculosis may not necessarily infect others.Latent infection of Mycobacterium tuberculosis is generally not infectious, but can progress to active tuberculosis when the immune function of the body is reduced, thus becoming infectious.
Active pulmonary tuberculosis patients are usually highly infectious, but most of them can become non infectious after at least two weeks of appropriate drug treatment.
Predisposing factors
Known risk factors associated with tuberculosis include:
Age: The elderly and infants are at increased risk of tuberculosis.
Working in the medical field: doctors, nurses, social workers or health care providers are all at high risk of tuberculosis.
Drug and alcohol abuse.
Go to geographical regions where untreated TB is common, such as Latin America, Africa, Asia, and parts of Europe.
Chronic lung disease.
Smoking.
Use certain drugs that inhibit the immune system, such ashormoneandInfliximab。
symptom
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The clinical manifestations of pulmonary tuberculosis are different:
There was no clinical manifestation of pulmonary tuberculosis in patients with latent infection of Mycobacterium tuberculosis.
Inactive pulmonary tuberculosis also has no obvious symptoms, only found in the chest imaging examination.
Active pulmonary tuberculosis usually produces cough, expectorationhemoptysis, night sweatChest pain, fatigue and other symptoms.
early symptom
It is impossible to say exactly what the early symptoms of pulmonary tuberculosis are. Some patients may not have any clinical manifestations.It is worth noting that coughing, expectoration for more than two weeks or blood in sputum are common suspicious symptoms of pulmonary tuberculosis, and fever is the most common systemic symptom.If you have any of the above discomfort in your daily life, you can actively seek medical advice for early diagnosis and troubleshooting of your own disease.
Typical symptoms
Cough, expectoration ≥ 2 weeks, blood in sputum or hemoptysis are suspected symptoms of pulmonary tuberculosis.
Latent infection of Mycobacterium tuberculosis
There is no clinical symptom of pulmonary tuberculosis, and there is no infectivity.Among the 2.5 billion people infected with Mycobacterium tuberculosis worldwide, most of them are latent infections.However, people with latent infection of Mycobacterium tuberculosis may develop active pulmonary tuberculosis, and their lifetime risk of tuberculosis is as high as 15%.
Inactive pulmonary tuberculosis
The patient may have no obvious symptoms, only found in the chest imaging examination.
Active pulmonary tuberculosis
Most cases of pulmonary tuberculosis start slowly.As the disease progresses, patients may have cough, expectoration, blood in sputum or hemoptysis, and some patients may have recurrent symptoms of upper respiratory tract infection.
If the lesion occurs in the pleura, there may be irritating cough, chest pain, dyspnea and other symptoms.
Those who occur in the trachea and bronchus mostly have irritating cough, which lasts for a long time. Those who form broncholymphatic fistula and break into the bronchus or have bronchial stenosis may have wheezing or dyspnea.
Children with pulmonary tuberculosis may also show stunted growth. Primary pulmonary tuberculosis in children may compress the trachea or bronchus due to the enlargement of the trachea or parabronchial lymph nodes, or lymph node bronchial fistula may occur, often with wheezing symptoms.
Tuberculosis patients may also have systemic symptoms, such as night sweating, fatigue, intermittent or continuous afternoon low heat, loss of appetite, weight loss, etc. Female patients may be accompanied by menstrual disorders or amenorrhea.A few patients have acute onset, moderate to high fever, and some have varying degrees of dyspnea.
Accompanying symptoms
A few patients may be accompanied by tuberculous hypersensitivity syndrome, including:
Alternating diarrhea and local tenderness of tuberculosis of digestive system;
Painless hematuria and infertility of urogenital tuberculosis.
Medical treatment
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In case of fever, unexplained weight loss, night sweats or persistent cough for more than 2 weeks, seek medical advice.These are usually signs of tuberculosis, but may also be caused by other diseases. Therefore, when seeking medical advice, you should explain the symptoms and contact history of tuberculosis to the doctor in detail, and clarify the development process of symptoms has reference significance for the diagnosis of tuberculosis.The doctor will confirm whether the patient has tuberculosis by combining the medical history and examination results.
The diagnosis principle of pulmonary tuberculosis is based on the examination of etiology (including bacteriology and molecular biology), combined with the epidemiological history, clinical manifestations, chest images, relevant auxiliary examinations and differential diagnosis, etc., to make a comprehensive analysis and diagnosis.The diagnosis was based on the results of etiology and pathology.The diagnosis of pulmonary tuberculosis in children should pay attention to the pathogenic examination of gastric juice in addition to the pathogenic examination of sputum.
Latent tuberculosis infection screening should be carried out for people with increased risk of tuberculosis, including HIV infection/AIDS, intravenous drug use, contact with tuberculosis patients, and people living or working in areas where tuberculosis is common.
Diagnostic process
Screening of patients with suspicious symptoms: About 86% of active pulmonary tuberculosis patients and 95% of sputum smear positive pulmonary tuberculosis patients have suspicious symptoms.The main suspicious symptoms were cough, expectoration lasting for more than 2 weeks and hemoptysis, followed by low fever in the afternoon, fatigue, night sweats, irregular menstruation or amenorrhea, and a history of exposure to tuberculosis or extrapulmonary tuberculosis.In the above cases, the possibility of pulmonary tuberculosis should be considered, and sputum acid fast bacilli and chest X-ray examination should be carried out.
Whether it is pulmonary tuberculosis: if abnormal shadows are found in the lungs by X-ray examination, systematic examination must be carried out to determine whether the nature of the lesions is tuberculous or other.If it is difficult to determine at the moment, it can be rechecked after about 2 weeks of observation. Most inflammatory lesions will change, while pulmonary tuberculosis will not.
Whether there is activity: if it is diagnosed as pulmonary tuberculosis, it should be further determined whether there is activity, because the active lesions of tuberculosis must be treated.On chest radiographs, active lesions usually show patchy shadows with blurred edges, which may have central lysis or cavities, or have disseminated lesions.Chest X-ray shows calcification, induration or fibrosis, sputum examination does not discharge bacteria, without any symptoms, which is inactive pulmonary tuberculosis.
Whether to expel bacteria: after determining the activity, it is also necessary to determine whether to expel bacteria, which is the only way to determine the source of infection.
Drug resistance: drug sensitivity test is used to determine whether the drug is resistant.
Clarify the initial treatment and retreatment: the medical history inquiry clarifies the initial treatment and retreatment patients, and the treatment schemes of the two are quite different.
Diagnostic basis
Epidemiological history (history of exposure to tuberculosis);
clinical manifestation;
Chest imaging examination;
Laboratory inspection;
Bronchoscopy.
Visiting department
If you are suspected of suffering from tuberculosis, you should go to the local tuberculosis designated medical institution for treatment in time.
Relevant inspection
Chest imaging
Chest X-ray examination is the conventional preferred method for diagnosis of pulmonary tuberculosis. It can find early mild tuberculosis lesions and determine the scope, location, shape, density, etc. of the lesions;Determine the nature of the lesion, whether there is activity, whether there is cavity, etc.
CT can improve the resolution, evaluate the subtle features of the lesions, reduce overlapping images, and have the advantage of easily finding hidden lesions in the chest, trachea, and bronchi. It is commonly used in the diagnosis of pulmonary tuberculosis and the differential diagnosis of other chest diseases, and can also be used to guide puncture, drainage, and interventional treatment.
Primary pulmonary tuberculosis
The main imaging manifestations were primary lung lesions and intrathoracic lymph node enlargement, or simple intrathoracic lymph node enlargement.Primary pulmonary tuberculosis in children can also be manifested as cavity, caseous pneumonia and broncholymphatic fistulaBronchial tuberculosis。
Hematogenous disseminated pulmonary tuberculosis
Acute hematogenous disseminated pulmonary tuberculosis shows miliary shadow with uniform distribution and density in both lungs;The diffuse focus of subacute or chronic hematogenous disseminated pulmonary tuberculosis is mostly distributed in the upper and middle parts of both lungs, with different sizes, densities, and fusion.
Acute hematogenous disseminated pulmonary tuberculosis in children sometimes only shows ground glass like shadow. The miliary lesions in infants have obvious exudation around them, and the edges are fuzzy, which is easy to fuse.
Secondary pulmonary tuberculosis
The chest imaging showed various manifestations.
In mild cases, the main manifestations were patches, nodules and cord shadows, or tuberculoma or solitary cavities.
In severe cases, it may be manifested as lobar infiltrationCaseous pneumoniaMultiple cavity formation and bronchial dissemination.
Repeated delayed progression may lead to lung damage, reduced volume of damaged lung tissue, multiple fibrous thick walled cavities, secondary bronchiectasis, or multiple calcifications;The adjacent hilar and mediastinal structures were pulled and displaced, the thorax collapsed, and the pleural thickening and adhesion;In other lung tissues, compensatory emphysema and new and old bronchial dissemination lesions appeared.
Tuberculosis of trachea and bronchus
The main manifestations are irregular thickening of the trachea or bronchial wall, stenosis or obstruction of the lumen. Secondary atelectasis or consolidation, bronchiectasis and other bronchial dissemination lesions may occur in the distal lung tissue of the stenosis bronchus.
Dry pleurisy is an early inflammatory reaction of the pleura, usually without obvious imaging manifestations.
The main manifestation of exudative pleurisy is pleural effusion, which can be a small or medium amount of free effusion, or localized effusion in any part of the chest.Slow absorption is often associated with pleural thickening and adhesion, which can also evolve into pleural tuberculoma and empyema.
laboratory examination
Including bacteriology, molecular biology, tuberculosis pathology and immunology.
Bacteriological examination
The specimens are sputum, body fluid (blood, pleural effusion, etc.), pus, lavage fluid, etc.The sputum mycobacterium tuberculosis test is the main method for diagnosing pulmonary tuberculosis, and also the main basis for formulating chemotherapy plans and assessing treatment effects.
The examination results of mycobacterium tuberculosis infection are:
Smear microscopy was positive;
Mycobacterium culture was positive, and the strain was identified as Mycobacterium tuberculosis complex.
Molecular biological examination
The nucleic acid test of Mycobacterium tuberculosis is positive, indicating that it is infected by Mycobacterium tuberculosis.
Pathological examination
It includes biopsy and biopsy.
Immunological examination
The results of tuberculin skin test indicate moderate or strong positive, positive interferon gamma release test and positive antibody to Mycobacterium tuberculosis, which can also help to determine whether Mycobacterium tuberculosis is infected.
Bronchoscopy
Bronchoscopy can directly observe the pathological changes of trachea and bronchus, as well as aspirate secretions, brush examination and biopsy.
Bronchial tuberculosis is characterized by mucosal congestion, ulcer, erosion, tissue hyperplasia, scar formation and bronchial stenosis.
differential diagnosis
Tuberculosis should be differentiated from pneumonia, lung cancer and other diseases.
It is mainly differentiated from secondary pulmonary tuberculosis.
Various pneumonia have different clinical characteristics due to different pathogens, but most of them have an acute onset, accompanied by fever, cough, expectoration, increased blood leukocytes and neutrophils.Chest radiographs showed thin and uniform patchy or patchy shadows. After antibacterial treatment, the body temperature dropped rapidly, and the shadows were obviously absorbed about 1~2 weeks.
The most common symptoms are chronic cough and expectoration, and rarely hemoptysis.It occurs frequently in winter, and fever can occur in acute exacerbation period.Pulmonary function examination showed obstructive ventilation dysfunction.Chest imaging examination is helpful for differential diagnosis.
The disease is characterized by chronic repeated coughing and expectoration, with a lot of purulent sputum and often repeated hemoptysis.In mild cases, X-ray chest film shows no abnormality or only thickening of lung markings, typical cases show curly hair like changes, and CT, especially high-resolution CT, can detect the expansion of the bronchial lumen, which can be confirmed.
Most patients have a long history of smoking, manifested as irritating cough, blood in sputum, chest pain and emaciation.Chest X-ray or CT findings of lung cancer masses are often lobulated, with burrs and incisions.After necrosis and liquefaction of cancer tissue, eccentric thick walled cavities can be formed.
Multiple sputum exfoliated cells and mycobacterium tuberculosis examination and focus biopsy are important methods for differentiation.
Most patients have high fever and cough a lot of pus, smelly sputum.Chest radiographs show cavities with fluid planes and dense inflammatory shadows around them.White blood cells and neutrophils increased.
Mediastinal and hilar diseases
Primary pulmonary tuberculosis should be differentiated from mediastinal and hilar diseases.
The intrathoracic thyroid mostly occurs in the right upper mediastinum;Lymphatic system tumorMost of them are located in the middle mediastinum, and most of them are found in young people, with many symptoms.Tuberculin test can be negative or weakly positive.
Dermoid cysts and teratomas are mostly cystic shadows with clear edges, which mostly occur in the anterior mediastinum.
Other diseases
Different types of tuberculosis often have different types of feverTyphoid fever、septicemia、leukemiaDifferentiation of other febrile diseases.
Typhoid fever often presents as persistent fever, with relatively slow pulse and skin roseola. It can be diagnosed by blood, urine and stool culture and Feida test.
Sepsis has an acute onset, fever is characterized by chills and relaxant fever, often with a recent history of infection, and pathogenic bacteria can be found through blood culture.
Leukemia has fever, hepatosplenomegaly and obvious bleeding tendency. Bone marrow smear and dynamic X-ray chest film follow-up are helpful for diagnosis.
treatment
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Drug treatment is the cornerstone of tuberculosis treatment. Compared with other types of bacterial infections, tuberculosis treatment may take longer.
For active pulmonary tuberculosis, anti tuberculosis drugs must be taken for at least 6-9 months.The specific drugs and treatment time depend on the patient's age, overall health status and drug resistance.
chemotherapy
ChemotherapyIt is the most important basic treatment for pulmonary tuberculosis. Its goal is not only to sterilize and prevent drug resistance, but also to ultimately sterilize, prevent and eliminate recurrence.
The principle of chemotherapy for pulmonary tuberculosis is early, regular, whole process, appropriate amount and combination. Common drugs includeisoniazid、Li Fuping、Pyrazinamide、EthambutolEtc.In addition, DOTS management strategy should be implemented during the treatment.
DOTS refers to that in the treatment process of pulmonary tuberculosis patients, each medication must be carried out under the direct supervision of medical personnel or trained family supervisors, and remedial measures must be taken to ensure the regular medication according to the doctor's instructions when no medication is used for some reason.DOTS can improve treatment compliance and cure rate, and reduce the occurrence of multidrug resistance cases.
Treatment plan for primary active pulmonary tuberculosis (including smear positive and smear negative)
The whole treatment plan is divided into two stages: strengthening and consolidation.
Daily medication plan
The intensification period was isoniazid, rifampicin, pyrazinamide and ethambutol, taken orally for 2 months;
The consolidation period is isoniazid, rifampicin, single dose, 4 months.
Abbreviated as: 2HRZE/4HR.
Intermittent medication scheme
The strengthening period was isoniazid, rifampicin, pyrazinamide and ethambutol, once every other day or three times a week for two months;
The consolidation period is isoniazid and rifampicin, once every other day or three times a week for four months.
Abbreviated as: 2H3R3Z3E3/4H3R3.
Treatment plan for retreated smear positive pulmonary tuberculosis
Drug sensitivity test is strongly recommended for retreated smear positive pulmonary tuberculosis patients. Sensitive patients shall be treated according to the following scheme, and drug resistant patients shall be treated according to the drug resistance scheme.
Drug regimen for recurrent smear positive sensitivity
The strengthening period was isoniazid, rifampicin, pyrazinamide, streptomycin and ethambutol once a day for 2 months;
The consolidation period was isoniazid, rifampicin and ethambutol once a day for 6 to 10 months.
Abbreviated as: 2HRZSE/6~10HRE.
Intermittent medication scheme
The strengthening period was isoniazid, rifampicin, pyrazinamide, streptomycin and ethambutol, once every other day or three times a week for two months;
The consolidation period was isoniazid, rifampicin and ethambutol, once every other day or three times a week for six months.
Abbreviated as: 2H3R3Z3S3E3/6~10H3R3E3E3.
matters needing attention
DOTS management must be adopted when the above intermittent medication scheme is given to ensure that patients use drugs regularly without interruption, so as to improve treatment compliance and cure rate, and reduce the occurrence of multidrug resistance.
Treatment of multidrug resistant pulmonary tuberculosis
WHO recommends the use of new generation fluoroquinolones as far as possible;
Do not use cross resistant drugs, and the treatment plan contains at least four second-line sensitive drugs;
At least include pyrazinamide, fluoroquinolones, kanamycin or amikacin for injection, ethidium or propylthioisoniazid and PAS or cycloserine;
The drug dose depends on body weight;
The enhancement period should be 9 to 12 months, and the total treatment period should be 20 months or longer, depending on the treatment effect.
Sputum culture is the best way to monitor the therapeutic effect.
The best strategy to prevent drug-resistant tuberculosis is to strengthen the implementation of DOTS strategy, so that the newly treated smear positive patients can achieve a high cure rate under good management.On the other hand, we should also strengthen the timely detection of MDR-TB and give reasonable treatment to prevent its transmission.
surgical treatment
The main indications for surgical treatment of pulmonary tuberculosis are:
Ineffective after reasonable chemotherapy;
Multi drug resistant thick walled cavity;
Large cheese stove;
Tuberculous empyema;
Bronchopleural fistula;
Severe hemoptysis with ineffective conservative treatment.
TCM treatment
The TCM treatment of the disease is not supported by evidence-based medical evidence, but some TCM treatment methods or drugs can alleviate symptoms, so it is recommended to go to regular medical institutions and treat under the guidance of doctors.
Other treatments
Symptomatic treatment
The general symptoms of pulmonary tuberculosis disappear quickly under reasonable chemotherapy, without special treatment.
Hemoptysis is a common symptom of pulmonary tuberculosis. Generally, a small amount of hemoptysis is mainly used to comfort patients, relieve tension, and rest in bed. Hemostasis can be stopped by aminocaproic acid, aminotoluidic acid, ethylphenesulfonate, carbachol, etc.
For massive hemoptysis caused by destruction of bronchial artery, bronchial artery embolization can be used.
Glucocorticoid therapy
It is only used for patients with severe toxic symptoms of tuberculosis.The use of effective anti tuberculosis drugs must be ensured.
The dosage depends on the condition of the patient. Generally, 20 mg prednisone is taken orally daily for 1 to 2 weeks, and then decreases by 5 mg every week for 4 to 8 weeks.
prognosis
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After following the doctor's advice and reasonable and standardized medication, the general prognosis of pulmonary tuberculosis patients is good, and most of them can be cured.Symptoms usually subside after 2-3 weeks of treatment.
Without proper treatment, the infection may worsen, spread from the lungs to other body parts, and develop into a disseminated disease, even life-threatening.
complication
If not treated early, it may lead to permanent lung injury;
Infection may spread to other organs, such as intestine, liver, ovary and uterus;
Anti tuberculosis drugs may bring adverse reactions, such as abnormal liver function, vision changes, orange or brown tears or urine, skin rashes, peripheral nerve numbness, gout attacks, etc.
inoculationBCG vaccine, pay attention to exercise and improve their resistance.
history
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Tuberculosis is also calledconsumptionThe recorded history of the world can be traced back to Italy and Egypt 6000 years ago.A 2100 year old female corpse unearthed from Tomb 1 of Mawangdui in Changsha, Hunan, China in 1973 was found to have tuberculosis in the upper lung and left hilumCalcification focus, indicating that he was a patient with pulmonary tuberculosis before his death, which is the earliest case of pulmonary tuberculosis with a certificate available in China.《Synopsis of the Golden Chamber》On empty labor, there is a description of "those who are caught in the scab are all caused by labor", which belongs to the modern sayinglymphadenitisorTuberculosis of lymph nodesIt can be seen that as early as 1500 years ago, the relationship between pulmonary tuberculosis and peripheral lymphoid tuberculosis was pointed out. Lymph node tuberculosis is a common complication of pulmonary tuberculosis.From the Han Dynasty to the Tang Dynasty, the disease was considered infectious, and tuberculosis was rampant in the Sui and Tang Dynasties.Ge Hong in the Jin Dynasty《Elbow backup emergency square》China has preliminarily recognized that tuberculosis is a chronic infectious disease transmitted by family.The first monograph on the treatment of tuberculosis, written by Ge Kejiu of the Yuan Dynasty《Ten Medicine Book》It recorded ten important prescriptions for the treatment of asthenia, fatigue and hematemesis, which laid the foundation for the systematic medication of tuberculosis.Doctors in the Ming and Qing Dynasties realized that the treatment of tuberculosis was closely related to the nutritional conditions of patients, so《Phlegm fire and snow》It details various kinds of medicated diet ingredients suitable for tuberculosis patients, such as otter liver, eel fish, turtle meat, pig belly, pig liver, mutton, etc., which is also consistent with the idea that "high-quality protein should be added to the diet of tuberculosis patients".
In fact, Mycobacterium tuberculosis has survived on the earth for nearly a thousand years. Even though humans have developed a variety of antibiotics, they still haven't been exterminated, which shows their tenacious vitality.From the 17th century to the 20th century, tuberculosis, known as the "white plague", was one of the major "killers" in western countries.China also has the saying of "ten consumptions and nine deaths".It has defeated many celebrities, including Shelley, a romantic poet who wrote "Winter is coming, can spring be far behind?".Tuberculosis is one of the diseases with high morbidity and mortality in history.Until the 1930s, the treatment of tuberculosis was only indirect therapy such as rest, breathing fresh air, and enhancing nutrition, and the efficacy was less than 25%.Usually, patients with pulmonary tuberculosis are pale and thin, which is just in line with the aesthetic standards of the public at that time.The blush in the afternoon added a blush to the pale face of the tuberculosis patient, which looked extremely beautiful.Therefore, tuberculosis was once considered "fashionable" and "beautiful".Therefore, many literary works have the figure of tuberculosis. Margaret in "La Traviata", in which tuberculosis adds a luster and mystery to Margaret;The heroine of Jane Eyre, Helen, a good friend of Jane in the orphanage, finally died of tuberculosis.
On March 24, 1882, Robert Koch, a famous German microbiologist, announced the discovery of Mycobacterium tuberculosis.In 1965, Sylvius, a French scholar, anatomized the corpses of people who died of so-called "consumptive disease" or "tuberculosis", and found granular lesions in the lungs and other organs. According to their morphological characteristics, they were called "Tuberculous consumption tubers",tubercle）。Since then, the name of tuberculosis has been used to this day.Mycobacterium tuberculosis can pass throughrespiratory tract、digestive tract, skin and other ways to invade the human body, of which tuberculosis is the most common, mostly throughDroplet transmission。Mycobacterium tuberculosisAfter invading the body, if the resistance is strong enough, it can prevent the disease for life, but onceDecreased immunityThe TB bacilli latent in the body are about to get sick, and the clinical manifestations arecough、fever、night sweat, fatigue, emaciation, some will occurhemoptysis、Chest pain, evendyspnea。Generally, TB bacilli can be diagnosed when they are found in sputum, but the positive rate of sputum test for active pulmonary tuberculosis is only 30-50%, so chest radiographs are often requiredChest CTAnd other imaging assistance.The imaging of pulmonary tuberculosis often lacks typical signs. Many doctors like to call TB bacilli "fickle demons" because it can imitate various diseases, such as common diseasespneumonia、mycotic infection, tumor lesions, etc., extremely cunning.
In the 1940s, a series of anti tuberculosis drugs were introduced, such asstreptomycinThe aminosalicylic acid (PAS) in 1949, isoniazid in 1952, and rifampicin in 1965 ushered in a new era of tuberculosis chemotherapy, with the efficacy increased to 90%.After the 1990s, the World Health Organization (WHO) popularized the DOTs under the direct view of the world, which made TB patients receive standard treatment management during 6-8 months of treatment, and further improved TBcure rate。The treatment of tuberculosis, which once turned pale when talking about tuberculosis, has made a leap from "no way out when the mountains are heavy and the rivers are heavy" to "another village is bright when the willows are dark".The diagnostic rate and cure rate of tuberculosis in China are also increasing significantly,mortalityIt decreases year by year.
Domestic status
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According to the Statistics Bulletin of China's Health Development in 2022 issued by the Health Commission, the number of cases of tuberculosis in China in 2022 will be 560847, and the number of deaths will be 2205.The total number of reported cases of tuberculosis and the number of reported deaths are among the top five in the national reports of Class A and B infectious diseases.
Relevant regulations
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Measures for the Prevention and Control of Tuberculosis.
