Systemic symptoms, generally speaking, tuberculosis is a chronic infectious disease. At the beginning, patients did not feel uncomfortable because of mild symptoms, and generally did not attract attention. Symptoms only appear when the disease develops. Some people have poor resistance, and the bacteria infected with tuberculosis are large and toxic, so the symptoms will be obvious. General malaise, fever, fatigue, fatigue, upset, loss of appetite, weight loss for a long time, lesbians sometimes make menstruation abnormal.
1, fever. Fever is one of the common symptoms of many diseases. Tuberculosis is no exception. But the fever of tuberculosis still has its own characteristics: (1) Long-term low fever usually appears in the afternoon and evening. The so-called low fever, that is, below 38℃, can return to normal body temperature in the morning. Many patients may not know that they have a fever at all, and some patients may be bored and uncomfortable. ⑵ The body temperature may be unstable, you may feel fever and fatigue at work, and your body temperature cannot return to normal after a short rest; (3) When the disease worsens and progresses, fever is obvious, especially when there are other bacterial infections in the lungs, high fever may occur, sometimes at 39℃ ~ 40℃. When the body's resistance is extremely low, tuberculosis can spread to the whole body, and then persistent chills and high fever may occur; (4) Lesbians can get fever through blood flow before and after menstruation, but when suffering from tuberculosis, fever will not return to normal immediately after menstruation is clean.
2, night sweats. The so-called night sweats, that is, patients sweating all over when they fall asleep or wake up, generally occur in children with weak constitution (sometimes normal children may also have this phenomenon). Night sweats are more common in patients with severe lung diseases. In severe cases, clothes and quilts can be soaked, and patients feel tired and weak.
What is mentioned above is systemic symptoms, that is, symptoms of systemic poisoning after being infected with tuberculosis. Next, let's talk about the local symptoms of tuberculosis.
1, cough. This is the most common local symptom of tuberculosis. Early cough can be very mild, often a single cough, that is, we say half cough, dry cough without phlegm, and the impact on work and life is not obvious. Cough can be aggravated when the lesion progresses; When accompanied by endobronchial tuberculosis, cough can be aggravated, and sometimes choking can occur. For patients who have been ill for a long time, such as bronchial displacement, tracheal traction caused by pathological adhesion, or bronchial deformation caused by peripheral lymph node compression, irritating cough may occur due to poor ventilation, similar to choking by eating, and even dyspnea.
2, expectoration. At the beginning of the disease, expectoration is not obvious, or there is a small amount of white mucus sputum, but when the lesion expands or even there is a cavity in the lung, the amount of sputum will increase. When infected by other pathogenic bacteria, the amount of sputum will also increase, and yellow pus and phlegm may appear, accompanied by systemic symptoms of fever and chills.
3, chest pain. Chest pain is also the main local symptom of pulmonary tuberculosis, but it usually has to spread to the pleura, especially in parietal pleura. Parietal pleura is the front chest tuberculosis, and parietal pleura is as shown in Figures 2 and 3. Sometimes there will be dull pain in uncertain parts, which is caused by nerve reflex and is not affected by lung breathing movement. If there is a fixed tingling sensation in this part, which is aggravated with breathing and coughing, it means that inflammation has stimulated the pleura, and some patients often feel pain in the shoulder or upper abdomen, which is probably caused by inflammation stimulating the diaphragm through nerve reflex.
4. Hemoptysis. We often find that many patients don't know that he has tuberculosis in advance. I don't care if I cough at ordinary times, and I don't feel a fever. But when they cough, they find bloodshot sputum, blood clots and even blood in their mouths, and then they go to the hospital to see a doctor. After examination, they found that there were many lesions in the lungs, and some even had cavities. Hemoptysis patients account for about 1/3 of the total patients. It is impossible for any patient to have hemoptysis. Blood comes from blood vessels. Therefore, it will only happen when the lesion affects the permeability of the blood vessel wall or directly damages the blood vessel. The amount of bleeding depends on the degree of vascular damage. We believe that the number of lung lesions is not proportional to the amount of bleeding. Some patients have small lesions but damaged blood vessels, so they will bleed. On the contrary, there are many lesions, but there is little or no bleeding, and blood vessels are not damaged. Of course, the more pathological changes, the more chances of blood vessel bleeding.
5. others. The structure of the lung has been introduced in detail. Because of its huge compensatory function and huge reserve potential, mild lesions will not cause respiratory dysfunction. Lung is the main organ for oxygen exchange between human body and natural environment, and oxygen exchange mainly depends on alveolar tissue in lung tissue. Pulmonary tuberculosis begins with alveoli. When the lesions are extensive, a large number of alveolar tissues are destroyed and oxygen exchange is blocked, the body will have difficulty breathing due to lack of oxygen, and even the whole body will be in a state of lack of oxygen, and the lips will turn purple (the tip of the tongue can appear first). Long-term chronic hypoxia will make the phalanges of fingers change like a drum hammer, which we call it. Due to systemic hypoxia, the functions of various organs and tissues of the body will change to varying degrees. For example, digestive system hypoxia can lead to indigestion and malnutrition, brain hypoxia can lead to lethargy and even coma, and heart hypoxia can lead to angina pectoris and so on.
Clinical manifestations of pulmonary tuberculosis
Patients with pulmonary tuberculosis at the initial stage or with slight pathological changes often have no symptoms or mild symptoms, which are easy to be ignored by patients. Compared with many other respiratory infections, the general symptoms are generally less characteristic except for persistent symptoms.
(1). general symptom
1. Fever: seen in the progressive stage of the disease, characterized by low fever in the afternoon (which may be caused by the increased absorption of tissue destruction products into the blood after a day of physical activity). Severe patients have irregular high fever or even heat loss, and fever often represents the activity of tuberculosis.
2. Night sweats When you fall asleep or wake up, you are all sweaty and your underwear is wet.
3. Fatigue, listlessness, weight loss, loss of appetite, rapid heartbeat (consistent with body temperature) and menstrual disorder.
(2) Local symptoms
1. Cough and expectoration
With the development of the disease, the cough is aggravated and the amount of sputum is increased. Phlegm (mucus sputum-mucus sputum mixed with yellow and white purulent small pieces)
2. Hemoptysis
Blood in sputum-inflammatory focus, increased capillary permeability;
Moderate hemoptysis-small vessel injury;
Massive hemoptysis-hollow rupture.
3. Chest pain
The position is uncertain, and it often hurts faintly. If it is a needle-like pain, and it is aggravated with respiratory movement, it means that the pleura is involved. Pleura at the apex of lung is involved, and chest pain can radiate to shoulder. Our respiratory department is a comprehensive ward, not an infectious department, so we don't accept infectious tuberculosis. Most patients have tuberculous pleurisy, so chest pain is typical.
4. Difficulty breathing
The lung has a great compensatory function, and mild and moderate lesions will not cause dyspnea.
In recent years, the number of tuberculosis patients in the elderly over 60 years old in China is on the rise, with hematogenous disseminated type and chronic fibrosis being more common, tuberculosis in young people in Chongqing is on the rise, and pleurisy is more common. Many diseases and factors have adverse effects on tuberculosis, and diabetes is one of them. With the increase of blood sugar and ketone bodies, tuberculosis is easy to reproduce. Diabetes complicated with pulmonary tuberculosis, if urine sugar is not controlled, the focus progresses rapidly, often showing cheese necrosis and bronchial diffusion. Pregnancy has a bad influence on pulmonary tuberculosis, and active pulmonary tuberculosis needs artificial abortion. Under the full protection of anti-tuberculosis drugs, the focus will not recur during delivery.
References:
Http://www.dph- Questions and answers about tuberculosis prevention and control.
1. What is tuberculosis?
Tuberculosis is a chronic infectious disease caused by the invasion of Mycobacterium tuberculosis into human body. For a long time, people have a strong fear of tuberculosis because there is no effective drug treatment and it is highly contagious. With the development of science and technology, scientists have developed more than a dozen effective anti-tuberculosis drugs since 1950s. As long as it is found early and treated regularly, A can be completely cured. Mycobacterium tuberculosis can invade any organ of the human body, which means that tuberculosis can occur in all organs of the human body.
Second, what is bone and joint tuberculosis?
Bone and joint tuberculosis is a kind of tuberculosis. More common in children and adolescents. The disease has a slow onset, a long course and many complications. Most patients have a history of tuberculosis and a history of contact with tuberculosis. The clinical manifestations are local pain, limited joint activity, muscle spasm, cold abscess or fistula formation, which may be accompanied by systemic symptoms of tuberculosis poisoning, such as low fever, night sweats and emaciation. At present, the main treatment methods are non-surgical interventional therapy, local puncture, pus aspiration and drug injection. Early diagnosis and treatment can prevent the development of lesions in time, shorten the course of disease and protect joint function.
3. What are the symptoms of tuberculosis?
Early tuberculosis or mild tuberculosis, without any symptoms or mild symptoms, can be ignored. If the lesion is in an active and progressive stage, the following symptoms may appear: 1. Fever: manifested as low-grade fever in the afternoon, and the body temperature rises at 4-8 pm, generally between 37-38℃. At this time, patients are often accompanied by general weakness or emaciation, night sweats, and women can cause irregular menstruation or menopause. 2. Cough and expectoration: It is the most common early symptom of tuberculosis, but it is also the easiest to be mistaken for "cold" or "tracheitis" by patients or doctors, leading to misdiagnosis. 3. Blood in sputum: there are bloodshot or small blood clots in sputum, and blood in sputum is mostly caused by tuberculosis.
4. What should I do if I suspect that I have tuberculosis?
When you know what tuberculosis is and what its symptoms are, if you have the above symptoms and suspect that you have tuberculosis, especially cough and expectoration with blood in the sputum for more than two weeks, you should immediately go to the local tuberculosis prevention and control institution for early diagnosis, regular treatment and early recovery. In addition, close contacts of relatives of bacteria-discharging tuberculosis should also be examined in time.
5. How to describe the medical history to the doctor?
When visiting a doctor in a tuberculosis clinic, there are usually two aspects to describe the medical history to the doctor. 1. When pulmonary tuberculosis is suspected: < 1 > onset time, symptoms and disease evolution. (2) Diagnosis and treatment before this visit. < 3 > whether it is complicated with other diseases, especially rheumatism and diabetes. (4) whether there is a history of close contact with bacteria-discharging tuberculosis or other circumstances, such as occupation, working conditions and living conditions. 2. Known tuberculosis patients: (1) voluntarily tell their doctors about their illness. 〈2〉 What kind of examination have you done, especially chest X-ray examination and sputum examination? < 3 > detailed treatment plan, including drug name, dosage, usage, efficacy and side effects. Because it can help doctors understand the past illness, estimate the curative effect and prognosis, choose reasonable drugs and make effective chemotherapy plans.
Sixth, why do you want to do sputum examination?
When you suspect that you have tuberculosis, you should have a chest X-ray first. If the doctor finds abnormal shadows in your lungs, he will give you a sputum test. Sputum examination is to look for mycobacterium tuberculosis with a microscope. Once Mycobacterium tuberculosis is found in sputum, the diagnosis of tuberculosis can be confirmed. Sputum examination is the most accurate method to diagnose tuberculosis and find the source of infection. In addition, the doctor will ask you to check the sputum regularly after the patient receives treatment, so as to evaluate and evaluate the therapeutic effect. After the course of treatment, the patients with positive sputum bacteria were cured after three consecutive negative sputum tests.
Seven, how to correctly take sputum specimens?
Sputum examination is so important that patients should master the correct method of sputum retention, otherwise it will directly affect the results of sputum examination. The correct method of sputum retention is to rinse your mouth with clear water several times before sputum retention to remove food residues and some miscellaneous bacteria in your mouth. The retained sputum should be coughed out from the trachea after coughing hard, and then put into the sputum box for inspection. Don't spit saliva or snot into the sputum box, so as not to affect the sputum test results. When sputum examination is needed for the first time, the doctor requires three kinds of sputum samples: < 1 > instant sputum: sputum coughed at the time of seeing a doctor, < 2 > nighttime sputum: sputum coughed the night before, < 3 > early morning sputum: sputum coughed deeply after getting up, and the first time in the morning is the best.
8. What does it mean to be positive for tuberculin test?
Tuberculin is a biological product made from the culture filtrate of tuberculosis, which only contains tuberculosis protein and does not contain tuberculosis body. At present, tuberculin commonly used in China is a pure protein derivative of Mycobacterium tuberculosis, abbreviated as PPD. After people are infected with tuberculosis for a period of time, tuberculin can appear positive reaction. The method of judging the result is as follows: within 24-72 hours after PPD injection, the skin induration is measured. Negative (-) within 5mm, weakly positive (+) within 5~9mm, positive (++) within 10~ 19mm, strongly positive (++) within 20Mmm, with blisters and necrosis. If tuberculin is positive, it can only show that you have been infected with tuberculosis, and whether you have tuberculosis or not, you need a doctor to analyze your clinical manifestations, bacteriological examination of sputum and X-ray examination before you can make a final judgment. If it is negative, the infection of tuberculosis cannot be denied, because the immune response of the initial infection has not been established, and the immune function of the human body has been suppressed, such as tumor, severe tuberculosis, severe malnutrition, and the use of immunosuppressants.
9. What are the commonly used anti-tuberculosis drugs?
1. isoniazid (INH): It has a very strong killing effect on tuberculosis, and its price is low. It is an essential drug for the treatment of tuberculosis. 2. Streptomycin (SM): It is one of the drugs in the chemotherapy scheme of initial treatment and intensive phase of pulmonary tuberculosis, and has obvious bactericidal effect on mycobacterium tuberculosis. This medicine is harmful to the brain, and can cause dizziness, tinnitus, hearing loss, deafness, numbness of lips and other side effects, so pregnant women, children and the elderly should not use it with caution. 3. Rifampicin (RFP): It has a strong killing effect on tuberculosis. It is the most effective anti-tuberculosis drug after isoniazid, and it is also an indispensable component drug in the initial treatment of tuberculosis. 4. Ethambutol (EMB): It can inhibit tuberculosis, especially tuberculosis resistant to isoniazid and streptomycin. Attention should be paid to the changes of vision during medication. 5。 Pyrazinamide (PZA): It has a special killing effect on intracellular or static Mycobacterium tuberculosis. The above five drugs are the most commonly used or effective drugs to treat tuberculosis at present, and doctors can form a reasonable chemotherapy plan according to the patient's condition and medication.
X. What are the principles for treating tuberculosis?
1. Early stage: The diagnosed pulmonary tuberculosis should be treated as soon as possible, which is not only conducive to the repair of the lesion, but more importantly, it can reduce the infection to relatives and surrounding healthy people. 2. Combination: Choose two or more anti-tuberculosis drugs to form a chemotherapy scheme. Combined therapy can not only ensure the therapeutic effect, but also delay and prevent the drug resistance of tuberculosis from causing chemotherapy failure. 3. Appropriate dosage: too small dosage can not kill bacteria, and it is easy to produce drug resistance, but too large dosage is easy to produce toxic and side effects and interrupt treatment. Therefore, we must adhere to the prescribed dose of drugs in accordance with the doctor's advice in order to complete the scheduled course of treatment and ensure the curative effect. 4. Regularity: During the prescribed course of treatment, use drugs in strict accordance with the times specified in the chemotherapy plan and at the same time intervals, so as to avoid missing or interrupting the use of drugs as much as possible. 5. The whole process: complete the prescribed course of treatment as required. If the drug is stopped before the end of the course of treatment, the treatment will fail or lead to recurrence. However, taking medicine indefinitely beyond the course of treatment can not only improve the curative effect, but also easily produce toxic and side effects and increase unnecessary economic burden.
XI. What is the initial treatment for tuberculosis?
Initial treatment of tuberculosis refers to patients who have not received any anti-tuberculosis drugs for the first time, or who have received irregular and unreasonable anti-tuberculosis treatment after discovering tuberculosis, but the course of treatment does not exceed 1 month. Without treatment, newly treated tuberculosis patients are highly contagious to their families and the surrounding healthy people, and are the source of infection of tuberculosis epidemic. However, as long as patients actively cooperate with tuberculosis doctors and insist on effective, reasonable and full-course chemotherapy, the infectivity can disappear quickly within 2-4 weeks, and the cure rate can reach over 95%. The key is to follow the doctor's advice, obey the management, complete the course of treatment and strive for a complete cure.
Twelve, what is retreatment of tuberculosis?
Retreatment of pulmonary tuberculosis refers to the recurrence of patients who have been initially treated or failed in treatment. Or those who have received irregular and unreasonable chemotherapy for more than 1 month after being diagnosed with pulmonary tuberculosis. Clinically, retreatment of pulmonary tuberculosis is more complicated, often with the characteristics of serious illness and poor health, which is mostly caused by nonstandard or unreasonable chemotherapy (not insisting on treatment according to doctors' requirements, or treating in non-tuberculosis professional institutions, or even wild doctors buying drugs in informal pharmacies). At this time, tuberculosis has formed drug resistance, so it is much more difficult to treat than the initial treatment of tuberculosis. The key to retreatment of pulmonary tuberculosis is to establish confidence in overcoming the disease, actively cooperate with doctors, select chemotherapy schemes composed of anti-tuberculosis drugs according to drug sensitivity tests, and persist in completing the treatment.
Thirteen, tuberculosis patients need to pay attention to after starting treatment?
1. Establish a correct scientific viewpoint and confidence: Due to the influence of traditional ideas, tuberculosis is regarded as an incurable disease, especially in rural areas. Suffering from tuberculosis, he has a heavy mental burden, and even refuses to check and treat, taking an uncooperative attitude. As a result, the opportunity for treatment was delayed and the opportunity for cure was lost. 2. Follow the doctor's advice: take the medicine in strict accordance with the doctor's requirements. Some people treat tuberculosis lightly, don't follow the doctor's advice, don't take medicine on time, don't insist on completing the whole course of treatment, and stop taking medicine too early, which makes the condition worse and worse, and can't be completely treated, which becomes a chronic source of infection that can't be cured for a long time. Some people think that the bigger the dose, the better the disease will be, so they increase the dose themselves, causing toxic reactions and being forced to stop taking drugs. Others are afraid of the side effects of the medicine and reduce the dose themselves. In this way, insufficient dose will affect the curative effect. Familiar with medication methods, such as requiring anti-tuberculosis drugs to be taken once, increasing the bactericidal concentration in blood, and taking rifampicin on an empty stomach 1 hour before breakfast, otherwise the curative effect will be affected. In addition, if there are adverse reactions after taking the medicine, don't stop taking the medicine by yourself, and report it to the doctor in time. 3. Persist in taking medicine and check regularly: Persisting in taking medicine and completing the course of treatment is the key to cure tuberculosis. At the same time, patients should also be examined regularly as required, so that doctors can master the efficacy of drugs and the repair of lesions. 4. Family members of patients should actively cooperate with the treatment: family members have the closest contact with patients and know patients best, which will have a positive impact on patients' care and understanding. Children, the elderly or illiterate people should be helped to take medicine, know medicine and keep medicine, and play the role of voluntary supervisors. 5. It is best to supervise the whole process of chemotherapy: that is, every time the patient takes medicine during the treatment, it is carried out under the direct supervision of medical staff, so that the medicine is delivered to the hands, seen in the mouth and swallowed before leaving. "
Fourteen, why should I be vaccinated with BCG?
BCG is actually an attenuated live Mycobacterium tuberculosis. After 230 consecutive transplants and subculture in artificial culture medium 13, Mycobacterium bovis lost its pathogenicity to human body, but it can make the body immune. After BCG vaccination, people who are not infected with tuberculosis are artificially infected with slight primary infection, which has no risk of disease and stimulates the body to produce specific immunity. This acquired immunity can prevent people from getting sick when they are infected with tuberculosis again. After decades of research and practical observation, BCG has indeed become an effective weapon for human beings to prevent tuberculosis, especially for children and adolescents.
15. What should TB patients pay attention to in their diet?
Patients with pulmonary tuberculosis should be given food with high protein and high heat energy. Any symptom of tuberculosis will seriously consume tissue protein and heat energy, so the supply of food protein and heat energy is higher than that of normal people The daily supply of protein is 1.5 ~ 2.0g/kg, and the main sources of protein are milk, eggs, animal offal, fish and shrimp, lean meat and bean products. Milk is rich in casein and calcium, which is an ideal nutritious food for tuberculosis patients. The principle of heat energy supply is to maintain the normal weight of patients, and 40 ~ 50 kilocalories can be supplied per kilogram of body weight. Carbohydrate staple food can meet the supply according to the amount of food eaten, without restriction, but it is not advisable to eat more fat, mainly vegetable oil. Vitamins and inorganic salts can greatly promote the rehabilitation of pulmonary tuberculosis. Among them, vitamin a has the function of enhancing the body's disease resistance; Vitamins B and C can improve various metabolic processes in the body, stimulate appetite, and improve the functions of lungs and blood vessels. If there are patients with recurrent hemoptysis, they should also increase the supply of iron, eat more green leafy vegetables, fruits and miscellaneous grains, and supplement a variety of vitamins and minerals.
Tuberculosis patients have a particularly poor appetite. In order to increase their appetite, we can make great efforts in cooking, so that the varieties are diversified and the colors, flavors and shapes are good. Conditional in addition to three meals a day, you can add snacks twice. Avoid irritating food and spicy, dry and expectorant things. Because tuberculosis is a chronic infectious disease, we should pay attention to adequate rest and proper outdoor activities, and pay attention to the environment and tableware hygiene while taking medicine and eating.
Sixteen, tuberculosis patients should be how to carry out home disinfection and isolation?
Tuberculosis patients should not spit everywhere, but spit in paper or spittoon, and then burn it or disinfect it and throw it away. Don't talk loudly, don't cough or sneeze at your family. It is best to wear a mask and wash it after boiling every day.
It is best to have a separate bedroom with sufficient light and good ventilation, and the room should be disinfected frequently. You can light the moxa stick or put a spoonful of rice vinegar on the stove for fumigation according to 1-2 per cubic meter of space, and close the doors and windows for ventilation after 1-2 hours. The simplest way to disinfect heat-resistant articles such as utensils and appliances used by patients is to boil them, such as utensils and clothes. The boiling time is 10~ 15 minutes.
The clothes and quilts used by patients should be cleaned and exposed to the sun frequently to kill mycobacterium tuberculosis.
Microwave disinfection: Microwave can penetrate glass, plastic film and paper. However, the disinfection effect of microwave oven varies with the power of microwave oven. Generally, the power of household microwave oven is above 700 watts, and the disinfection effect can be achieved in 4 ~ 7 minutes. Note: ① Microwave does not penetrate metal, so disinfection items should not be put in metal utensils. ② Microwave is most easily absorbed by water molecules, and it is best to put a glass of water in the furnace for disinfection, so that the disinfection effect is better.