Discussion on the importance of tuberculosis to the public
4hw.org: we have heard about tuberculosis for a long time. In China, there are also areas with high incidence of tuberculosis. We have also vaccinated them. In recent years, the problem of tuberculosis infection has decreased. But recently, a number of students in a middle school in Hunan Province have infected with tuberculosis. We have never returned this disease to the public.
Next, I will introduce the symptoms of tuberculosis, especially the early symptoms of tuberculosis. What are the manifestations of tuberculosis? What will happen if you get tuberculosis?
Symptoms of tuberculosis
Typical symptoms: low fever, fatigue, anorexia, emaciation, night sweat, etc. If the lung lesions spread, it often presents irregular high fever. Women may have menstrual disorders or amenorrhea.
Related symptoms: low fever, anorexia, fatigue, cough, flushing, emaciation, expectoration 1. Symptoms
Typical tuberculosis starts slowly and has a long course, including low fever, tiredness, anorexia, cough and a small amount of hemoptysis. However, most of the patients had mild lesions and no significant symptoms, which were occasionally found by X-ray examination. There are also empty hemoptysis was diagnosed, retrospective history can have mild systemic symptoms. A small number of patients were confirmed as acute miliary tuberculosis or caseous pneumonia by X-ray examination because of sudden onset, prominent toxic symptoms and respiratory symptoms. The elderly patients with tuberculosis are easy to be covered by the symptoms of chronic bronchitis. Occasionally, there is a high fever due to the secondary infection of the undetected severe tuberculosis, and even it has developed to septicemia or respiratory failure before going to see a doctor. In view of the diversity of clinical manifestations of tuberculosis, in the areas where the epidemic situation of tuberculosis has been basically controlled and the incidence is low, medical staff should recognize its atypical manifestations in their daily diagnosis and treatment work.
1. General symptoms
Performance for afternoon low heat, fatigue, anorexia, emaciation, night sweat and so on. If the lung lesions spread, it often presents irregular high fever. Women may have menstrual disorders or amenorrhea.
2. Respiratory symptoms
It is usually dry cough or with a small amount of mucus sputum. When secondary infection occurs, the sputum is mucopurulent. About 1 / 3 of the patients have hemoptysis in varying degrees, and the blood in sputum is mainly caused by the expansion of the capillaries of the inflammatory focus; the hemoptysis in medium or more amounts is related to the injury of small blood vessels or the rupture of the hemangioma from the cavity. After hemoptysis, there is often low fever, which may be caused by the absorption of blood clots in the bronchioles or the obstruction of bronchi. If the fever persists, the spread of tuberculosis should be considered. Sometimes sclerotic calcified tuberculosis can be due to mechanical damage to blood vessels, or with bronchiectasis and hemoptysis. Haemorrhagic shock may occur during massive hemoptysis, and asphyxia may occur occasionally due to blockage of large airway by blood clots. At this time, the patient is extremely fidgety, nervous, struggling to sit up, chest tightness, shortness of breath, cyanosis, and should be rescued immediately.
When the inflammation of the focus involves the parietal and pleura, the corresponding chest wall has tingling, which is usually not severe, and aggravates with breathing and coughing. Chronic severe pulmonary tuberculosis, respiratory dysfunction, often progressive dyspnea, or even hypoxia cyanosis. If complicated with pneumothorax or a large amount of pleural effusion, its dyspnea symptoms are particularly serious.
Two. Signs
In the early stage, the lesions were small or deep in the lung tissue, with no abnormal signs. If the lesion area is large, the respiratory movement of the affected side of the lung is weakened, and the percussion is dullness, and the breath sound is decreased during auscultation, or the breath sound is bronchoalveolar. Because tuberculosis often occurs in the posterior segment of the upper lobe tip and the dorsal segment of the lower lobe, the percussion of the upper and lower clavicles and the interscapular area is slightly turbid, and the moist rale can be heard occasionally after coughing, which is of reference significance for diagnosis. When extensive fibrosis or pleural adhesion and thickening occur in lung lesions, the chest on the affected side often presents depression, narrowing of costal space, tracheal displacement and turbid percussion, and the opposite side may have compensatory emphysema.
1. Primary tuberculosis
When the human body's resistance is reduced, the inhaled tubercle bacilli form exudative intercalated foci in the lung, most of which are at the bottom of the upper lobe, the middle lobe or the upper part of the lower lobe (the part with larger lung ventilation), causing lymphadenitis and lymphangitis, and the primary focus and lymph nodes can all have caseous necrosis. The primary focus of the lung, lymphangitis and local lymphadenitis, collectively referred to as the primary syndrome (Figure 2). Primary tuberculosis is often found in children, but also in remote mountainous areas, rural areas for the first time into urban adults. Most patients can have no symptoms, or only mild cold like symptoms, such as low fever, light cough, loss of appetite, weight loss, etc., which will take several weeks to improve. X-ray showed that the primary focus of the lung, lymphatics and pulmonary lymph nodes were enlarged. Most lesions can be absorbed or calcified by themselves. If the primary focus in the lung is close to the pleura, pleurisy can be caused when the human body is in an allergic state. The primary focus of the lung is usually absorbed quickly, leaving no trace or only becoming a small calcified focus. Lymphadenitis of the hilar lung can occasionally be prolonged and spread to the adjacent mediastinal lymph nodes. If the enlarged hilar lymph nodes compress the bronchus, they may lead to atelectasis, distal lung inflammation or secondary bronchiectasis. Tuberculosis of hilar or mediastinal lymph nodes is more common than primary syndrome.
The primary focus of the lung, lymphangitis and local lymphadenitis, collectively referred to as the primary syndrome.
The primary pulmonary focus of primary tuberculosis, especially the tuberculosis in the hilar lymph nodes, often has a small amount of bacteria entering the blood circulation, and then spread to all organs of the body, but because of the strong resistance of the human body, the focus is limited to the tip of the lung (or the upper part of the lung), bone, brain, liver, urogenital organs and so on, and gradually heals, but the tuberculosis bacteria in it can survive for a long time and become the possibility of recurrence (secondary formation) Tuberculosis).
2. Hematogenous disseminated tuberculosis
This type of tuberculosis is more serious. Most of them developed from primary tuberculosis, but in adults, they were caused by the rupture of extrapulmonary tuberculosis focus (such as the caseous focus of urogenital organs) to blood vessels.
Acute miliary pulmonary tuberculosis is a part of acute systemic blood disseminated tuberculosis. It has acute onset and systemic toxic blood symptoms, often accompanied by tuberculous meningitis. X-ray shows that both lungs are covered with clear miliary shadow on dense reticular shadow, with a diameter of about 2mm, and the size and density are almost the same (Fig. 3). At the beginning of the disease, there may be no obvious miliary shadow on chest film, or only diffuse reticular change, which is easily misdiagnosed as typhoid, septicemia and other febrile diseases.
On the dense reticular shadow, the two lungs are covered with clear miliary shadow with a diameter of about 2mm, and the size and density are almost the same.
If the human body has a strong resistance, a small amount of TB enters the lung by blood circulation in batches, and its blood dissemination foci are often uneven in size, old and new, and distributed symmetrically in the upper and middle parts of both lungs, it is called subacute or chronic blood disseminated tuberculosis. The development of the disease is slow, usually no significant toxic symptoms, patients may not have conscious symptoms, occasionally found in the X-ray examination. At this time, the focus is more stable or has hardened and healed.
3. Infiltrative tuberculosis
It is the most common type of tuberculosis. Its symptoms, signs and X-ray manifestations may vary greatly depending on the nature, scope and development stage of the disease.
Most of the patients with infiltrative pulmonary tuberculosis are adult patients with slow onset, early stage and small focus, often without obvious symptoms and signs. It is often found by physical examination or chest X-ray examination for other reasons. The clinical symptoms depend on the scope of focus and human response. The lesions were located above and below the clavicle. The X-ray showed flake and flocculent shadow with fuzzy edge. When the human body is in an allergic state, and a large number of tuberculosis bacteria enter the lung, the focus of caseous necrosis, liquefaction, and then the formation of cavities and the focus of bronchi spread. When infiltrative pulmonary tuberculosis is accompanied by large areas of caseous necrosis, it often presents acute progress and severe toxic symptoms. It is clinically called caseous (or tuberculous) pneumonia. When some of the caseous necrotic foci dissipate, a fibrous capsule is formed around them; or the drainage bronchi of the cavity are blocked, and the caseous matter in the cavity is difficult to be discharged, forming a spherical focus, which is called tuberculoma.
4. Chronic fibrocavitary tuberculosis
Pulmonary tuberculosis was not found in time or treated improperly, the cavity did not heal for a long time, the cavity wall was thickened, and the focus appeared extensive fibrosis; the fluctuation of random body immunity, the focus absorption, repair and deterioration, and progress alternately occurred, becoming chronic fibrous cavity type tuberculosis. The focus often has repeated bronchi dissemination, the focus absorption, repair and deterioration, progress alternate, become chronic fibrous cavity type tuberculosis. The focus often has repeated bronchi dissemination, the course of disease is prolonged, the symptoms fluctuate from time to time, and the sputum contains tuberculosis bacteria, which is an important source of infection of tuberculosis. X-ray showed single or multiple thick walled cavities on one or both sides (Fig. 5), most of which were accompanied by bronchiectasis and obvious pleural thickening. Because of the contraction of lung tissue fibers, the hilus of lung is pulled upward, the lung striae is in the shape of willow shadow, and the mediastinum is pulled to the diseased side. The adjacent or contralateral lung tissues often have compensatory emphysema, often complicated with chronic bronchitis, bronchiectasis, secondary infection or chronic cor pulmonale. Extensive destruction of lung tissue and hyperplasia of fibrous tissue further lead to contraction of lung lobes or whole lung. These changes can be regarded as the sequelae of secondary tuberculosis.
There are single or multiple thick walled cavities on one or both sides, most of which are accompanied by bronchiectasis and obvious pleural thickening. Because of the contraction of lung tissue fibers, the hilus of lung is pulled upward, the lung striae is in the shape of willow shadow, and the mediastinum is pulled to the diseased side.
5. Caseous pneumonia (tuberculous lobar pneumonia)
It is often seen in the patients with weak body and large amount of tuberculosis. It is mainly caused by cheese necrosis of bronchial lymph nodes, breaking through the bronchi and spreading to the lung leaves, or by the rapid deterioration of infiltrative tuberculosis. There are many upper right lobes with large exudative lesions, rapid cheese necrosis and dissolution to form a wall free cavity. Most of the patients have severe poisoning symptoms and rapid failure, and the upper right lobe may have signs of consolidation. The leukocyte count and neutrophils of hemogram often increased, and the ESR increased rapidly. After 2-3 weeks of the onset of the disease, the sputum tubercle bacilli were positive. X-ray chest film: the shadow of dense and uneven density in the upper right lobe can be seen. It can dissolve rapidly within ten days or weeks, forming a silkworm erosion cavity, and there can be bronchi spread.
6. Tuberculous pleurisy
It is the pleura inflammation caused by tuberculosis infection. Clinically, it can be divided into three types: dry pleurisy, exudative pleurisy and tuberculous empyema (rare).
The onset of the disease can be rapid or slow, more acute. The symptoms of systemic poisoning include: moderate and high fever, night sweat, fatigue, general malaise, etc. Local symptoms may include chest pain, dry cough, and a large amount of pleural effusion may include shortness of breath, chest tightness, upright breathing and cyanosis.
The respiratory movement of the affected side of dry pleurisy is limited, with local tenderness, palpable sense of pleural friction, and auscultation of pleural friction sound. When there is more pleural effusion in exudative pleurisy, the thorax on the affected side is full, the costal space is widened, the respiratory motility and chatter are weakened, the trachea and heart are shifted to the healthy side, the dullness is detected below the liquid level, the respiratory sound is weakened or disappeared, there may be bronchoalveolar respiratory sound above the liquid level, occasionally there is vesicular sound. The boundary of liver dullness disappeared in the right pleural effusion. If there is pleural adhesions and hypertrophy, the local thorax is sunken. If the respiratory movement is limited, the turbid sound is detected and the respiratory sound is weakened.
7. Other extrapulmonary tuberculosis
Other extrapulmonary tuberculosis are named according to the location and organs, such as bone and joint tuberculosis, tuberculous meningitis, renal tuberculosis, intestinal tuberculosis, etc.
8. Summary
To sum up, the clinical evolution of tuberculosis is a reflection of the outcome of the competition between human body and tuberculosis bacteria.
When the resistance of human body is strong and regular treatment is carried out, the lesions can dissipate and absorb, or the lesions tend to be ill due to calcification; otherwise, if the resistance of human body is low and the treatment is not reasonable, the lesions can be caseous