I can see the status bar

Chapter 551 Tuberculosis? (May 5st 21th for subscription)

Tuberculosis is a very troublesome disease.Tuberculosis is a very, very troublesome disease, no matter for respiratory medicine, infectious disease or even emergency department.

This trouble is not only reflected in the long treatment period and the longer disease period, but also in the diagnosis.

Yes, tuberculosis is one of the most difficult diseases to diagnose in the world.

There used to be a popular joke among respiratory physicians, and the content is roughly like this - if you are asked by the old professor to diagnose the patient's condition during the general consultation, and you are unlucky and distracted, there is no Listen to the patient's situation clearly, don't worry, you just need to cough lightly, and then answer "tuberculosis cannot be ruled out" in a very calm manner.

No old professor can deny this diagnosis, and basically all respiratory diseases can be diagnosed with "tuberculosis cannot be ruled out".This can also explain from the side how many different manifestations of tuberculosis this disease has.

20% of tuberculosis patients have no symptoms or only mild symptoms, and even if they have symptoms, they are basically limited to "cough", "chest pain", "dyspnea", and "fever".In other words, tuberculosis patients are either asymptomatic or have no specific symptoms.

So what about the introduction of imaging testing?

The situation is equally bad.The chest radiographs of pulmonary tuberculosis have no characteristic changes, and doctors in the imaging department can only pass through some calcified spots; lesions occur in the posterior segment of the non-upper lobe, dorsal segment of the lower lobe, and posterior basal segment; there are spherical lesions and slow absorption It is very subjective and unreliable "characteristics" to put forward the opinion of "suspect tuberculosis, please combine it with clinical".

CT has certain supplementary diagnostic value, but it is only for further differentiation of lesions in some hidden parts or lesions that are difficult to diagnose. CT, like X-rays, cannot directly give a diagnosis.

After two waves of unreliable diagnosis of symptoms and imaging, if doctors still think that it may be tuberculosis (of course, it may be because they really can't think of other types of disease), they will treat it The patient was diagnosed with etiology.

The next most unreliable place appeared, because the diagnosis of tuberculosis generally adopts the detection method of sampling smear staining.In clinical testing, the probability of negative staining of tuberculosis sampling smears is too high.So much so that it is recommended in the diagnosis and treatment guidelines that patients need to undergo at least three consecutive smear staining tests to minimize the possibility of false negatives—what’s more, a positive smear may not necessarily mean tuberculosis. Nontuberculous Mycobacterium, Mycobacterium leprae, Nukajun, and Actinomycetes may also show false positive reactions under the stain.

Therefore, the current "gold standard" recommends using the isolation and culture method for a more accurate diagnosis-but the positive rate of the isolation and culture method is still not ideal, and the entire period of time is not normal.The modified Roche culture method commonly used in China needs to be cultivated for four to six weeks, that is, one month to one and a half months, about 45 to [-] days.

The well-known PCR technology can be used in detection. It can amplify a small amount of tuberculosis DNA in a sample and amplify hundreds of times in a short period of time to facilitate detection.However, the defects of false negatives and the inability to distinguish tuberculosis mycobacteria from non-tuberculosis mycobacteria have not been improved, and there are even more troubles such as the inability to distinguish dead and live bacteria, and the inability to determine the clinical efficacy.

And the tuberculin skin test (TST), which is also relatively specific, is even worse-after the age exceeds three years, the effect of this test is basically meaningless.The reason is also very simple. TST cannot distinguish whether a patient is currently infected or has a history of infection.And because BCG vaccination is generally carried out for infants and young children in China, its reference is even worse.The ghost knows whether the positive TST reaction of adults is due to BCG vaccination, or because they have had an infection before, or are currently being infected.

Putting aside the advantages and disadvantages of detection technology for the time being, if three consecutive sputum smears and one isolation and culture of Mycobacterium tuberculosis were all negative, can this patient be ruled out to be infected with tuberculosis?
The answer is no.

In the field of treating tuberculosis, there is something called "bacteria-negative pulmonary tuberculosis".

Even if Mycobacterium tuberculosis cannot be detected, if the patient has clinical symptoms of pulmonary tuberculosis—that is, those non-specific symptoms; there are lung X-ray findings—it is also a non-specific lesion; and the anti-tuberculosis treatment is effective, excluding For other non-tuberculous lung diseases, PCR test positive, TST test positive, extrapulmonary histopathological examination confirmed tuberculosis, and bronchus or lung histopathology confirmed tuberculosis, then the diagnosis of "bacterial-negative pulmonary tuberculosis" can be made.

Not to mention the differences in the performance of tuberculosis under various underlying diseases.Immunocompromised persons, extremely immunocompromised persons, AIDS patients, and diabetic patients have different progression and manifestations of tuberculosis, and even tuberculosis caused by bronchial tuberculosis has different symptoms from patients with primary tuberculosis.

Tuberculosis is nothing short of a gigantic Rubik's Cube edifice.As long as you set foot in this area, if you want to know "who am I", "where am I" and "where am I going", you have to work hard to get a direction.

Sun Lien has been working on diagnosis wholeheartedly for almost a year.He never found diagnosis to be a problem—as long as tuberculosis was not involved.

He even showed some face in the prayer status column, and when he met a tuberculosis patient, he would just prompt a "tuberculosis infection" and that would be fine.Don't give yourself some symptoms to reason as usual.But now it seems... The status bar doesn't seem to intend to give him Sun Li'en this face.

Liu Baoguo's symptoms are indeed somewhat similar to tuberculosis. Although it is not clear why high fever and tuberculosis usually appear differently, the "low-afternoon fever" manifests differently, but it is true that this cannot be used to deny the possibility of tuberculosis.There are so many symptoms of tuberculosis that it is not surprising to have a high fever.

"Mr. Liu, have you...have you ever had such a cough before?" Sun Li'en raised his vigilance to the highest level in an instant. Out of the sensitivity of a doctor who specializes in diagnosis, he decided to make some inquiries about tuberculosis first, "Your period In addition to back pain and high fever, have you ever had chest pain, difficulty breathing or coughing up blood?"

"Cough cough...no, no, nothing." Liu Baoguo finally got his breath together. He glanced at Sun Lien helplessly, as if he understood that his cough had frightened the young doctor, "I didn't What's the matter, I just accidentally choked while drinking tea just now."

Choking and coughing after drinking water may be just an accident, but it may also indicate that Liu Baoguo has swallowing dysfunction in the soft palate—this may mean a lesion in the nervous center, it may be some kind of infection, or it may be a cavity block—that is, it will happen. Certain ischemic microinfarcts deep in the brain.

"Then how many times have you choked on water in the past month?" Sun Lien was still a little worried, and Liu Baoguo seemed to be the kind of patient who didn't like to cooperate with doctors.Since he refused to take the initiative to speak, he could only ask little by little.

"Good guy, is it okay to choke on water every day?" Liu Baoguo glanced at Sun Lin dissatisfied, "Let's say it's been a month, I haven't been choked on in the past few years!"

　When you see this large paragraph of diagnosis content, you not only see the diagnosis content, but also see the collapsed mood when I first checked the tuberculosis diagnosis and treatment guidelines in detail

　　
　
(End of this chapter)