Super detailed! All the frequently asked questions of tuberculosis patients are answered here

I have summarized the questions I have heard from patients about tuberculosis over the years, and written them down here with their answers. Through the "Good Doctor Online" online platform, more people can see them and help more people, completing the mission that our clinic cannot accomplish: medical knowledge and health education. I also hope that patients can learn about knowledge through the Internet, rather than seeking it in the clinic (which is like looking for fish in a tree), and then complaining about the doctors.

1. What kind of disease is tuberculosis?

Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis. It can occur anywhere in the body, mostly in the lungs (accounting for more than 80%).

2.How is tuberculosis transmitted?

Tuberculosis is transmitted through the respiratory tract. When a pulmonary tuberculosis patient coughs, sneezes, talks loudly, or laughs, droplets containing Mycobacterium tuberculosis are discharged into the air; or when the patient spits, the Mycobacterium tuberculosis in the sputum flies into the air, and healthy people inhale the sputum and become infected. Transmission through other routes such as the digestive tract and skin is rare.

3. Is tuberculosis common? Isn’t it going to be eradicated soon?

According to the fifth national tuberculosis epidemiological sampling survey in 2010, the prevalence of active pulmonary tuberculosis in people aged 15 and above is 459/100,000, and the prevalence of smear-positive pulmonary tuberculosis is 66/100,000. Every year, there are 1.5 million new tuberculosis patients in my country and 130,000 people die from tuberculosis. Tuberculosis is the infectious disease that causes the most deaths in the world.

In my country, tuberculosis is a common disease, and pulmonary tuberculosis is a common disease in the respiratory department. Patients who cough and expectorate for more than 2 weeks, or who have blood in their sputum, need to be highly alert to pulmonary tuberculosis; half of patients with pleural effusion have tuberculous pleurisy.

4. Will I definitely be infected with tuberculosis after contact with a patient with pulmonary tuberculosis?

No. After being infected with tuberculosis, 90% of people will eliminate the tuberculosis bacteria with their own immunity and will not develop the disease; a small number of infected people (about 10%) will develop the disease due to weak immunity.

5. I discovered it during a physical examination and I don’t have any symptoms. How could I have tuberculosis?

About 20% of active pulmonary tuberculosis has no symptoms or mild symptoms.

6.What are the typical symptoms of tuberculosis?

① Respiratory symptoms: cough and sputum for more than 2 weeks, which may be accompanied by hemoptysis, chest pain, dyspnea, etc.;

②Symptoms of systemic tuberculosis poisoning: fever (often low-grade fever in the afternoon), which may be accompanied by night sweats, fatigue, decreased appetite, weight loss, and menstrual disorders.

But not every patient gets sick according to what is written in the book. The symptoms may not be typical and there may be only one or two symptoms, such as a mild cough.

7. In what cases should I consider tuberculosis? How can I get a diagnosis?

① Chest X-ray during physical examination revealed abnormal lung shadows consistent with the imaging characteristics of pulmonary tuberculosis;

or ② Coughing and expectoration for more than 2 weeks;

or ③ blood in sputum;

Or ④ "Pneumonia" that is repeatedly ineffective with anti-inflammatory treatment.

First of all, the most important thing is to take a chest X-ray or chest CT, check for tuberculosis in sputum, bronchoscopy, blood T-SPOT TB, etc. I won't explain the others one by one.

8. I didn’t find any tuberculosis bacteria in my sputum. How did the doctor diagnose me with pulmonary tuberculosis?

The sputum bacteria positivity rate for pulmonary tuberculosis is very low, only about 1/4. That is to say, among the patients who are finally diagnosed with pulmonary tuberculosis, only about 1/4 of the patients have tuberculosis bacteria found in their sputum, while most patients with pulmonary tuberculosis do not have tuberculosis bacteria in their sputum. Therefore, pulmonary tuberculosis cannot be diagnosed solely based on sputum bacteria positivity, otherwise most patients with pulmonary tuberculosis will delay their condition.

Not finding tuberculosis bacteria in sputum does not mean that there are no tuberculosis bacteria in the lungs. It is like there are fish in the pond but the fishing net cannot catch any fish.

Most cases of pulmonary tuberculosis are negative tuberculosis, and its diagnosis is relatively complicated. Chest CT is an important basis for diagnosing pulmonary tuberculosis. Other tests include blood tests, bronchoscopy, etc. The doctor will make a diagnosis based on a combination of various information (medical history, physical examination, tests, examination results).

9. If the sputum test is negative for bacteria, it is not contagious. Is that right?

No. All pulmonary tuberculosis is contagious to a certain extent. Sputum positive is highly contagious, 100%; sputum negative is less contagious, reported to be about 30%. People who only have extrapulmonary tuberculosis but not pulmonary tuberculosis are not contagious.

10. Does a positive sputum acid-fast bacilli smear ( ) confirm pulmonary tuberculosis?

No. According to the fifth national tuberculosis epidemiological survey in 2010, 22.9% of the specimens with positive mycobacterial culture were non-tuberculous mycobacteria, which means that most of the acid-fast bacilli smears ( ) were tuberculosis, and a small part were non-tuberculous mycobacteria. The proportion of patients with existing bronchiectasis suffering from non-tuberculous mycobacterial lung disease is higher than that of ordinary people. Identification depends on mycobacterial culture and bacterial type identification, or genetic testing. Before confirmation, it is generally treated as tuberculosis.

11. What will be the outcome of tuberculosis if we don’t use Western anti-tuberculosis medicine?

① In the era when there were no Western anti-tuberculosis drugs, half of patients with sputum smear-positive pulmonary tuberculosis died 2 to 4 years after onset of the disease, nearly a quarter became chronic sources of infection, and only a quarter of patients were cured (spontaneously).

② Even if the patient recovers on his own, the recurrence rate is still very high. It has been reported that the 5-year recurrence rate is 36.5%.

③ Each source of infection can infect about 10 people per year on average, and each death from tuberculosis can infect 30 to 50 people.

12. Can tuberculosis be cured? Is it easy to relapse?

Most (more than 90%) cases of newly diagnosed pulmonary tuberculosis can be cured through regular anti-tuberculosis treatment. Early detection, early diagnosis, and early treatment are the key to whether pulmonary tuberculosis can be cured. You should cooperate with your doctor to undergo tuberculosis examinations. Once diagnosed, you should follow the doctor's instructions to take medication and have follow-up examinations throughout the course. The treatment course for newly diagnosed pulmonary tuberculosis generally takes 6-8 months, and you cannot miss or interrupt medication during the course. The recurrence rate is about 10%.

The cure rate of retreatment tuberculosis is much lower than that of initial treatment, and it is even lower for multidrug-resistant tuberculosis.

13. I heard that Western medicine for treating tuberculosis is very toxic, especially damaging to the liver. Can I not use it?

No. The harm caused by tuberculosis to the human body is far greater than the harm caused by anti-tuberculosis drugs. "Choose the lesser of two evils."

Drug toxicity and side effects do not occur to everyone, and the incidence rate is generally around 10%. In addition, most cases are treated promptly by doctors and will not cause serious consequences. Only less than 1% of cases are truly serious. However, the adverse consequences of tuberculosis are as high as 75%.

14.How to treat tuberculosis?

Principles of anti-tuberculosis treatment: early, combined, appropriate, regular, and full course.

Once tuberculosis is confirmed, or if tuberculosis is highly suspected and a decision is made to start diagnostic anti-tuberculosis treatment, anti-tuberculosis treatment should be started immediately. The first two months of initial treatment of pulmonary tuberculosis are the intensive period, and the standard regimen is to use a combination of four drugs: isoniazid, rifampicin, pyrazinamide, ethambutol (or streptomycin, one of the two), and the dosage of each drug is determined according to body weight, and the medication is taken every day; the next four months are the consolidation period, using isoniazid and rifampicin. Depending on the severity of the disease and the severity of the drug reaction, the regimen can be adjusted appropriately. When severe adverse drug reactions occur, the regimen is different; the regimen for retreatment and drug resistance is different from this.

15.How long does it take to cure tuberculosis?

The course of anti-tuberculosis treatment:

For common mild pulmonary tuberculosis, the initial treatment course is half a year, and the retreatment period is at least 8 months.

Severe pulmonary tuberculosis: 9 months to 1 year.

Pulmonary tuberculosis complicated with diabetes, pneumoconiosis, etc.: 1 year;

Ordinary extrapulmonary tuberculosis (tuberculous pleurisy, bronchial tuberculosis, lymph node tuberculosis, renal tuberculosis, intestinal tuberculosis, etc.): 1 year.

Tuberculous meningitis: 1 and a half years.

Multidrug-resistant tuberculosis: 21 months to 2 years.

16. What will happen if tuberculosis is not treated properly?

Some patients feel that it does not affect their normal life, and do not check or treat lung diseases; some patients stop taking medicine privately or take it intermittently (take it on and off) after receiving short-term regular treatment and their symptoms are relieved; some patients are worried about adverse drug reactions, so they do not take medicine according to the prescribed plan or reduce the dosage privately. These wrong practices will make tuberculosis difficult to cure and very easy to relapse, and develop into difficult-to-treat multidrug-resistant tuberculosis. The treatment of multidrug-resistant tuberculosis is difficult, time-consuming, and requires many types of drugs. The side effects of drugs are more serious, the treatment cost is higher, but the efficiency is much lower. Moreover, multidrug-resistant tuberculosis can be transmitted to others, eventually leading to the death of oneself and others.

17. What should tuberculosis patients pay attention to?

① Get enough rest and don’t stay up late;

② Comprehensive and balanced nutrition;

③ No strenuous exercise;

④ Do not spit anywhere. Spit into a covered cup filled with disinfectant and pour it into the toilet after disinfection.

⑤It is best to wear a mask when in contact with people;

⑥ Don’t cough or talk loudly in front of others.

⑦Open windows frequently for ventilation.

⑧ During the acute phase, do not go to crowded places with polluted air, such as supermarkets, shopping malls, subways, mahjong rooms, Internet cafes, cinemas, etc.

⑨Avoid catching a cold, as a cold can weaken your immune system and may worsen tuberculosis or lead to lung inflammation.

⑩ Actively treat complications, common ones include: diabetes, chronic bronchitis, heart disease, hypertension, etc. Especially diabetes must be actively treated.

18. What should tuberculosis patients eat? What should they not eat?

Traditional Chinese medicine has many dietary taboos, but Western medicine does not agree with them and has no basis in fact.

① You should pay attention to the nutrition and combination of food, including various meats (including poultry, livestock, and fish), eggs, vegetables, fruits, staple foods, milk, and soy products. It is enough to combine all kinds of food reasonably.

②Don’t smoke or drink. Smoking hurts the lungs, and drinking hurts the liver, which will make things worse.

③ Patients with hemoptysis have certain dietary restrictions: Do not take hot or tonic medicines or foods, such as ginseng, dog meat, mutton, donkey-hide gelatin, lychee, longan, too spicy food, or very hot food, such as hot pot.

④ Some people will experience increased uric acid in the blood and joint pain after taking pyrazinamide. At this time, you should eat less seafood, animal offal, and soy products. Generally, pyrazinamide is taken for 2 months, and there is no need to avoid it after stopping pyrazinamide.

19. What should family members and close contacts of tuberculosis patients pay attention to?

① Once a patient is diagnosed with pulmonary tuberculosis, all family members and close contacts should have a chest X-ray. If there is a problem, further examination and treatment are required; if there is no problem, it is best to have another chest X-ray every six months, because tuberculosis has a latent period and may develop after 1-2 years.

② Pay attention to protection, because tuberculosis is transmitted through the air, so it is difficult to prevent. Patients or family members wear masks and open windows for ventilation frequently.

③Exercise to improve immunity.

20. What should we pay attention to during anti-tuberculosis treatment?

① Take medicine every day according to the doctor's instructions. Do not skip or stop taking medicine without a valid reason. Pay attention to rest and nutrition, especially do not stay up late. ② If you do not feel uncomfortable, go to the hospital for regular checkups and prescriptions.

③ If you feel uncomfortable, go to the hospital immediately. The doctor will decide whether to stop or change the medication. If the reaction is very serious, you should stop taking the medication first and go to the doctor as soon as possible.

21. What symptoms require immediate hospital visit?

Poor appetite, nausea, vomiting, right abdominal distension or discomfort, yellowing of the face or eyes, rash, skin bleeding spots, fever, severe insomnia, excitement, depression, irritability, joint pain, blurred vision, decreased vision, reduced or impaired visual field, tinnitus, hearing changes or decreases, dizziness, vertigo, balance disorders, low back pain, soy sauce-colored urine, etc.

22. What should I do if adverse reactions occur?

Some minor adverse reactions do not require discontinuation of medication, some require adjustment of anti-tuberculosis drugs, and some must be discontinued. Improper handling can lead to serious consequences. If you ignore it and continue to use the drug, some reactions will cause serious damage; and if you stop taking the drug inappropriately or use a too weak regimen, tuberculosis cannot be cured and develops into refractory chronic tuberculosis. Note: Not all doctors can correctly understand and deal with the adverse reactions of anti-tuberculosis drugs, so you must find an experienced doctor from a professional institution to deal with it.

23. After one year of treatment for tuberculosis, why does the chest CT still show that the lesions are not good?

Most pulmonary tuberculosis patients will have their lung lesions absorbed in the first 1-3 months after anti-tuberculosis treatment. It is impossible for lung lesions to disappear completely, and some will remain (usually 10% to 100% of the lesions will remain). This is a normal phenomenon of pulmonary tuberculosis. As long as the regular treatment lasts for a sufficient period of time, the symptoms disappear, the sputum bacteria turn negative, and the lesions remain stable and do not increase, it is judged that the pulmonary tuberculosis is cured and the medication can be stopped.

24. Under what circumstances can the medication be stopped?

There are only two situations in which stopping medication is reasonable, and all others are not valid reasons.

① The anti-tuberculosis treatment course has been completed. The doctor says that tuberculosis has been cured and the medication can be stopped.

② Anti-tuberculosis drugs have certain adverse reactions, and the doctor said that some or all of the drugs have to be discontinued, but once the situation improves, the plan needs to be adjusted and the drugs should be used again as soon as possible.

25. How should tuberculosis patients be treated and see a doctor after being discharged from the hospital?

① When you are discharged from the hospital, you usually take one month's worth of medicine with you. After discharge, you need to go to the outpatient clinic for a follow-up examination and to get your medicine filled.

②During the intensive period (the first 2-3 months of treatment), check liver function, uric acid and blood routine every half a month. If streptomycin or amikacin is used, check kidney function and urine routine. During the consolidation period, check the above items once a month. Also tell the doctor if you feel any discomfort. If you feel obvious discomfort, see an outpatient immediately, regardless of whether the half-month deadline has arrived.

③ Prescriptions can only be taken in advance and cannot be delayed. You must not stop taking the medicine for a few days just because you have finished taking the medicine or have no time to get the prescription filled.

④ If you cannot make an appointment with a specialist, go to the ordinary clinic for a follow-up examination and prescription. Never stop taking the medicine because it is out of stock while waiting for the specialist, or delay treatment if there is a serious reaction.

⑤ In our outpatient clinic, after registering, go to the clinic first and ask the doctor to issue a follow-up test report (you need to tell the doctor the items), then go for a blood test, and then wait in line to see the doctor. Don't wait until your number is in line to issue a test report, as you will not have time to read the report.

⑥ Recheck sputum bacteria at the end of 2, 5, and 6 months after anti-tuberculosis treatment. Recheck chest CT 1-2 months after anti-tuberculosis treatment, and then recheck CT every 1-3 months according to the condition.

⑦ There are many kinds of anti-tuberculosis drugs. Patients must understand the drug name, dosage, and usage, and never make mistakes. If you are not sure, you can ask the doctor carefully, record the drugs on paper or take photos with your mobile phone to show the doctor. Be careful not to use inferior drugs, which have poor efficacy and great toxic side effects. Look for good manufacturers.

⑧ Two months after discharge, go to the medical history room to copy the tuberculosis culture and drug sensitivity results. If ( ) you need to see an outpatient, show them to the doctor.

⑨Chest X-rays, CT scans and various medical records should be kept well. Do not fold or roll the films. If the discharge summary needs to be submitted for reimbursement, please make a copy. Bring them to the doctor and do not throw them away even after you recover. You will need to compare them in the future follow-up.

Liang Li, Chief Physician, Tuberculosis Department, Shanghai Pulmonary Hospital