Rereading "Dream of Red Mansions", what exactly is the "tuberculosis" that Lin Daiyu suffered from?

Author: Yang Jie Emergency Department, Shunyi District Hospital, Beijing

Reviewer: Guo Shubin, Chief Physician, Emergency Department, Beijing Chaoyang Hospital, Capital Medical University

Rereading "Dream of Red Mansions", is the image of Lin Daiyu in your mind like this? She is more intelligent than Bi Gan, and her illness is three times worse than Xi Shi's. She has a peerless appearance, extraordinary talent, and a proud character. It's a pity that she is weak and sickly, and often coughs. When she heard that Baoyu wanted to marry Baochai, she was so angry that she vomited blood and finally died of tears.

It is generally believed that Daiyu died of tuberculosis. She often coughed up blood because the tuberculosis invaded the pulmonary blood vessels and caused the blood vessels to rupture.

Figure 1 Copyright image, no permission to reprint

Tuberculosis is a serious chronic respiratory infectious disease that spreads quickly and has a wide range of transmission routes. Anyone can be infected. Although the incidence of tuberculosis has declined significantly in recent years, the epidemic trend remains severe[1].

Let’s talk about tuberculosis.

Besides cough, what other symptoms does tuberculosis have?

The most common symptom of pulmonary tuberculosis patients is cough, which is mainly dry cough, and sputum is relatively rare. If accompanied by bronchial tuberculosis, the cough will turn into a severe irritating dry cough [1].

When the necrotic lesions of tuberculosis affect the walls of the pulmonary capillaries, blood may appear in the sputum. If the large blood vessels are damaged, hemoptysis of varying amounts may occur[2].

In addition, patients with pulmonary tuberculosis usually have symptoms of tuberculosis poisoning, the most common of which is afternoon fever, that is, the body temperature gradually rises after 12 noon, generally not exceeding 38 degrees Celsius, but will gradually return to normal at 3 to 4 pm even without the use of drugs. Some patients also have hot flashes on the cheeks, palms, and soles of the feet.

Some patients with weak constitutions may also suffer from insomnia, just as the description of Lin Daiyu after she entered the Jia Mansion in A Dream of Red Mansions: "She often suffers from insomnia and can only sleep soundly for a dozen days a year."

Some patients even suffer from night sweats, in which their sweating almost soaks their clothes while they are sleeping, and the sweating usually stops after they wake up.

In addition, patients usually show loss of appetite, weight loss, fatigue and weakness. Female patients may also experience menstrual disorders or early amenorrhea.

Except for a few patients with acute onset of pulmonary tuberculosis, most patients have a chronic course. Severe cases may cause breathing difficulties and even endanger life due to tuberculous pleurisy, large amounts of pleural effusion, etc. [2].

If a patient has been coughing and expectorating for more than 2 weeks, he or she should go to the local designated tuberculosis medical institution in time to determine whether he or she has pulmonary tuberculosis.

Figure 2 Copyright image, no permission to reprint

Tuberculosis is easily transmitted

Pulmonary tuberculosis is a chronic respiratory infectious disease mainly caused by Mycobacterium tuberculosis infecting the lungs and is easily transmitted through the air.

The tuberculosis bacteria discharged by patients when they cough, expectorate or sneeze are suspended in droplets or dust and may cause infection after being inhaled into the respiratory tract.

Tuberculosis can also be transmitted through the digestive tract. If cups, bowls and chopsticks used by tuberculosis patients are provided to others without strict disinfection, they are likely to cause lesions in the pharynx or intestines.

In addition to the above transmission routes, tuberculosis can also be transmitted through contact with broken skin, mucous membranes, reproductive organs, etc.

People who live, work or study with tuberculosis patients are close contacts and are likely to be infected with tuberculosis bacteria. Whether or not the disease develops after infection is related to the number of tuberculosis bacteria and personal resistance.

In addition, patients with AIDS, silicosis, and diabetes are also at high risk of developing tuberculosis and should go to the hospital regularly for relevant examinations and receive preventive treatment when necessary.

Densely populated areas are risky locations for tuberculosis. Once there is an infectious source, tuberculosis can easily spread. Therefore, we should conduct regular tuberculosis examinations every year to detect and treat tuberculosis early.

Figure 3 Copyright image, no permission to reprint

Treatment and prevention of tuberculosis

If you are unfortunately infected with tuberculosis, most patients can be cured as long as they are discovered in time, see a doctor early, and cooperate with doctors to take regular drug treatment as soon as possible. However, if the treatment is not standardized, it is easy to develop drug-resistant tuberculosis, the cure rate will be lower, the treatment cost will increase, the treatment time will be longer, and in severe cases it may even be life-threatening.

Patients with tuberculosis should strictly follow the doctor's orders for medication, relax their minds, avoid excessive fatigue in daily life, maintain a regular work and rest schedule, consume more fresh and nutritious food, pay attention to physical exercise, and improve their own immunity.

After 2-3 months of standard treatment, tuberculosis patients are generally not contagious. So we should not discriminate against tuberculosis patients, but give them more care and help.

Tuberculosis is preventable. Paying attention to nutrition, improving resistance, personal protection, ventilating the room, wearing a mask when entering crowded places, and getting BCG vaccination on time can all help prevent tuberculosis.

Tuberculosis patients should actively avoid others and cover their mouths and noses when coughing or sneezing. They should not spit anywhere, but should spit sputum into disinfected wet wipes or sealed sputum bags. Develop good living habits, wear masks frequently, wash hands frequently, and avoid spreading germs to others.

To control tuberculosis, it is important to actively control the source of infection, protect susceptible populations, cut off the transmission routes, and put prevention first.

References

[1] National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital, Editorial Board of Chinese Journal of Antituberculosis. Expert consensus on criteria for judging the activity of pulmonary tuberculosis and its clinical application. Chinese Journal of Antituberculosis, 2020, 42(4):301-307.

[2] Chinese Medical Association, Chinese Medical Association Journal, Chinese Medical Association General Practice Branch, et al. Guidelines for diagnosis and treatment of pulmonary tuberculosis at the primary level (2018). Chinese Journal of General Practitioners, 2019, 18(8):709-717.

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