Dozens of school students in Jiangsu have been infected with tuberculosis. How terrible is this disease?

Real points:

Tuberculosis is a chronic infectious disease caused by infection with Mycobacterium tuberculosis, which mainly invades the lungs. Droplets are its main mode of transmission. Therefore, in order to minimize the spread of droplets containing tuberculosis bacteria through the air, patients and their contacts need to wear professional N95 masks. In addition, not everyone will get sick after being infected with tuberculosis bacteria. The main characteristics of susceptible people are malnutrition (such as hypoproteinemia, anemia, etc.), smoking, staying up late for a long time leading to sub-health, diabetes, long-term depression, etc. If the cough lasts for more than 2 weeks, you need to go to the hospital for early diagnosis.

Verified by: Chu Naihui | Director of Tuberculosis Department 1, Beijing Chest Hospital, Chief Physician

Recently, some netizens claimed that dozens of students at Jiangsu Normal University were infected with tuberculosis, questioning the school's lax inspection and improper management. On the evening of the 14th, Jiangsu Normal University issued a "Situation Statement", saying that the 22 tuberculosis patients found previously had been suspended from school, and recent screening found 43 students with abnormalities, most of whom have been hospitalized in Xuzhou Infectious Disease Hospital for further diagnosis.

Speaking of tuberculosis, you may not be unfamiliar with it. In China, it has another more famous name: pulmonary tuberculosis. In ancient times, the Chinese often said "nine out of ten tuberculosis patients die". In the 19th century, Europe also regarded tuberculosis as the white plague. In modern history, many celebrities (Lu Xun, Lin Huiyin) also died of tuberculosis. What exactly is tuberculosis? Is there really no way for humans to deal with it?

1. Common Misconceptions About Tuberculosis

Before introducing the knowledge about tuberculosis, let us first talk about some common misunderstandings.

1. Has tuberculosis been eliminated in our country?

Fact check: Tuberculosis has not been eliminated worldwide, and my country is currently the second largest country with tuberculosis in the world.

2. Will you be infected if you come into contact with a tuberculosis patient?

Truthful identification: Only a small number of people can get sick after contact with patients, and most of them are related to the group's own immune status.

3. Does coughing up blood mean you have tuberculosis?

Fact check: Many diseases can cause hemoptysis, such as bronchiectasis, lung cancer, etc. Tuberculosis is one of the diseases that may manifest as hemoptysis.

4. If you have tuberculosis, you will have symptoms such as coughing and hemoptysis. If there are no symptoms, it does not mean you have tuberculosis?

Fact check: Some tuberculosis patients may not have any symptoms.

5. Tuberculosis only occurs in the lungs?

Fact check: Except for the lungs, almost all organs in the body can be infected with tuberculosis.

6. Are tuberculosis drugs free in our country?

Truth Check: Only first-line anti-TB drugs are free at the Tuberculosis Prevention and Control Center, and second-line drugs are not free. All drugs in the hospital are not free. Almost all drugs are covered by medical insurance.

2. What kind of disease is tuberculosis?

Tuberculosis remains one of the top ten causes of death worldwide and is the number one killer among single infectious diseases, including AIDS.

In 2017, there were an estimated 10.1 million new cases of TB worldwide, including 5.8 million in men, 3.2 million in women, and 1 million in children.

Tuberculosis patients are found in all countries and in different age groups. Overall, 90% are adults (≥15 years old), 9% are HIV-infected (72% of whom are from Africa), and two-thirds of patients come from the following eight countries: India (27%), China (9%), Indonesia (8%), the Philippines (6%), Pakistan (5%), Nigeria (4%), Bangladesh (4%) and South Africa (3%). China is currently the second largest country in the world for tuberculosis.

It is estimated that 23% of the world's population (approximately 1.7 billion people) have latent tuberculosis infection and are at risk of developing active tuberculosis during their lifetime.

Tuberculosis is a chronic infectious disease caused by infection with Mycobacterium tuberculosis (tubercle bacillus). Mycobacterium tuberculosis may invade various organs of the human body, but mainly invades the lungs, which is what we usually call pulmonary tuberculosis. Pulmonary tuberculosis is mainly transmitted through droplets. When patients with pulmonary tuberculosis sneeze and cough, they can release the tuberculosis bacteria in the lungs in the form of droplets, or more professionally, in the form of aerosols into the air, which can be spread and infect other people. When healthy people inhale air containing a sufficient amount of tuberculosis bacteria, some people will become ill. Some of these people will recover without treatment, while others will gradually experience worsening symptoms and need drug treatment to recover.

3. What are the symptoms of tuberculosis?

The first organ infected by tuberculosis is the lungs. When the lung lesions gradually worsen, they may spread to nearby tissues and organs, or spread to other organs through the blood or lymphatic systems, which can be life-threatening in severe cases.

Usually, the symptoms of tuberculosis are atypical and not easy to distinguish from other diseases (colds), such as fever, fatigue, loss of appetite, weight loss, or the gradual appearance of some respiratory symptoms, such as cough, sputum, and even hemoptysis. When the cough lasts for more than 2 weeks, you need to go to the hospital for early diagnosis, including sputum examination and imaging examination (chest X-ray and chest CT) and immunological examination (including PPD, interferon gamma release test, etc.).

Different tuberculosis symptoms are also different, specifically:

Pulmonary tuberculosis: Patients experience symptoms such as coughing and sputum production.

Gastric tuberculosis: Patients have upper abdominal discomfort or pain, often accompanied by acid reflux and belching. The abdominal pain is unrelated to eating.

Hepatic tuberculosis: The most common symptoms are fever and fatigue. Other symptoms include loss of appetite, nausea, vomiting, abdominal distension, and diarrhea.

Intestinal tuberculosis: The clinical manifestations are often not obvious in the early stages, and most cases have a slow onset and a long course of disease.

4. Who are susceptible to tuberculosis?

Not everyone will get sick after being infected with tuberculosis, but some people are susceptible to infection. These people may have the following characteristics: malnutrition (such as hypoproteinemia, anemia, etc.), smoking, people with sub-health due to staying up late for a long time, diabetics, long-term depression, etc. The more representative groups are the elderly, children, manual laborers, rural population, etc.

A white-collar worker who stayed up late to play games for a long time and had an irregular diet eventually contracted tuberculosis. During the treatment, I told him not only to take medicine and check on time, but more importantly, to correct his unhealthy work and rest habits, and pay attention to exercise and rest. In the end, this patient is in very good health. Not only did he cure tuberculosis, but he also has a well-proportioned body and a healthy life. There is also a college student who was infected with AIDS and his immunity decreased, which led to infection with tuberculosis bacteria and complications. Some people with autoimmune diseases are also at high risk of tuberculosis.

5. How should tuberculosis be treated?

Different tuberculosis types require different drug choices and treatment courses. Tuberculosis is divided into sensitive tuberculosis and drug-resistant tuberculosis, of which sensitive tuberculosis is a type that is easier to treat, and most of these patients are infected with tuberculosis for the first time. The choice of treatment drugs is also relatively simple, usually 3-4 anti-tuberculosis drugs are taken together, including isoniazid, rifampicin, pyrazinamide and ethambutol. The course of treatment is relatively short, and most patients can complete the treatment in 6-9 months. For some patients with extrapulmonary tuberculosis, the course of treatment may need to be extended to 1 year or more. This treatment method is usually more effective, and the adverse drug reactions are also lighter than those of drug-resistant tuberculosis, most of which are appetite discomfort, fatigue, abnormal liver function, etc.

Another type of tuberculosis is drug-resistant tuberculosis. Patients with this type of tuberculosis usually need to use 5-7 drugs at the same time, including some infusion drugs. The entire course of treatment is also long, and the medication needs to be used for at least 20 months. There are also many adverse reactions to the drugs. For example, some drugs may cause appetite discomfort, abnormal liver function, abnormal kidney function, abnormal thyroid function, abnormal hematopoietic system (such as anemia, thrombocytopenia, etc.), and abnormal nervous system (such as leg numbness, blurred vision, etc.). The price of the drug is high, and the cost of a drug for one month can reach thousands or even tens of thousands of yuan. The cure rate of this type of drug-resistant tuberculosis patients is low. Part of the reason is related to the difficulty of controlling this type of drug-resistant bacteria itself. Another part of the reason is that the treatment course of drug-resistant tuberculosis is long, the cost is high, and there are many adverse reactions. Therefore, many patients find it difficult to persist in completing the entire course of treatment, which leads to an increase in patients with treatment failure.

Many tuberculosis patients have great psychological pressure. First of all, we should tell them that tuberculosis can be cured. In addition, some tuberculosis treatments can enjoy the care of national policies.

In my country, every area of ​​considerable size has a tuberculosis prevention and control center, referred to as the TB prevention and control center. Tuberculosis patients can receive certain free anti-tuberculosis drugs at the TB prevention and control center, but the free drugs are limited to sensitive tuberculosis. The types of drugs are first-line anti-tuberculosis drugs, namely isoniazid, rifampicin, pyrazinamide and ethambutol. These drugs can also be bought in tuberculosis specialized hospitals or tuberculosis departments of general hospitals, but they are not free when prescribed in hospitals. This type of drug is relatively cheap. For drug-resistant tuberculosis, second-line anti-tuberculosis drugs are needed. These drugs are not free and need to be purchased, but most of them can be covered by medical insurance.

At present, my country fully supports the international prevention, diagnosis and treatment of tuberculosis, including support for some tuberculosis projects. Selected patients can enjoy some free drugs or partial financial subsidies.

If tuberculosis patients cannot afford tuberculosis treatment due to financial problems, they can choose to participate in such programs to obtain partial or full drug or financial support to continue anti-tuberculosis treatment.

6. How to prevent tuberculosis?

When we need to contact tuberculosis patients, we must take double precautions. First, if people around tuberculosis patients need to be in close contact, they should wear professional N95 masks to prevent the inhalation of air containing tuberculosis bacteria. Tuberculosis patients should also wear masks to minimize the spread of droplets containing tuberculosis bacteria through the air, and spit sputum and other secretions into the plastic bags they carry with them and seal them, and avoid too much close contact with people around them.

In clinical practice and tuberculosis laboratories, the most commonly used masks are medical N95 masks. The so-called N95 is tested with 0.3 micron sodium chloride particles, and the blocking rate must be above 95%. This type of mask usually has a metal pressing piece on the bridge of the nose. Press the metal pressing piece by hand to fit tightly against the bridge of the nose and the face, and adjust the rest of the mask to fit the face. Usually, most of the tuberculosis bacteria in the air can be blocked and filtered, which has a preventive effect on tuberculosis. Therefore, if you need to contact tuberculosis patients or enter infected areas, you need to choose professional-grade N95 masks for prevention. The common blue or white disposable non-woven masks in life or the cotton masks that can be disinfected and used multiple times cannot effectively protect against tuberculosis bacteria.

Editor of this article: yhxi