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Chapter 70 Tuberculosis? (May 21, 1/1

Tuberculosis is a very troublesome disease. Whether for respiratory medicine, infectious diseases or even emergency departments, tuberculosis is a very, very troublesome disease.

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 in the world to diagnose.

There was a joke between a respiratory physician before, and the general content was like this - if you were named by an old professor during a major consultation and asked to diagnose the patient's condition, and you were very unlucky and lost your mind and didn't hear the patient's condition clearly at all, don't worry, you just need to cough lightly and then put on a very calm look and answer "Tuberculosis cannot be ruled out."

No old professor can deny this diagnosis. Basically, all respiratory diseases can be diagnosed using "tuberculosis cannot be ruled out". This can also indirectly explain how many different manifestations of tuberculosis are.

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", "difficult breathing", and "fever". In other words, tuberculosis patients have either no symptoms or no specific symptoms.

So what about introducing imaging testing?

The situation is also bad. The chest X-ray performance of pulmonary tuberculosis has not changed characteristically. Doctors in the imaging department can only put forward the opinions of "suspicion of tuberculosis, please combine it with clinical practice" through some calcified spots; the lesions occur in the posterior segment of the non-topic lobe, the dorsal segment of the lower lobe, and the posterior basal segment; spherical lesions and slow lesion absorption.

CT has certain complementary diagnostic value, but it is only further distinguishing lesions in certain hidden areas or lesions with difficulty in diagnosis. Like X-rays, CT cannot directly give a confirmation opinion.

After two unreliable diagnoses of symptoms and imaging, if doctors still think that this may be tuberculosis (of course, it may also be because they really can't think of other types of diseases), an etiology diagnosis will be carried out for the patient.

The most unreliable place next appeared, because tuberculosis diagnosis generally uses the detection method of sampling smear staining. In clinical testing, the possibility of negative tuberculosis sampling smear staining is too high. As a result, the diagnosis and treatment guidelines recommend that patients need to undergo at least three consecutive sampling smear staining tests to minimize the possibility of false negatives. What’s more, positive smears may not be really tuberculosis, non-tuberculosis, Fubucoli leprosy, Nukajun and Actinomycetes may also show false positive reactions under staining.

Therefore, the current "gold standard" recommends the use of isolation culture method for more accurate diagnosis - but the positive rate of isolation culture method is still not ideal, and the whole period is not ordinary. The modified Roche culture method commonly used in China requires four to six weeks of cultivation, that is, one month to one and a half months, and about thirty to forty-five days.

The famous PCR technology can be used in detection. It can amplify the microtuberculosis DNA in the sample and amplify it hundreds of times in a short period of time to facilitate detection. However, the defects of false negative and inability to distinguish between Fibrobacterium tuberculosis and non-Fibrobacterium tuberculosis have not only not improved, but also have more troubles such as the inability to distinguish dead bacteria and live bacteria and the inability to determine clinical efficacy.

The tuberculin skin test (TST) is also even worse - after the age of three, the effect of this test is basically meaningless. The reason is very simple. TST cannot tell whether the patient is infected with a symptom or has had a history of infection. Because BCG is widely used for infants and young children in China, its reference is even worse. Do you know whether the TST positive reaction in adults is because of the BCG vaccine, because of the infection, or being infected.

The advantages and disadvantages of the detection technology are for the time being. The tests of adding three consecutive sputum smears and the isolated culture of tuberculosis were all negative. So can this patient be ruled out that he was infected with tuberculosis?

The answer is no.

In the field of treating tuberculosis, there is something called "bacterial tuberculosis".

Even if the patient cannot detect TST, if the patient has clinical symptoms of tuberculosis - that is, those without specific symptoms; X-rays of the lungs - they are also without specific lesions; and anti-tuberculosis treatment is effective, and other non-tuberculous lung diseases are excluded. PCR tests are positive, TST tests are positive, extrapulmonary tissue pathological examinations confirm tuberculosis lesions, bronchial or lung histopathology confirms tuberculosis lesions, and then "bacterial tuberculosis" can be diagnosed.

Not to mention that the manifestations of tuberculosis vary under various underlying diseases. The progress and manifestations of tuberculosis in immune impairment, extremely low immune function, AIDS patients, and diabetic patients are different. Even the tuberculosis caused by bronchial tuberculosis is different from those in patients with primary tuberculosis.

Tuberculosis is simply a huge psychedelic Rubik's Cube building. As long as you step into this area, you have to work hard to get into one direction if you want to know "who am I", "where am I?" and "where am I going".

It has been almost a year since Sun Lien devoted himself to the diagnosis. He never thought diagnosis was a difficult problem - as long as it doesn't involve tuberculosis.

He even gave him some face in the prayer status bar, and when he encountered a tuberculosis patient, he could just tell him a "tuberculosis bacillus infection". Don't give some symptoms as usual to reason with yourself. But now it seems... the status bar doesn't seem to be planning to give him Sun Lien the face.

Liu Baoguo's symptoms are indeed somewhat like tuberculosis. Although it is not certain why the "low fever in the afternoon" that usually occurs in tuberculosis is different, it is true that we cannot deny the possibility of tuberculosis based on this. There are too many symptoms of tuberculosis, and it seems that it is not surprising that there is a high fever.

"Mr. Liu, have you ever... coughed like this before?" Sun Lien instantly raised his vigilance to the highest level. Due to the sensitivity of a doctor who was diagnosed, he decided to ask about tuberculosis first. "Did you have any chest pain, difficulty breathing or coughing up blood during this period?"

"Cough cough... no, no, nothing." Liu Baoguo finally breathed evenly. He looked at Sun Lien helplessly, as if he understood that his cough scared the young doctor, "I'm fine, I just choked accidentally while drinking tea."

Drinking water to cough may be just an accident, but it may also indicate that Liu Baoguo has a soft palate swallowing dysfunction - this may mean a central nervous system, an infection of some kind, or a cavity infarction - that is, some ischemic microinfarction that occurs deep in the brain.

"Then how many times have you choked on the water in this month?" Sun Lien was still a little worried. Liu Baoguo seemed to be the kind of patient who didn't like to cooperate with the doctor. Since he refused to say it on his own, he could only ask him little by little.
Chapter completed!
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