The hilum refers to the place where the pulmonary vessels (arteries and veins) of the lung meet with the pulmonary bronchi and bronchioles. This place is the most susceptible to infection. People have left and right lungs. When both the left and right hilum suffer from tuberculosis, it is called bilateral hilum tuberculosis or bilateral hilum tuberculosis. As long as we insist on anti-tuberculosis treatment, it can be cured. It's okay. Don't worry. Children with this disease are at high risk. If mycobacterium tuberculosis is detected in sputum, it should be isolated from others to prevent infection.

Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis, which can involve many organs of the whole body, but tuberculosis is the most common.

The pathological features of this disease are tuberculosis nodules and necrosis of trunk, which is easy to form cavities. Clinically, it is mostly a chronic process, and a few of them can have an acute onset. There are often systemic symptoms such as low fever and fatigue, and respiratory manifestations such as cough and hemoptysis.

Tuberculosis, commonly known as "consumption", is an infection caused by the invasion of Mycobacterium tuberculosis into the body. It is a chronic and slow-onset infectious disease, which occurs in young people. It can occur all year round.1Teenagers aged 5 to 35 are the peak age of tuberculosis. The incubation period is 4 ~ 8 weeks. 80% of them occur in the lungs, and other parts (cervical lymph, meninges, peritoneum, intestines, skin and bones) can also be infected. It is mainly transmitted through the respiratory tract, and the source of infection is tuberculosis patients who are exposed to bacteria. After liberation, people's living standards have been continuously improved, and tuberculosis has been basically controlled. However, in recent years, with the spread of environmental pollution and AIDS, tuberculosis has made a comeback, and the incidence rate is about to increase.

"Pale face, emaciated body, bouts of heartbreaking cough ..."/Kloc-There are many such descriptions in novels and dramas in the 9th century, and what caused these people to be in such a state was tuberculosis, which was called "white plague" at that time, that is, "consumption".

Research history of tuberculosis

[Edit this paragraph]

/kloc-in the 0/9th century, I don't know how many people lost their relatives or friends by this ruthless and powerful infectious disease. Although the emergence of various effective antibiotics and preventive drugs in the 20th century led to a rapid decrease in tuberculosis cases worldwide, it was a big mistake to relax our vigilance. The World Health Organization warned that in recent years, tuberculosis has made a comeback around the world, and the prevention and control of this infectious disease should not be slackened.

1882, German scientist robert koch announced the discovery of Mycobacterium tuberculosis, and divided it into four types: human type, bovine type, bird type and mouse type, among which human type is the main pathogen of human tuberculosis. Tuberculosis is a highly contagious chronic wasting disease, which is mainly caused by human tuberculosis invading the lungs. Common clinical manifestations include cough, expectoration, hemoptysis, chest pain, fever, fatigue, loss of appetite and other local and systemic symptoms. More than 90% of tuberculosis is transmitted through the respiratory tract. Patients cough, sneeze, make loud noises, etc. , so that the liquid with bacteria is sprayed out of the body, and healthy people will be infected after inhalation.

From 65438 to 0945, the advent of the specific drug streptomycin made tuberculosis no longer an incurable disease. Since then, the successive synthesis of drugs such as remifentanil, rifampicin and ethambutol has greatly reduced the number of tuberculosis patients worldwide. In prevention, BCG vaccination and chemical prevention are the main methods. Among them, the advent of 1952 isoniazid made the prevention and control of chemical drugs successful. Isoniazid has strong bactericidal power, few side effects, economy and convenience for taking. Taking it for 6 to 12 months can reduce the incidence of 10 by 50% to 60%.

The advent of antibiotics, BCG and chemotherapy drugs is a landmark victory in the history of human struggle against tuberculosis. Because of this, the United States even thought that tuberculosis could be eliminated by the end of the 20th century in the early 1980s. However, this stubborn "consumption" has launched a new round of challenges to mankind. According to the report of the World Health Organization, in recent years, tuberculosis has resurfaced all over the world. In 1995, 3 million people died of the disease, which was the year with the largest number of deaths, greatly exceeding the epidemic of tuberculosis in 1900. On March 24th, 2003, on the occasion of World Tuberculosis Day, the figures released by the world action organization Stop Tuberculosis showed that at present, 5,000 people still die of tuberculosis every day in the world, and the number of people suffering from tuberculosis exceeds 8 million every year.

The main reason for the above situation is that many parts of the world have neglected policies in the past 20 years, resulting in the destruction or even disappearance of tuberculosis prevention and control systems; The probability that AIDS patients are infected with tuberculosis is 30 times that of ordinary people, and most AIDS patients die of tuberculosis. With the spread of AIDS around the world, the number of tuberculosis patients is also increasing rapidly. The emergence of multiple drug-resistant tuberculosis strains has increased the difficulty of tuberculosis prevention and treatment.

World Health Organization declares World Tuberculosis Day.

[Edit this paragraph]

To this end, the World Health Organization declared that "the world is in a state of tuberculosis emergency". In order to further promote the global publicity activities of tuberculosis prevention and treatment, the organization decided to designate March 24th of each year as World Tuberculosis Day at the end of 1995, and announced an action plan called "directly observed short-term treatment" in 1997, with the goal of curing 95% of tuberculosis patients. The core of this scheme is that medical workers directly supervise patients to take medicine, so as to avoid patients from delaying treatment and causing large-scale spread of diseases.

Types of tuberculosis

[Edit this paragraph]

Tuberculosis is divided into primary and secondary, and most of them are primary (type I) when they are infected for the first time. However, the symptoms left after the initial infection may be reinfected when the human body's resistance decreases, and the secondary infection (types ⅱ ~ ⅳ) may be caused by blood circulation or direct transmission.

(1) Primary pulmonary tuberculosis (type I): It is common in children, mostly asymptomatic, sometimes manifested as low fever, mild cough, sweating, rapid heartbeat, poor appetite, etc. A few people's breathing sounds are weakened, and occasionally they can smell dry or wet rales.

(2) Hematogenous disseminated pulmonary tuberculosis (type II): Acute miliary pulmonary tuberculosis is characterized by acute onset, chills and high fever, and the body temperature can reach above 40℃, mostly due to loose fever or heat leakage, with reduced white blood cells and accelerated erythrocyte sedimentation rate. The course of subacute and chronic hematogenous disseminated pulmonary tuberculosis is slow.

(3) Infiltrative pulmonary tuberculosis (type Ⅲ): There are exudation, infiltration and dry and cool lesions in the lungs. Most of them have a slow onset and no obvious symptoms in the early stage, and then they gradually have symptoms such as fever, cough, night sweats, chest pain, emaciation, expectoration and hemoptysis. Blood routine examination showed that ESR increased rapidly and sputum culture was positive.

(4) Chronic fibrocavitary pulmonary tuberculosis (type IV): repeated fever, cough, hemoptysis, chest pain, night sweats, loss of appetite, etc. Chest deformation, chest subsidence of the affected side, narrowing of intercostal space, limited respiratory movement, tracheal displacement to the affected side, and weakened breathing. The erythrocyte sedimentation rate (ESR) increased rapidly in routine blood examination, and sputum culture was positive. X-ray showed three characteristics: cavity, fibrosis and bronchial dissemination.

Etiology and pathogenesis:

[Edit this paragraph]

I. Mycobacterium tuberculosis

It belongs to the genus Mycobacterium, and the smear is acid-resistant, also known as acid-fast bacilli. The external resistance is strong, and more than five people can survive in wet places, but exposure to the hot sun for 2 hours can kill them. 5- 12% contacts Lysol for 2- 12 hours, and 70% contacts alcohol for 2 minutes, or boils 1 minute. The simplest sterilization method is to spit on paper and burn it directly.

Second, the route of infection.

Tuberculosis is mainly transmitted through respiratory tract. The main source of infection is the sputum of tuberculosis patients who excrete bacteria. The second route of infection is through the digestive tract into the body.

Third, the human body's reaction ability.

The immunity of tuberculosis is mainly cellular immunity, which is manifested by the enhancement of lymphocyte sensitization and phagocytosis. After the invading mycobacterium tuberculosis is swallowed, it is treated to transmit antigen information to T lymphocytes to sensitize them. When sensitized T lymphocytes encounter mycobacterium tuberculosis again, they will release a series of lymphocytes. Factor makes macrophages gather around bacteria, devour and kill bacteria, then transform into epithelioid cells and Langerhans giant cells, and finally form tuberculosis nodules.

Pathology: Tuberculosis invades human body, causing inflammatory reaction. The contest between bacteria and human resistance is ups and downs, and the pathological process is complex, but its basic pathological changes mainly include exudation, proliferation and deterioration.

Clinical manifestations:

[Edit this paragraph]

Typical pulmonary tuberculosis has a slow onset and a long course, with low fever, fatigue, loss of appetite, cough and a small amount of hemoptysis. However, most patients have mild symptoms and often have no obvious symptoms, which can only be found through X-ray health examination. Some patients think that sudden hemoptysis is discovered by accident, but it can often be traced back to mild poisoning symptoms in the course of the disease.

First, systemic symptoms:

Symptoms of systemic poisoning include low-grade fever in the afternoon, fatigue, loss of appetite, weight loss, night sweats and so on. When lung symptoms spread rapidly, high fever may occur, and women may have menstrual disorder or amenorrhea.

Second, the respiratory system:

There is usually a dry cough or only a small amount of mucus. When accompanied by secondary infection, phlegm is mucinous or purulent. About13 patients have different degrees of hemoptysis. When the inflammation spreads to parietal pleura, there is a tingling sensation in the corresponding chest wall, which is generally not serious, and it gets worse with breathing and coughing. Chronic severe pulmonary tuberculosis, slow respiratory function, dyspnea.

Laboratory and other inspections:

First, tuberculosis examination

Finding tuberculosis in sputum is the main basis for diagnosing tuberculosis.

Second, X-ray examination.

Lung X-ray examination can not only find tuberculosis early, but also diagnose the location, scope, nature, development and effect of symptoms.

Third, tuberculin test.

Positive: indicates tuberculosis infection, but not necessarily a disease. If the skin test dilution is positive, it often suggests that there are active tuberculosis lesions in the body.

Negative: indicates that there is no tuberculosis infection. However, the following situations should be ruled out.

A, it takes 4-8 weeks for allergic reaction to be completely established after tuberculosis infection; Therefore, in the early stage of allergic reaction, nodulin test can be negative.

B, the application of glucocorticoid and other immunosuppressants, malnutrition and measles, whooping cough patients, the tuberculin reaction can temporarily disappear.

C, severe pulmonary tuberculosis and various critically ill patients have no response to tuberculin.

D, others such as patients with lymphoimmune system deficiency (leukemia, sarcoidosis) and the elderly often have negative tuberculin reaction.

Diagnosis:

1, sputum tuberculosis examination

2.x-ray health examination

3. Clinical symptoms

Treatment measures:

[Edit this paragraph]

Mainly chemical drug therapy, commonly used drugs are isoniazid, rifampicin, streptomycin, pyrazinamide, ethambutol and thiosemicarbazone. The application of chemotherapy should follow the following five principles: ① Early stage. Once diagnosed, take medicine immediately; 2 combination. Two or more anti-tuberculosis drugs are used in combination to ensure curative effect, prevent drug resistance and reduce toxic and side effects; ③ Appropriate amount. 4 regularity. Avoid omissions and interruptions; ⑤ The whole journey. It usually takes more than one year to stop taking medicine.

Anti-tuberculosis chemotherapy plays a decisive role in the control of tuberculosis. Reasonable chemotherapy can sterilize and cure all symptoms. Traditional rest and nutrition play an auxiliary role.

(Criteria for disease diagnosis, classification and staging)

Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis, which can involve many organs in the whole body. But tuberculosis is the most common. Sterilized patients are the source of social infection. People infected with tuberculosis may not get sick, but only when their resistance is low. The pathological features of this disease are tuberculous nodules and caseous necrosis, which are easy to form cavities. Except for a few cases that may be acute, the clinical process is mostly chronic. There are often systemic symptoms such as low fever and fatigue, and respiratory manifestations such as cough and hemoptysis. Since the 1950s, although the epidemic situation of tuberculosis in China has generally shown a downward trend, due to the large population and unbalanced epidemic control in various regions, tuberculosis is still an important public health problem and one of the top ten causes of death in China, which should arouse our serious concern.

Diagnostic points

First, fatigue, weight loss, fever, night sweats.

The second is expectoration, and X-ray chest film shows pulmonary infiltrative changes.

Third, the tuberculin test is positive.

Fourth, sputum smear is positive for acid-fast staining.

Five, sputum culture is positive for Mycobacterium tuberculosis.

Diagnostic criteria (formulated by the National Conference on Tuberculosis Prevention and Control, Liuzhou, June 1978)

Transmission path:

[Edit this paragraph]

The transmission routes of tuberculosis are respiratory tract, digestive tract, skin and uterus, but mainly through respiratory tract.

The digestive tract is very resistant to tuberculosis. Once mycobacterium tuberculosis enters the stomach, it is easy to be killed by a large amount of gastric acid. Unless you eat a lot of tuberculosis, it is not easy to be infected, but the respiratory tract is different. As long as 1~2 tuberculosis is sucked into alveoli, once the body's resistance is low, it can cause disease. Tuberculosis of digestive tract is mostly caused by drinking raw milk. A survey in Inner Mongolia found that 10.6% of tuberculosis patients among farmers and herdsmen were bovine tuberculosis, and they had the habit of drinking raw milk. Tuberculosis is a zoonotic disease. Many animals such as pigs, cats, dogs, cows, sheep, deer and monkeys may suffer from tuberculosis. Frequent contact with these animals will make people infected by animals suffering from tuberculosis, and will also transmit their own tuberculosis to the raised animals. Rhinoceros, an ornamental animal in Beijing Zoo, was diagnosed as tuberculosis, and its sputum bacteria were identified as human tuberculosis, indicating that the audience was infected with them.

Tuberculosis is transmitted and infected through the respiratory tract. The traditional view focuses on dust-borne infection, and now it is called bacterial dust aerosol infection, which means that tuberculosis patients spit everywhere, and after drying, bacteria fly with dust and are inhaled by others, causing infection. Therefore, in the past, in the prevention and treatment measures of tuberculosis, special emphasis was placed on disinfection of sputum of tuberculosis patients, and it was advocated that sputum of tuberculosis patients was boiled in hospitals or families and spit in sputum bottles, and sputum could be buried deep in rural areas. A wide and lasting publicity campaign against spitting has been carried out among the masses. In addition, it also emphasizes that patients should be isolated from healthy people, and they can be divided into rooms, beds or beds. Pay attention to the disinfection of patients' utensils to prevent digestive tract infection.

Of course, we should pay attention to the above infection methods, but we should also pay attention to the infectivity of droplets discharged into the air when patients with bacterial discharge talk, cough and sneeze. Because modern research on respiratory transmission mechanism believes that patients with bacterial discharge usually laugh loudly, sing, cough and sneeze to create infectious sputum droplets (micro-droplets); When it spreads in the air, the particles below 4 microns can directly enter the alveoli through the respiratory tract, causing infection. If the droplet nucleus is greater than 5~ 10 micron; After inhalation, no alveoli can be found, and finally the alveoli are excreted through the ciliary movement of bronchial wall and the patient's cough, so as not to cause infection. The spread of tuberculosis is mainly at night, and children and adolescents living in the same room as patients with bacterial discharge are the most susceptible to infection.

The number of potentially infectious droplets scattered by pulmonary tuberculosis patients during breathing is related to the speed of exhaled gas. During normal breathing, the number of droplets exhaled by the patient is very small, but a cough can increase the number of infectious droplets to 3000, which is equivalent to the number of droplets discharged within 5 minutes of talking loudly, while the number of droplets discharged by a sneeze can be as high as 654.38+00,000. The number of coughs is closely related to infectivity. It has been observed that patients cough at night and the negative rate of tuberculin children in the same room. Results: The more coughs, the higher the positive conversion rate of tuberculin in children. In addition to the number of coughs, the infectious situation of cough with phlegm and cough without phlegm is also different. The positive conversion rate of tuberculin in close family contacts was significantly higher than that in close family contacts with dry cough and no phlegm. When pulmonary tuberculosis patients are treated with chemical drugs, their cough symptoms will be improved, and some investigations have found that; After 1 month of treatment, more than half of the patients' cough symptoms disappeared, and all of them disappeared after 3 months of treatment. At the same time, the number of mycobacterium tuberculosis in sputum decreased after chemotherapy, indicating that patients can reduce infectivity after reasonable treatment, that is, reduce the chance of transmission.

Prevention guide:

[Edit this paragraph]

1. Children should be vaccinated with BCG on time. After inoculation, the immune ability can be improved and the disease caused by infection with mycobacterium tuberculosis can be avoided.

2. The main route of transmission of tuberculosis is droplet infection. When patients with open tuberculosis cough, sneeze and laugh loudly, they spray droplets with bacteria and infect healthy people. If the patient spits everywhere, the sputum bacteria will spread with the dust flying in the air after the sputum is dried. Patients with mycobacterium tuberculosis found in sputum should wear masks when going out, don't talk to other people's faces, don't spit everywhere, don't spit in handkerchiefs or waste paper, and focus on disinfection or burn with fire for sterilization. Sputum can be disinfected by soaking in 5 ~ 12% lysol solution for 2 ~ 12 hours. Patients should form the habit of eating separately. Eating with patients or food contaminated by mycobacterium tuberculosis can cause digestive tract infection.

3. Patients with positive sputum examination should be isolated. If the family is isolated, the patient's room should be separated, and the diet, utensils and utensils should be separated. Bedclothes, clothes, etc. Exposure to the sun for 2 hours can disinfect, and tableware boiling 1 minute can kill mycobacterium tuberculosis.

The living room should be well ventilated and sunny, and the doors and windows should be opened three times a day for 20 to 30 minutes each time. Generally, when sputum bacteria are negative, isolation can be cancelled.

We should have a correct understanding of tuberculosis. At present, there are specific drugs for tuberculosis, and the curative effect is very satisfactory. Tuberculosis is no longer an incurable disease Only with an optimistic spirit and a positive attitude can we insist on taking medicine on time and in quantity and complete the prescribed course of treatment, otherwise it is easy to relapse.

5. You can choose Qigong, health care, Tai Ji Chuan and other sports to exercise, which can make the physiological function of the body return to normal.

Gradually restore health and enhance disease resistance. Usually pay attention to cold and warmth, and control sexual intercourse.

6. The diet is mainly high in protein, sugar and vitamins, and you should eat more fresh vegetables, fruits and beans. Quit smoking and drinking.

Recent studies have proved that smoking can reduce the blood concentration of anti-tuberculosis drugs, which is not conducive to the treatment of tuberculosis. It can also increase the secretion of bronchial sputum, aggravate cough, spread tuberculosis symptoms, and aggravate hot flashes, hemoptysis, night sweats and other symptoms. Drinking alcohol can increase the toxic effect of anti-tuberculosis drugs on the liver, lead to drug-induced hepatitis, dilate the blood vessels of the body, and easily produce hemoptysis symptoms.

Seven: common sense of prevention:

After entering the 1990s, tuberculosis, which had already been controlled, appeared a general epidemic trend in the world. People's struggle against tuberculosis has entered a new era. Drug-resistant tuberculosis is more difficult to treat, so it is very important to prevent tuberculosis. When you have unexplained low-grade fever, emaciation, fatigue, cough and night sweats, and no other causes are found, you should go to the hospital for examination and diagnosis quickly. Under the guidance of a specialist, the drug should be used regularly and throughout the course, and the course of treatment should not be less than half a year. Patients should have enough patience. Rest, adequate nutrition, proper outdoor activities and strengthening general resistance are still important conditions for overcoming diseases. It is very important to isolate patients properly in the process of sterilization and protect the health of family members and collective people, especially children.

Differential diagnosis of pulmonary tuberculosis

[Edit this paragraph]

1. Lung cancer: the central type has nodular shadow at hilum or hilum mediastinal lymph node metastasis, which needs to be differentiated from lymph node nuclei; Peripheral type has small infiltration and nodules around the lung, which should be differentiated from tuberculoma or tuberculous infiltrative disease. Lung cancer is mostly over 40 years old, with squamous cell carcinoma as the central type, and often has a long history of smoking. Generally, there is no fever, dyspnea or chest tightness, chest pain aggravation, irritating cough, blood in sputum and progressive emaciation. If there is supraclavicular metastasis, hard lymph nodes can be touched, and some patients can have bone and joint hypertrophy. X-ray nodules may have lobulated burr, no satellite focus, generally no calcification, and may have cavity sign; Peripheric pleural invagination can be seen. 70% of sputum can detect cancer cells, and 50% of tuberculosis can detect tuberculosis. New organisms can be found in the central type of fiberoptic bronchoscope, pathological diagnosis can often be obtained by biopsy, cancer cells can be found by brush examination and BAL, and tuberculosis can be found in patients with tuberculosis. Tuberculin test is usually negative for lung cancer and strongly positive for tuberculosis. Serum PPD-IgG or LAM-LgG tuberculosis is often ELISA positive. The determination of serum sialic acid and CEA (+) often indicates cancer. If the above items cannot be diagnosed, thoracotomy should be performed. If there are more indications of tuberculosis activity, such as TB-DNA positive detected by sputum PCR, tuberculin 1u strong positive or 0. 1u general positive, or PPD-IgG or LAM-IgG(+) detected by ELISA, you can try anti-tuberculosis treatment and observe and differentiate.

2. Pneumonia: Non-bacterial (mycoplasma, virus, allergic) lungs often show patchy shadows similar to early invasive pulmonary tuberculosis, while bacterial pneumonia with lobar lesions can be mixed with tuberculous caseous pneumonia, and the two need to be differentiated. Mycoplasma pneumonia usually has mild symptoms and heavy X-ray, and disappears spontaneously in 2-3 weeks. Allergic patients have increased eosinophils in the blood and wandering shadows in the lungs, each with its own characteristics and easy to distinguish. Bacterial pneumonia can start with acute onset, chills, high fever, coughing up rust-colored sputum, oral herpes with sputum TB(-), streptococcus pneumoniae positive, and can be quickly recovered after antibiotic treatment, < 1 month. Therefore, generally, anti-tuberculosis treatment is not used first, but anti-inflammatory treatment is used first, which can be differentiated from inflammation, which can quickly and clearly diagnose and avoid drug resistance caused by irregular use of anti-tuberculosis drugs.

Third, lung abscess: Infiltrative tuberculosis often needs to be differentiated from lung abscess if there is a cavity, especially the tuberculosis cavity in the lower tip needs to be differentiated from acute lung abscess, and chronic lung abscess needs to be differentiated from chronic lung abscess. The main difference is that there is TB(+) in the sputum of pulmonary tuberculosis patients, but lung abscess (-). The onset of lung abscess is more acute, and the total number of white blood cells and neutrophils increases. Antibiotics are effective, but sometimes tuberculosis cavity can be secondary to bacterial infection, and tuberculosis in sputum is not easy to detect at this time.

Iv. Bronchitis target = _ blank & gt Chronic bronchitis: The symptoms are often similar to those of patients with chronic fibrospongiosa, but X-ray and sputum examination are easy to distinguish. In patients with chronic bronchitis, X-ray only shows texture changes, but there are no substantial tuberculosis lesions, while in patients with chronic fibrospongiosa, there are definite severe tuberculosis (+) lesions.

5. Bronchiectasis: The symptoms are cough, expectoration and repeated hemoptysis, which are easy to be mixed with slow fiber cavity, but X-rays generally only show rough texture or curly hair shadow.

6. Other diseases with fever: Acute miliary pulmonary tuberculosis is mixed with typhoid fever, septicemia and leukemia due to high fever, hepatosplenomegaly, leukopenia or leukemia-like reaction, and should be carefully identified according to their respective characteristics. Adult patients with fever and hilar lymphadenopathy are easily confused with mediastinal lymphoma and nodular diseases, which can be differentiated by tuberculin test, serum PPD-IgG test, ACE test, Kveim test and biopsy, and can be treated with anti-tuberculosis drugs if necessary. When differentiating tuberculosis from tumor, anti-tuberculosis drugs should be used first, and then anti-tuberculosis drugs should be used if there are hormones, so as not to interfere with diagnosis and cause spread.

I wish you health and happiness every day!