Tuberculosis poisoning

Introduction Tuberculosis is a common chronic respiratory infection caused by Mycobacterium tuberculosis. It is more common in young adults. It is mainly characterized by low-heat, night sweats, fatigue, loss of appetite and other symptoms of tuberculosis and respiratory symptoms. Early detection, regular treatment can be cured. At present, the disease has an increasing trend. Tuberculosis is widely distributed and easily transmitted, but as long as people take precautions, they can control its prevalence. Do not take your child to a public place during the epidemic season.

Cause

Etiology

The pathogen of tuberculosis is Mycobacterium tuberculosis, which is a mycobacterium, which is acid-resistant and therefore also known as acid-fast bacilli. In nature, Mycobacterium tuberculosis is human, bovine, bird and mouse, but the human pathogenic effects are mainly human and bovine. Tuberculosis bacteria have strong resistance to the outside world, can survive for many years in the human body, can survive for more than 5 months in the damp area, and can maintain the infectiousness of 8-10 days in the cognac, which may be contagious with the disease. It is easy to relapse. However, it can be killed by exposure to hot sun for 2 hours, boiling for 1 minute or mixing with 5% to 10% cresol soap solution and an equal amount of disinfectant for 1-2 hours. The simplest and most reliable method of sterilization is to burn the cockroaches directly onto the paper.

The tuberculosis bacteria in the lesions are often composed of several tuberculosis bacteria with different growth rates. The tuberculosis group A grows and grows fastest, so its pathogenic ability is the strongest and the most infectious, but it is also the most easily killed by anti-tuberculosis drugs; B group and C group grow slower and grow, so they are only sensitive to a few drugs, which can become the root cause of future recurrence; tuberculosis D group is dormant group, generally resistant, but can be gradually eliminated by phagocytic cells.

Pathogenesis

Whether the body is ill and the severity of the disease after infection with tuberculosis mainly depends on two aspects: one is human immunity and allergic reaction; the other is the number of infected tuberculosis bacteria and the strength of virulence.

1. Human immunity and allergic reaction:

Immunization includes both specific and non-specific immunity. Specific immunity refers to the specific immunity to tuberculosis obtained by inoculation of BCG or previous infection with tuberculosis; non-specific immunity refers to the physical condition of the body, that is, the natural immunity of the body to tuberculosis. In general, people who have specific immunity and good physical condition are generally not infected after infection with tuberculosis, or they are mildly infected, often as a latent infection; on the contrary, they are prone to tuberculosis and have a serious condition.

2. Number and virulence of tuberculosis:

The more the number of tuberculosis infected by the human body and the greater the virulence, the greater the incidence of the disease, and the more serious the condition may be. 4 to 8 weeks after tuberculosis invades the body, the body's sensitive response to tuberculosis and its metabolites is called allergic reaction. This reaction can cause fever, fatigue, polyarthritis, skin nodular erythema and the like. The level of human allergies is related to the occurrence of tuberculosis and the severity of the disease.

pathology

There are three main types of pulmonary tuberculosis: exudation, proliferation, and dry necrosis. The pathological changes caused by tuberculosis are mainly related to the structure of the bacteria. Mycobacterium tuberculosis consists mainly of three parts: lipidoids, proteins and polysaccharides. Protein causes allergic reactions, leading to hyperemia, edema, neutrophils and other inflammatory cell infiltration, called exudative lesions, mainly seen in the early stage of disease or deterioration of the lesion, when there are more tuberculosis in the lesion. Lipid-like lipids can induce the infiltration of monocytes, epithelioid cells and lymphocytes to form tuberculous nodules, which are called proliferative-like lesions. They are mainly found in patients with strong immunity and are manifested in the direction of good disease. Tuberculosis is rarely found. Caseous necrosis occurs in patients with weaker resistance and more infection with tuberculosis, and contains a large number of tuberculosis in undead tissues.

an examination

Related inspection

Mycobacterium tuberculosis antigen, antibody test plasma cell sputum bacterial culture sputum routine examination sputum culture

Clinical manifestation

The disease occurs in young adults, generally slow onset, clinical manifestations are diverse, light can be without any symptoms, only found during physical examination. Symptoms, mainly manifested in two major types of symptoms: systemic symptoms (tuberculosis symptoms) manifested as low fever in the afternoon, night sweats, loss of appetite, fatigue, weight loss, female menstrual disorders.

Respiratory symptoms, such as cough, hemoptysis, chest pain, difficulty breathing.

1 cough tuberculosis cough is mostly dry cough, combined with bacterial infection can increase the amount of sputum or see jaundice.

2 hemoptysis with blood or a small amount of blood, severe cases can be hemoptysis.

3 chest pain is the involvement of the pleural wall layer, coughing or forced breathing can make it worse.

4 dyspnea due to large area of lung tissue or a large number of pleural effusion, pneumothorax and other effects on lung ventilation and ventilation, the body is hypoxic and breathing difficulties.

Sign

There were no obvious signs in the early stage. If the lesion area is large, the respiratory movement of the affected side is weakened, the voiced sound of the lesion is diagnosed, the auscultation breath sound is weakened or a small amount of small blisters are heard. When there is pleural effusion, pneumothorax, pleural adhesion, there are corresponding signs.

Classification and staging:

1. The classification is divided into five types according to the X-ray performance:

1 original type of tuberculosis (type I): more common in children, is the mildest type of tuberculosis, due to the mild condition, so the clinical symptoms and signs are not obvious. The prognosis is good.

2 blood line disseminated tuberculosis (type II): divided into acute, subacute and slow. Sexual bloodstream disseminated tuberculosis. This type of tuberculosis, especially acute miliary tuberculosis, has severe clinical symptoms, such as high fever, cough, dyspnea, and even tuberculous meningitis. It is difficult to detect due to fluoroscopy, so it is easily misdiagnosed.

3 invasive pulmonary tuberculosis (type III): the most common in adults, clinical symptoms of tuberculosis and lung symptoms. However, there are no obvious symptoms, especially the majority of symptoms of senile pulmonary tuberculosis patients should be noted. A small blisters sound can be heard at the tip of the lung.

4 Chronic fibrous cavity tuberculosis (type IV): It is rare now, mainly manifested as recurrent and aggravated symptoms of tuberculosis and severe cough, repeated massive hemoptysis, progressive exacerbation of dyspnea, etc., clinical signs are diverse, and finally more Died of breathing and circulatory failure.

5 tuberculous pleurisy (V type): clinical symptoms of tuberculosis poisoning are more mild. Mainly manifested as low or moderate fever, chest tightness, dyspnea, dyspnea and chest pain; when pleural effusion, the body can be seen full of thoracic and respiratory movements, tactile tremor weakened or disappeared, a large number of pleural effusions There is a tracheal shift to the healthy side, a diagnosis of the actual sound, auscultation of the breath sounds weakened or disappeared.

Staging

(1) Progress period:

Should have one of the following: newly discovered active lesions; lesions worsened than before; new voids or voids increased; sputum positive.

(2) The period of improvement:

One of the following is better: the lesion is absorbed earlier; the cavity is closed or reduced; the bacillus is turned negative.

(3) Stability period:

The lesion has no activity change. The cavity is closed and the sputum is continuously negative (at least once a month) for more than 6 months. If the cavity is still present, the sputum should be continuously negative for more than 1 year. Open tuberculosis refers to patients with advanced and partially improved stage of tuberculosis. There are often tuberculosis in the sputum, which is highly contagious and must be treated in isolation.

Differential diagnosis

Differential diagnosis:

Primary tuberculosis: In addition to the above typical symptoms, early tuberculosis, some patients have nodular erythema, sore conjunctivitis and joint rheumatism. If the enlarged lymph nodes in the thoracic cavity compress the trachea and bronchi, coughing may occur, and the coughing sound is similar to pertussis or metallic sound, and difficulty breathing. Hematogenous disseminated tuberculosis: Because a large number of tuberculosis enters the human bloodstream in a very short period of time, causing systemic reactions, often high fever, difficulty breathing and some symptoms of poisoning. However, some patients have low fever and few lung signs. Invasive pulmonary tuberculosis: In the early stages of the disease, the symptoms of tuberculosis are not obvious and are often not detected. As the disease progresses, the symptoms of tuberculosis are gradually appearing. X-ray films have different sizes and different density. The lesions are mainly above and below the clavicle, and sometimes there are cavities, higs, and lymph nodes that are not swollen.

Chronic Fibrous Cavity Tuberculosis (abbreviated as diffusion hole): Generally due to inappropriate development of invasive tuberculosis, primary tuberculosis and caseous pneumonia. Therefore, there are often typical symptoms of tuberculosis. Some patients have better compensatory functions and can maintain a certain amount of labor capacity for a long time. There are also some people whose condition is relatively stable. Although there are cavities, the body temperature can still be normal for a long time. If the tuberculosis patient has a body temperature that is higher than the normal temperature for a long time, it may be that the lesion spreads to form a large exudative lesion or a cheese-like lesion. If shortness of breath occurs, it is mostly because of a wide range of lesions, causing tracheal and bronchial displacement, emphysema or diaphragmatic adhesions affect the ventilation and ventilation function.

Tuberculous pleurisy: In addition to the typical symptoms of tuberculosis, chest pain is often the main symptom of this type, chest pain is like acupuncture, deep inhalation and cough are more obvious. Sometimes it radiates to the shoulders, upper abdomen and heart. As the exudate increases, the pain is reduced, but the difficulty in breathing increases. Some patients have less pleural effusion, patients have higher tolerance, and patients are often asymptomatic.

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