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Wang Xiang Yu
Pulmonology
About me
Loudi Central Hospital, Department of Respiratory Medicine, attending physician, has been engaged in clinical work in respiratory medicine for many years, and has rich clinical experience in the diagnosis and treatment of respiratory system diseases.
Proficient in diseases
Specializes in common respiratory diseases such as upper respiratory tract infections, pneumonia, chronic bronchitis, emphysema, and tuberculosis.
Voices
How is tuberculosis contracted?
Tuberculosis (TB) is an infectious disease and currently classified as a Class B infectious disease for management purposes. As an infectious disease, TB has a specific causative agent, the Mycobacterium tuberculosis complex, which includes four types: human, bovine, African, and rodent. Over 90% of human tuberculosis infections are caused by the human type of Mycobacterium tuberculosis, with the remainder caused by either bovine or African types. To contract tuberculosis, one must be exposed to an infectious source, primarily those with secondary tuberculosis. Tuberculosis patients can release the bacteria into the air through coughing, sneezing, laughing, or speaking loudly. Healthy individuals or the general population may then inhale these bacteria during breathing, leading to infection of the lungs and the development of tuberculosis.
Methods of Tuberculosis Examination
The examination methods for tuberculosis are now quite numerous, but achieving a diagnosis is still relatively difficult. The most commonly used method is still chest imaging, mainly X-rays and CT scans. Additionally, there are bacteriological examinations, such as examining sputum or other samples like pleural effusion under a microscope after staining. Culturing Mycobacterium tuberculosis, with sputum being the most commonly used sample, followed by pleural effusions and bronchoalveolar lavage fluid, is also common. A newer method is molecular biology examination, also known as Mycobacterium tuberculosis DNA nucleic acid testing. Then there is the pathological examination of tuberculosis, commonly referred to as biopsy, which involves taking a small piece of tissue from the lesion for observation. Moreover, some new immunological tests have emerged, including the traditional tuberculin skin test, still relevant today, and the gamma interferon release assays, along with traditional tests like Mycobacterium tuberculosis antibody tests. Additionally, some patients might require more invasive examinations, such as bronchoscopy, which allows direct observation of the trachea and bronchi and can be used for brush tests or biopsies at the lesion site.
How is tuberculosis diagnosed?
To diagnose tuberculosis, it's important to understand that tuberculosis is an infectious disease caused by the Mycobacterium tuberculosis, also known simply as the tuberculosis bacillus. This condition affects the main bronchi, bronchi, and pleura in the lungs. In 2017, new industry standards were formulated for diagnosing tuberculosis, which can be complex for those without a medical background to fully comprehend, as the diagnostic criteria in these standards span four chapters of A4-sized papers. Generally, the diagnosis of pulmonary tuberculosis is primarily based on etiological examination, combined with epidemiology—whether the patient has a history of exposure to tuberculosis—as well as clinical manifestations and chest imaging such as X-rays and CT scans. Additional laboratory tests like pathological and immunological assessments (e.g., T-SPOT.TB skin test, Mycobacterium tuberculosis antibody, bronchoscopy) are also considered for a comprehensive evaluation. The main basis for a definitive diagnosis still lies in the results of etiological and pathological examinations. "Etiological" here refers to detecting the presence of Mycobacterium tuberculosis through various methods, primarily bacteriological examination. This involves observing the bacteria under a microscope using samples such as sputum or pleural effusion. A positive observation confirms the presence of the bacteria. Mycobacterium tuberculosis can also be cultured from samples, though this process is lengthy, often taking several weeks or more. Recently, molecular biological tests, such as nucleic acid tests for Mycobacterium tuberculosis, have been introduced. Pathological examinations, which involve taking a biopsy from the lesion site and observing it under a microscope, can confirm the diagnosis if characteristic tuberculous changes, like caseous necrosis, are observed. However, most patients with pulmonary tuberculosis may not meet these strict criteria and are often diagnosed based on clinical symptoms, chest imaging, and supplementary tests. In such cases, most physicians will initiate a diagnostic anti-tuberculosis treatment for one month. If the patient's condition improves or stabilizes after this period, anti-tuberculosis treatment will continue. If the condition worsens or does not stabilize, tuberculosis might be ruled out, necessitating further examination.
Can tuberculosis be cured?
Can tuberculosis be cured? First, we need to understand that tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis. In recent decades, many drugs have been developed for anti-tuberculosis treatment. As long as one strictly follows the doctor's advice and adheres to the medication schedule, the vast majority of tuberculosis cases can be completely cured. However, it is crucial to recognize that the treatment duration for tuberculosis is lengthy. Typically, patients need at least six months, while those with recurrent tuberculosis might need eight months. Some patients with multidrug-resistant tuberculosis may even need to take medication for two years. Therefore, it is essential to undergo standardized anti-tuberculosis treatment. Nevertheless, some patients, due to non-adherence to medical advice, irregular medication intake, or discontinuation of treatment on their own without completing the full course, may face treatment failure. In severe cases, this can lead to multidrug resistance, significantly prolonging the treatment duration and drastically reducing the cure rate, and may even cause infertility. Additionally, some patients may experience severe adverse reactions to tuberculosis drugs, such as significant liver and kidney damage, or have comorbidities like diabetes, liver cirrhosis, or HIV/AIDS. Others may develop severe complications, such as cardiopulmonary disease or respiratory failure, which greatly reduce their chances of recovery and can even lead to death.
Tuberculosis is transmitted through the air.
The transmission of tuberculosis primarily depends on understanding its causative agent, which is the tubercle bacillus, also known simply as the tuberculosis bacillus. The main source of infection in tuberculosis is from patients who test positive for tuberculosis bacillus in their sputum. The respiratory tract is the principal route of transmission for tuberculosis patients. When patients who test positive for bacillus in their sputum cough, expel sputum, sneeze, or even speak loudly, they generate a large amount of droplets containing the tuberculosis bacillus. These bacteria can remain suspended in the air for a relatively long time. In poorly ventilated indoor environments, they may stay airborne for up to five hours. Healthy individuals can contract respiratory infections upon inhaling these bacteria. Furthermore, a very small portion of patients are infected through consuming milk or other dairy products from cows with tuberculosis.
How to test for tuberculosis
To examine pulmonary tuberculosis, it is essential to understand that it pertains to tuberculosis changes in the lung tissue, airways, bronchi, and pleura. The pathogen causing tuberculosis is Mycobacterium tuberculosis, also known as the tubercle bacillus. There are multiple tests available for people with pulmonary tuberculosis, as the disease can vary based on location and type. Therefore, such patients generally require numerous tests. The most commonly used are imaging studies for the chest, including X-rays and CT scans. In imaging studies, most patients will show some lesions, but there are instances where tuberculosis in the airways and bronchi might not be clearly visible on CT or X-rays, necessitating more invasive tests like bronchoscopy. Additionally, bacteriological examinations, such as sputum smear and pleural fluid smear, as well as culture for Mycobacterium tuberculosis, are typically conducted for patients. Nowadays, hospitals equipped with the necessary facilities conduct molecular biological tests, namely nucleic acid testing for Mycobacterium tuberculosis DNA. Furthermore, some patients with complex conditions may require a histopathological biopsy, commonly referred to as tissue sampling, at the site of the lesion to observe under a microscope for characteristic changes indicative of tuberculosis. There are also immunological tests that assist in diagnosing tuberculosis, such as the gamma interferon release assay (commonly known as the T-SPOT), tuberculin skin test, and traditional antibody tests against Mycobacterium tuberculosis.
How is tuberculosis treated?
The primary treatment for tuberculosis is still chemotherapy, also simply called chemo, but the chemotherapy for tuberculosis is completely different from the anti-tumor chemotherapy we talk about in cancer, and the medications are also completely different. There are about more than ten anti-tuberculosis drugs, which can be divided into first-line and second-line drugs, and currently, there are third-line drugs under research. Chemotherapy for patients with pulmonary tuberculosis should be started early and administered in combination. The types of combined medication for patients with pulmonary tuberculosis generally involve three or more drugs. Some patients may exhibit drug resistance or intolerance to some drugs' side effects, and thus, second-line drugs may be used. Additionally, some patients, due to special conditions, may require four or five types of anti-tuberculosis drugs. It is crucial to strictly follow medical advice regarding how to medicate and treat. Furthermore, patients with pulmonary tuberculosis must ensure complete medication adherence, as the treatment duration for tuberculosis is quite long, typically requiring at least six months, and some patients may need one or even two years. Regular medication intake is very important because some patients might experience symptoms like coughing up blood or others, such as those with pleurisy, who might develop pleural effusion. Therefore, treatments targeted at other symptoms are necessary. Patients who cough up blood might need hemostatic drugs, while those with severe hemoptysis may even require interventional surgery. Some with tuberculous pleurisy might need to have pleural effusion drained. Additionally, some patients with pulmonary tuberculosis might experience adverse reactions to medications, such as liver or kidney failure, visual impairment, or numbness in the hands, which would require adjustments to their medication or changes based on their complications. Treatment should also be targeted toward these adverse reactions.
Is pertussis a Class B infectious disease?
Pertussis, or whooping cough, is definitely classified as a contagious disease. According to the current infectious disease management laws in our country, pertussis is categorized under Class B infectious diseases. After understanding that it is a Class B infectious disease, we should also be aware of how infectious diseases are classified in our country. They are divided into Class A, Class B, and Class C based on the level of harm caused by the disease. Simply put, the more harmful, the less effective the treatment, and the higher the mortality rate, the more likely the disease will be classified as Class A, such as plague and cholera. On the other hand, diseases that are less harmful, such as influenza, rubella, and leprosy, are classified under Class C.
Can people with tuberculosis drink alcohol?
Whether patients with tuberculosis can drink alcohol, first of all, it is important to know that tuberculosis is a chronic infectious disease and a consumptive disease that consumes the body's calories. Drinking alcohol can affect the body's absorption of energy. Moreover, most patients with tuberculosis need to take anti-tuberculosis medication, most of which are metabolized through the liver and can cause varying degrees of liver damage. Drinking alcohol can exacerbate liver damage and reduce the effectiveness of the medication. Additionally, since there are many types of anti-tuberculosis medications for tuberculosis patients, some medications may cause adverse reactions when drinking alcohol. Therefore, all tuberculosis patients must strictly abstain from drinking alcohol during treatment.
Can tuberculosis be cured completely?
Whether tuberculosis can be completely cured varies from person to person. Most cases of tuberculosis, especially initial occurrences of pulmonary tuberculosis, can be cured in more than 80 to 90 percent of patients if they undergo standardized anti-tuberculosis treatment. However, it is essential that the treatment is standardized; it is not appropriate to simply take medication for one or two months and then stop when symptoms seem to disappear. The treatment duration for pulmonary tuberculosis is considered to be at least six months, and for some patients, it may even extend to a year. However, not all cases of pulmonary tuberculosis can be completely cured. A small percentage of patients may not achieve complete eradication due to resistance to tuberculosis bacteria or intolerance to the side effects of tuberculosis medications. In such cases, the prognosis might be poor, and some individuals may succumb to tuberculosis due to these factors.