Tuberculosis Is Making a Comeback; the Frail Face a Greater Risk of Infection
Once, I consulted Dr. Li—a Western physician and a lymphoma patient of mine—about the symptoms of a difficult case I was seeing. Dr. Li suspected the patient had contracted tuberculosis complicated by viral encephalitis. He told me that the infectious disease tuberculosis is making a comeback: because the country had let down its guard on TB control over the years, many TB patients were no longer forcibly isolated and treated with medication as in the past, so tuberculosis, once nearly extinct, has become rampant again. He said this resurgence has placed the health of the elderly, children, and frail chronic-disease patients under great threat.
Recently I gained a direct understanding of what Dr. Li said. A severe TB case appeared at the school where my wife teaches, which drew the attention of the Beijing municipal TB control center; the district TB clinic assigned to her school ordered screening of all teachers and students. Among the classmates of the TB patient, several more cases of tuberculosis were found. Because my wife taught a specialized course in that class, she too was asked to get tested. A positive TB test made the two of us quite nervous for a while. The clinic physician advised my wife to take anti-TB medication for a period to prevent the disease from developing.
Tuberculosis is the number-one infectious disease worldwide, seriously harming people's health. Globally about two billion people are currently infected; there are about 8–10 million new TB patients each year and about 2–3 million TB deaths annually. In China, annual TB incidence is about 1.3 million, with 130,000 TB deaths per year—more than the deaths from all other infectious diseases combined. China is one of the world's 22 countries with a heavy TB burden, and also one of the 27 countries with a heavy burden of multidrug-resistant TB. China ranks second in the world in number of TB patients, after India. Tuberculosis is one of the major diseases under key control in our country.
Pulmonary tuberculosis was historically called "lung consumption" (lao). It is a wasting disease comparable to cancer, extremely difficult to treat; late-stage TB patients are usually emaciated with very poor immunity. From the existing medical literature, neither Chinese nor Western medicine achieves very high cure rates for pulmonary tuberculosis. The "human-blood bun" Lu Xun once mentioned was a widely circulated folk "medicine guide" for consumption patients in the past; it actually did not work. In former times, nine out of ten cases of consumption could not be cured.
Below are Baidu's results on TB symptoms:
The clinical manifestations of pulmonary tuberculosis are diverse. Early on there may be no symptoms; in some patients symptoms are mild and easily mistaken for a cold and ignored. Typical pulmonary tuberculosis has an insidious onset and a long course, and may present with low fever, fatigue, poor appetite, cough, and hemoptysis. But most lesions are mild and asymptomatic, being discovered incidentally during physical examinations. A small number of patients have prominent toxic symptoms, mostly in miliary tuberculosis or caseous pneumonia. In elderly pulmonary-TB patients, symptoms are easily masked by long-standing chronic bronchitis.
General symptoms of tuberculosis:
1. Fatigue. Whole-body fatigue; feeling tired even without physical labor, not recovering after rest, accompanied by poor appetite and insomnia.
2. Fever. Characteristically low afternoon fever: body temperature usually rises between 4 and 8 p.m., generally between 37 and 38°C, seen mostly in mild TB. Some patients reach 39°C, mostly in acute, severe TB such as hematogenous-disseminated TB or caseous pneumonia. Some patients have long-term irregular fever of 38–39°C, mostly in chronic excreters.
3. Night sweats. Sweating after falling asleep that stops on waking is called night sweating; it is caused by autonomic nervous dysfunction and is also one of the toxic symptoms of TB.
4. Unexplained menstrual irregularity or amenorrhea.
5. Poor appetite, emaciation, weight loss.
6. TB hypersensitivity reactions: rheumatoid arthritis, erythema nodosum, etc.
Respiratory symptoms of tuberculosis:
Cough and sputum are common, recurring symptoms, mostly white sticky sputum; with concurrent infection the sputum may be purulent. A few patients may cough up caseous material. With concurrent infection, cough worsens and sputum increases. Patients with bronchial TB may have violent, frequent coughing.
Hemoptysis is common in pulmonary tuberculosis—usually blood-streaked sputum. As lung lesions progress and erode adjacent capillaries or small vessels, blood-streaked sputum or small hemoptysis may occur; when a large vessel or the bronchial artery ruptures, hemoptysis is massive and may even cause hemorrhagic shock or asphyxiation. Moderate or large hemoptysis may also occur.
Chest pain is usually fairly fixed and persistent; it worsens with deep breathing, loud talking or laughing, or coughing, indicating the lesion is adjacent to or invading the pleura.
Dyspnea: when lung tissue is extensively and severely damaged, or there is extensive pleural adhesions, shortness of breath appears, especially after activity.
Signs of pulmonary tuberculosis:
Early or small lesions may have no positive signs. When the lesion is extensive, reduced respiratory movement on the affected side and diminished breath sounds may appear; in some patients wet rales can be heard. When lung lesions are extensively fibrotic or there is destroyed lung, one-sided thoracic collapse with narrowed intercostal spaces may appear, and compensatory emphysema on the opposite side.
If a fellow patient has the above symptoms and other diseases have been ruled out, he or she should go to the local TB clinic for a TB screening.