This "white plague" caused Lin Daiyu to die and Lu Xun to pass away. You and I may be infected!

It is the disease that has killed the most humans to date and was once called the "White Plague".

It is said that Lin Daiyu, the frail, thin, frequent cougher and hemoptysis character in "Dream of Red Mansions", suffered from this disease, and the literary giant Lu Xun also died of this disease.

It is tuberculosis, also known as "consumption", an ancient disease that modern medicine has not yet completely conquered. Its pathogenic bacteria still lurk in the bodies of nearly 2 billion people around the world.

Is tuberculosis really that scary?

The answer is of course no. It is very easy to deal with it. There are vaccines and effective drugs. Thanks to this, in the past 20 years, the incidence of tuberculosis in China has dropped by 42% and the mortality rate has dropped by more than 90%.

But we still have a long way to go before we can eradicate tuberculosis. To date, tuberculosis is still prevalent in China, and there is a huge number of potential tuberculosis infections. Data show that the number of new tuberculosis patients in my country in 2020 was 842,000, an increase of 9,000 compared to 2019, and the number of cases ranked second in the world. [1]

Why is it so difficult to eliminate and yet can spread widely among the population? To find out, Youlai Doctors had a conversation with four experts from the Beijing Center for Disease Control and Prevention to find the answer.

"Tuberculosis is a systemic disease. Except for the hair and nails, other parts of the body may be infected," said Li Bo, chief physician of the Tuberculosis Clinic of Beijing Center for Disease Control and Prevention.

That's right, in addition to the lungs, lymph, meninges, intestines, skin, bones, etc. may be invaded by Mycobacterium tuberculosis.

Not only that, but tuberculosis bacteria are also very tenacious! Unlike other viruses and bacteria that quickly lose their activity once they leave their "host", tuberculosis bacteria are resistant to dryness, cold, acid, alkali, etc., and can even survive in dry sputum for 6 to 8 months.

Li Bo said: "If a patient with positive sputum smear for acid-fast bacilli (bacteria in sputum) spits in a corner of the house, the tuberculosis bacteria can survive there for more than six months and may even float in the air; if it adheres to dust, it can remain infectious for 8 to 10 days."

The extremely easy survival of tuberculosis bacteria will inevitably lead to some infections that are difficult to prevent.

"But there is no need to panic," said Sun Shanhua, deputy chief physician at the Tuberculosis Prevention and Control Institute of Beijing Center for Disease Control and Prevention. Infection with tuberculosis bacteria does not necessarily lead to pulmonary tuberculosis. Data show that among the nearly 2 billion infected people, only about 10% will develop active tuberculosis.

"I thought it was just a common cold, and didn't think too much about it." Li Bo has heard patients say this many times in his 30 years of outpatient work. However, because the symptoms of tuberculosis are very similar to those of a cold, many patients delay their treatment, which indirectly causes the clustered spread of the epidemic. This is the case with one of Li Bo's patients.

He is the founder and teacher of a children's football training class. When he had symptoms such as coughing, expectoration, low-grade fever, and fatigue, he thought it was just a common cold and didn't take it seriously. But this time the "cold" was unusual, and the cough did not heal for a long time, so he had to go to a general hospital for examination. After the doctor examined him, he only treated him as a cold, pneumonia and other diseases. However, this "cold" not only did not get better quickly like usual, but on the contrary, the condition became more and more serious.

"At that time, the patient was in despair and thought he had a terminal illness. He even started to deal with his funeral affairs." Li Bo can't help but sigh when he thinks of this patient now.

It was not until the doctor realized that it might be pulmonary tuberculosis that the patient was saved by the discovery of Mycobacterium tuberculosis in the sputum smear. The patient was then referred to the Beijing Center for Disease Control and Prevention.

But at this time, the patient's lungs already had cavities, and the patient had diabetes, so the treatment was more complicated and took longer. "What needs to be more vigilant is that tuberculosis may be hidden and spread in his training class and family, so I strongly asked him to notify the children and their parents to undergo tuberculosis screening, and also to bring his family members for screening."

Fortunately, the patient cooperated fully with the treatment and has recovered, and his family also received preventive treatment.

In order to avoid similar clustered epidemics, schools, enterprises, nursing homes and other crowded places will take tuberculosis prevention and control measures. He Xiaoxin, deputy director of the Tuberculosis Prevention and Control Institute of the Beijing Center for Disease Control and Prevention, said that schools conduct tuberculosis screening before new students enter school to prevent students from entering school with the disease and causing clustered transmission.

"You won't tell our unit?"

"This medicine has too many side effects, I don't want to take it!"

…

When tuberculosis is diagnosed and treated, patients will have all kinds of worries and questions because they are afraid that people around them will know, they are afraid of the disease, afraid of infection, and even more afraid of being discriminated against.

According to Luo Ping, chief physician of the Tuberculosis Clinic of Beijing Center for Disease Control and Prevention, the entire treatment period for tuberculosis patients is usually 6 to 8 months. Before being cured, patients are required to live alone as much as possible and stay away from crowds, such as students having to take a leave of absence from school, and corporate employees having to be suspended or resign. At the same time, anti-tuberculosis drugs are all chemical drugs, which have certain adverse reactions and can also cause damage to the liver and kidneys. Therefore, during treatment, patients are required to have regular check-ups, check routine blood and urine tests, liver and kidney function, etc., and adjust the dosage according to the specific situation.

In order to urge patients to take their medications and have regular check-ups, "we will establish a connection with the community hospital through the Internet. That is, after the patient has seen a doctor here, the community doctor will regularly visit the patient's home or make follow-up calls, and let family members or community leaders supervise the patient's medication use." Li Bo added.

However, due to various factors, many patients know the disease but do not seek treatment. For example, some patients leave false addresses and contact information when seeing a doctor, some patients refuse to answer calls from community hospitals, some patients refuse home visits, and some even refuse treatment directly.

One of Luo Ping's patients believed that the side effects of anti-tuberculosis drugs were too great, so he refused to take them. He also did not want others to know and insisted on relying on his own immunity to heal himself. However, Luo Ping's popular science and persuasion were of no avail. It was not until a year later that the patient's condition became serious and he came to see the doctor again. Lesions appeared on both lobes of his lungs, and he agreed to take medication for treatment.

"If active pulmonary tuberculosis is detected, it must be treated with regular anti-tuberculosis treatment to be cured, otherwise the spread of the lesions will be aggravated." Luo Ping emphasized, "Don't be afraid of seeing a doctor. You must face the disease, actively treat and cure it, and reduce the probability of recurrence."

Many people think that they can stop taking medicine if they feel comfortable or have no symptoms after taking it, or if they have adverse reactions. But for tuberculosis patients, stopping or missing medicine can have serious consequences. "Missing medicine is an irregular anti-tuberculosis treatment. If you miss medicine many times, it will lead to worsening or relapse of the disease, and in severe cases, it will develop into drug-resistant pulmonary tuberculosis." Luo Ping said.

Once drug-resistant tuberculosis occurs, the patient's sensitivity to drugs will decrease or even disappear, which will cause the drug's efficacy against tuberculosis to decrease or become ineffective, and the negative impact will be huge.

Unlike common tuberculosis, which has a six-month treatment cycle and is free of charge, drug-resistant tuberculosis not only has a low cure rate, but also has a treatment cycle that is extended to two years. The cost of treatment will rise sharply, and 30% to 50% of the medical expenses will be self-paid. At the same time, the long treatment cycle prevents patients from working and earning money, which will increase the financial burden on the family. Therefore, once tuberculosis is diagnosed, timely treatment is as important as regular medication.

Currently, drug-resistant tuberculosis patients account for about 8% of tuberculosis patients in my country. According to data from the World Health Organization (WHO), in 2019, there were approximately 65,000 new drug-resistant tuberculosis patients in China, of which only about 10,000 were actually included in hospital treatment and management. [2]

Advances in medicine have made the old sayings “nine out of ten tuberculosis cases” and “nine out of ten tuberculosis deaths” a thing of the past, but the road to ending tuberculosis is still long.

How to further enhance the public’s awareness and understanding of tuberculosis?

How to eliminate common misunderstandings among tuberculosis patients and their families?

How to enhance patients’ courage to face the disease and their confidence in curing the disease?

Tuberculosis is preventable and treatable. How to prevent and treat it?

…

Doctor Youlai and four tuberculosis prevention and control experts jointly called for: Let us act together, prevent, treat and recover early, end tuberculosis and enjoy health!

References:

[1] China CDC: The important "2021 Global Tuberculosis Report" is released - authoritative interpretation of key data in the report. 2021.10.19

[2] China Youth Daily: 8% of tuberculosis patients in China are multidrug-resistant, and nearly 300 million people are latently infected. 2021.3.28