Chen Yu, Zhao Yanping
Department of Tuberculosis, Shenyang Tenth People's Hospital and Shenyang Chest Hospital, Shenyang, China.
School of Public Health, The University of Hong Kong, Hong Kong, China.
BMJ Case Rep. 2018 Aug 11;2018:bcr-2018-225794. doi: 10.1136/bcr-2018-225794.
China has the second highest global incidence and prevalence of multidrug-resistant tuberculosis (MDR-TB). We describe here the life experience of a rural Chinese farmer with complicated and aggressive TB. It is unclear if this patient contracted MDR-TB initially or developed MDR-TB during treatment because the initial laboratory results are dubious. The lack of public awareness of TB in rural China fuelled by a belief in toxicity of TB treatment, as mentioned by his brother, caused the patient to stop his TB treatment repeatedly long before completion. The cost of MDR-TB treatment in China is unaffordable for most Chinese, especially those in rural areas. He paid about ¥300 000 (almost US$50 000) for his TB treatment. He was discharged early twice for 'financial difficulties'. This case highlights excessive costs, lack of public awareness, poor patient education, inadequate follow-up, lack of coordination between clinical services and the importance of treatment adherence.
中国耐多药结核病（MDR-TB）的全球发病率和患病率位居第二。我们在此描述一位患有复杂且侵袭性结核病的中国农村农民的生活经历。由于最初的实验室结果存疑，尚不清楚该患者最初是否感染耐多药结核病，还是在治疗过程中发展为耐多药结核病。正如他的兄弟所提到的，中国农村地区公众对结核病缺乏认识，加上认为结核病治疗有毒性，导致患者在远未完成治疗之前就多次中断治疗。在中国，耐多药结核病的治疗费用对于大多数中国人来说难以承受，尤其是农村地区的人。他为结核病治疗支付了约30万元人民币（近5万美元）。他曾两次因“经济困难”提前出院。该案例凸显了费用过高、公众意识缺乏、患者教育不足、随访不充分、临床服务之间缺乏协调以及治疗依从性的重要性。
