A BATTLE AGAINST TUBERCULOSIS

Tuberculosis…It is a curse more than a disease…never ending cough, blood in cough are some of its symptoms. TB is very dangerous and prevalent disease however people still are not totally aware of it unless until they have suffered it. We have tried to cover all aspects of TB in this article. Read it and create awareness on world TB day 24th March.

WHAT IS TUBERCULOSIS…?

1. Latent TB  – The bacteria remain in the body in an inactive state. They cause no symptoms and are not contagious, but they can become active.
2. Active TB – The bacteria do cause symptoms and can be transmitted to others.

Compared with other diseases caused by a single infectious agent, tuberculosis is the second biggest killer, globally. About one-third of the world’s population is believed to have latent TB. There is a 10% chance of latent TB becoming active, but this risk is much higher in people who have compromised immune systems i.e., people living with HIV or malnutrition, or people who smoke.

CAUSE OF TUBERCULOSIS

The Mycobacterium tuberculosis bacterium causes TB. It is spread through the air when a person with TB (whose lungs are affected) coughs, sneezes, spits, laughs or talks.
TB is contagious but not easy to catch. Most people with active TB who have received appropriate treatment for at least 2 weeks are no longer contagious.
Since antibiotics began to be used to fight TB, some strains have become resistant to drugs. Multidrug-resistant TB (MDR-TB) arises in such a case and is treatable and curable only with the use of very specific anti-TB drugs.

WHO IS AT RISK?

People with compromised immune systems are most at risk of developing active tuberculosis. HIV suppresses the immune system, making it harder for the body to control TB bacteria. Tobacco use has also been found to increase the risk of developing active TB.

SYMPTOMS OF TUBERCULOSIS

While latent TB is symptomless, the symptoms of active TB include the following:

• Coughing, sometimes with mucus or blood
• Chills
• Fatigue
• Fever
• Loss of weight
• Night sweats

 Tuberculosis usually affects the lungs, but can also affect other parts of the body.

• Pulmonary – If a tuberculosis infection does become active, it most commonly involves the lungs (in about 90% cases). Symptoms may include chest pain and the prolonged cough producing sputum. About 25% of people may not have any symptoms. Occasional, people may cough up blood in small amounts. Tuberculosis may become a chronic illness and cause extensive scarring in the upper lobes of the lungs. If left untreated, complications often develop, such as fluid collecting between the lung and the chest wall (pleural effusion). This can make the patient very breathless.
• Extrapulmonary – In 15-20% of active cases, the infection spreads outside the lungs, causing other kinds of TB. These are collectively denoted as ‘extrapulmonary tuberculosis’. It occurs more commonly in immunosuppressed persons and young children. In those with HIV, this occurs in more than 50% of cases. Notable extrapulmonary infection sites include the pleura, the central nervous system, the lymphatic system, the genitourinary system, and the bones and joints, among others.

DIAGNOSIS

Diagnosing active tuberculosis based only on signs and symptoms is difficult, as is diagnosing the disease in those who are immunosuppressed.

1. A chest X-Ray
2. Multiple sputum cultures for acid-fast bacilli

These are typically part of the initial evaluation.

3. Chest CT scan
4. Interferon-Gamma Release Assays (commonly known as TB Gold test)
5. Tuberculin skin tests (commonly known as Mantoux skin test)

These are of little use in the developing world.

The Mantoux tuberculin test is often used to screen people at high risk for TB. It is useful to diagnose latent tuberculosis.However, those who have been previously immunized may have a false-positive test result. The test may be falsely negative in those with sarcoidosis, Hodgkin’s lymphoma, malnutrition, and most notably, active tuberculosis.

TREATMENT

The majority of TB cases can be cured when the right medication is available and administered correctly. The precise type and length of antibiotic treatment depend on a person’s age, overall health, potential resistance to drugs, whether the TB is latent or active, and the location of the infection. Antibiotics are usually required to be taken for a relatively long time. The standard length of time for a course of TB antibiotics is about 6 months.
People with latent TB may need just one kind of TB antibiotics, whereas people with active TB (particularly MDR-TB) will often require a prescription of multiple drugs. Some cases of MDR-TB require extensive courses of chemotherapy, which can be expensive and cause severe adverse drug reactions in patients.

TB medication can be toxic to the liver, and although side effects are uncommon, when they do occur, they can be quite serious. Potential side effects should be reported to a doctor and include:
1. Dark urine
2. Fever
3. Jaundice
4. Loss of appetite
5. Nausea and vomiting

WHY IS IT IMPORTANT TO TAKE FULL COURSE OF TREATMENT

It is important for any course of treatment to be completed fully, even if the TB symptoms have gone away. Any bacteria that have survived the treatment could become resistant to the medication that has been prescribed and could lead to developing MDR-TB in the future.
Directly Observed Therapy (DOT) may be recommended. This involves a healthcare worker administrating the TB medication to ensure that the course of treatment is completed.

PREVENTION

A few general measures can be taken to prevent the spread of active TB.
1. Avoiding other people by not going to school or work, or not sleeping in the same room as someone, will help to minimize the risk of germs from reaching anyone else. Wearing a mask, covering the mouth, and ventilating rooms can also limit the spread of bacteria.
2. Vaccines – The only available vaccine as of 2011 is Bacillus Calmette-Guerin (BCG). In children, it decreases the risk of getting the infection by 20% and the risk of infection turning into disease by nearly 60%. The immunity induces decreases after about ten years.