Tuberculosis (TB)

Tuberculosis, MTB or TB, which was formerly known as “Consumption”, “Phthisis

pulmonalis”, is an infectious bacterial disease that is caused by mycobacteria

mainly by “Mycobacterium tuberculosis”. Lungs are the main site of infection in

the tuberculosis, but other systems of the body are also infected. Tuberculosis

spread through air droplets from a person who has active disease through

respiratory system.

Introduction & Background Tuberculosis is an infectious bacterial disease that is caused by mycobacteria

mainly by “Mycobacterium tuberculosis”. Tuberculosis spreads through air

droplets formed during coughing, sneezing. The typical symptoms of the

tuberculosis include chronic coughing, fever, bloody sputum, weight loss etc.

Tuberculosis mainly affects lungs but other organs of the body are also affected.

When in addition to lungs other organs of the body are infected then the patient

shows a variety of symptoms in addition to the typical symptoms of tuberculosis

i.e., fever, chronic cough, weight loss, bloody sputum.

It is said that about 30 % of world’s population is affected by tuberculosis. In

2007, there were 13 million reported cases of chronic tuberculosis worldwide and

in 2010; 8.8 million new cases were registered with 1.5 million deaths most

frequently in developing countries.

The rate of incidence of tuberculosis varies in different countries. The incidence

rate of tuberculosis is almost 75-80 % in Asia and Africa while in United States of

America (USA) it is quite less i.e., 5-10%. Most people in developing countries

develop tuberculosis because of poor hygienic conditions and weak immune

system.

Tuberculosis is high risk disease for the people, who are living in or traveling to

the following areas,

India

China

Mexico

Southeast Asia

What is Tuberculosis? Tuberculosis is an infectious bacterial disease that is caused by Mycobacteria, acid

fast bacilli mainly by “Mycobacterium tuberculosis”. Tuberculosis mainly spreads

through air droplets formed during coughing, sneezing.

The typical symptoms of the tuberculosis include chronic coughing, fever, night

sweats, bloody sputum, weight loss and loss of appetite etc. Tuberculosis mainly

affects lungs but other organs of the body are also affected. When in addition to

lungs other organs of the body are infected then the patient shows widespread of

symptoms in addition to the typical symptoms of tuberculosis i.e., fever, chronic

cough, weight loss, bloody sputum.

Sign & Symptoms of Tuberculosis Tuberculosis can affect any organ of the body but lungs are main site of infection

and this type of tuberculosis is known as pulmonary tuberculosis. There may be

extrapulmonary tuberculosis when mycobacteria affect other organs of the body

except lungs. Tuberculosis may be of active or latent type. In latent tuberculosis,

the patient has bacterial infection but the mycobacteria are in an inactive state

and do not cause typical symptoms of the tuberculosis. The latent tuberculosis,

also known as inactive tuberculosis, is not contagious like active tuberculosis. The

latent infection can transform into active disease, therefore treatment of the

latent form of infection is also necessary. Active tuberculosis starts with fever and

chronic cough and is easily transmitted from one person to other through

respiratory droplets.

The general signs and symptoms of tuberculosis are followings,

Fever

Chronic Cough

Blood tinged sputum

Weight loss

Night sweat

Chills

Malaise

Loss of appetite

Finger clubbing

Chest pain

Difficult breathing

The tuberculosis may be pulmonary or extrapulmonary depending upon the site

of infection.

1. In 90 % of cases, the site of infection is lungs and this condition is known as

Pulmonary tuberculosis. This type tuberculosis manifests itself with chest pain

and coughing with sputum. In 25 % of cases of pulmonary tuberculosis, the

patients remain asymptomatic i.e., do not show the symptoms. Some of the

patients cough up blood in small amount, and in rare cases there may be

erosion of pulmonary artery that leads to massive bleeding. There may

immense scarring of upper lobe of lungs.

2. In 15-20 % cases of active disease, the infection may spread outside the lungs.

Sites of extrapulmonary tuberculosis are following,

Pleura of lungs

Central nervous system (CNS)

Genital system

Bones and Joints (Osseous tuberculosis)

Lymphatic system (Scrofula of neck)

Skin

Most serious form of extrapulmonary tuberculosis is miliary tuberculosis that is

widespread form of infection.

When to See Your Doctor The patient must visit his family physician when there is fever, persistent

coughing, unexplained weight loss, night sweats, and loss of appetite. The doctor

might advise to undergo laboratory investigations or chest X-rays for further

diagnosis. Chronic coughing, fever and weight loss are main symptoms for

tuberculosis because other symptoms may result from other medical problems.

If you are suspicion of tuberculosis then you must immediately consult your

family physician but before appointment with a doctor you must prepare some

questions in your mind such as,

What are the main symptoms and when did these started?

Were you immunized in the childhood?

Did you have tuberculosis in past?

If you had tuberculosis then did you take medicine against mycobacteria?

Do you have AIDS or HIV?

Does anyone in your family have active form of tuberculosis?

What do you do?

Do you smoke?

Do you take alcohol?

These are the questions that are usually asked by the doctor and these must be

answered properly because these things are closely link to the manifestation and

development of the disease.

How Tuberculosis is diagnosed There are separate tests and laboratory investigations for active and latent types

of infections. Chest X-ray and sputum culture are the initial evaluation tests

performed in active disease. Interferon γ release assay (IGRA) and skin tuberculin

test is of little significance in an active disease. Define diagnosis is made by

observing mycobacterium tuberculosis in the sample (culture) or biopsy of lungs.

Almost 6 weeks are required for the growth of the organism therefore it is a time

requiring process. For rapid diagnosis of tuberculosis, nucleic acid amplification

test (PCR) and adenosine deaminase tests are performed.

For diagnosis of latent form of infection, Mantoux Tuberculin Skin test is

performed. Tuberculin test is falsely negative in patients of Hodgkin’s lymphoma,

sarcoidosis and malnutrition. Interferon gamma release assay (IGRA) is performed

in patients who are positive for Mantoux tuberculin skin test.

Risk Factors A healthy immune system is the main factor in the fight against tuberculosis.

Overcrowding and malnutrition are closely linked risk factors for catching

tuberculosis. There are many other risk factors for the development of the

tuberculosis, such as;

Diabetes

AIDS

HIV

Malnutrition

End stage renal disease

Overcrowding

Chronic lung disease

Silicosis

Smoking

Drinking

Crohn’s disease

Psoriasis

Advancing age

Certain type of cancer

Cancer chemotherapy

Certain drugs such as corticosteroids, infliximab etc.

Complications Tuberculosis is life threatening infectious disease that may become fatal if not

treated properly. The bacteria may spread to other parts of the body through

blood stream. There may following complications of organs of the body,

1. There may spinal pain and joint destruction when tuberculosis affects

bones.

2. When tuberculosis affects brain, then it may cause meningitis and

sometimes it may also lead to swelling of the meninges.

3. Tuberculosis may also lead to cardiac temponade if it affects the tissues

surrounding the heart. This leads to fluid accumulation that interferes with

contractile ability.

4. Functioning of the liver as well as of kidney is impaired when these organs

are affected by the tuberculosis.

Treatment Antibiotics are used against mycobacteria. Treatment of tuberculosis is much

difficult because of unusual structure of cell wall of mycobacteria that prevents

the entry of the drugs. Medications against tuberculosis are available but it takes

much longer time for treatment than other bacterial infections. 6-9 months

period of antibiotics medication is required for complete recovery from

tuberculosis and in case multi drug resistant strains of mycobacteria, the

treatment period may be 12 months. The time period of treatment and choices

of drug depends upon the age, health condition, drug resistance and, active and

latent form of tuberculosis.

Followings are most common drugs used for the treatment of tuberculosis,

1. Isoniazid

2. Rifampin

3. Ethambutol

4. Pyrazinamide

In case of latent type of infection, only one type of drug is usually used but in

active form of disease, combination of drugs is used for 6-9 months.

Side effects are also common due to the use of anti-mycobacterial drugs.

Following are important side effects of drugs used in treatment of tuberculosis,

Nausea

Vomiting

Jaundice

Optic neuropathy

Fever

Dark colored urine

Abdominal pain

Burning and tingling sensations of fingers

Preventions Getting immunization against tuberculosis properly.

Maintaining personal hygiene.

Having an active and healthy lifestyle.

If the patient has only latent form of infection, then it is advised to take

medications properly to reduce the risk of having active form of disease. Only

active form of tuberculosis is contagious that can be transmitted from one

person to other person. So only proper medication is required in latent

disease.

Unfortunately if you got tuberculosis, protect your family from

contamination.

If you have tuberculosis, do not go outside the house and stay inside a

specified room during first few weeks of treatment because there is greater

risk of contamination.

Use handkerchief during laughing, sneezing and coughing.

There should be proper ventilation of the room in which patient is staying

because tuberculosis is easily transmitted in closely spaced and congested

rooms.

Cover your face with a surgical mask to prevent the spread of respiratory

droplets.

Lifestyle modifications & Home Remedies There is no complete home remedy for tuberculosis but home remedies are used

to control the symptoms, boost up the immune system and combat the side

effects of the drugs. Home remedies alone are not sufficient for the treatment of

tuberculosis.

Herbs are quite useful in the home remedies. Green tea is most commonly

used as home remedy in tuberculosis because green tea has antioxidant

properties that strengthen the immune system.

Eucalyptus and spearmint may also provide some relief from symptoms.

Garlic is also used as a herb because of its antibacterial properties and it

also strengthens the immune system.

Eat vitamin B and iron rich foods such as green vegetables and whole

grains.

Use antioxidant rich foods such as blueberries, tomatoes etc.

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