Tuberculosis

Overview

Tuberculosis (TB) is a serious illness caused by a type of bacteria. It mainly affects the lungs, but it can spread to other parts of the body as well. TB can spread when an infected person coughs, sneezes, or sings, releasing tiny droplets containing the germs into the air. These droplets can be inhaled by another person, allowing the germs to enter their lungs. TB spreads easily in crowded conditions, such as in schools, prisons, and nursing homes. People with weakened immune systems, including those with HIV/AIDS, have a higher risk of catching TB. It can be treated with antibiotics, but some forms of the bacteria have become resistant to treatments. Symptoms can vary depending on the stage of infection, but common symptoms include cough, chest pain, fever, chills, night sweats, weight loss, tiredness, and general feeling of being unwell.

Understanding the disease

Symptoms

The symptoms of tuberculosis (TB) can vary depending on the stage of the infection and which part of the body is affected. Some common symptoms include:

1. Primary TB infection: Flu-like symptoms such as cough, coughing up blood or mucus, chest pain, fever, chills, night sweats, weight loss, tiredness, and feeling generally unwell.
2. Active TB disease outside the lungs: Symptoms may vary depending on the affected area, but common symptoms include fever, chills, night sweats, weight loss, lack of appetite, tiredness, pain near the infected site, and general feelings of being unwell.
3. Active TB disease in the voice box (larynx): Symptoms are similar to those of TB in the lungs. Tuberculosis can also present with swelling in the fluid around the brain or spinal cord in infants, causing symptoms such as being sluggish, not active, fussy, vomiting, poor feeding, a bulging soft spot on the head, and poor reflexes. It's important to see a healthcare provider if you have symptoms that don't improve with a few days of rest or if you experience chest pain, sudden severe headache, or other emergency symptoms.

Risk Factors

The risk factors for developing tuberculosis include:

1. Living or traveling in a country where TB is common, including several countries in Latin America, Africa, Asia, and the Pacific Islands.
2. Living or working in places where people live close together, such as prisons, nursing homes, and shelters for homeless people.
3. Living in a community identified as being at high risk of tuberculosis.
4. Working in health care and treating people with a high risk of TB.
5. A weakened immune system due to conditions or treatments like HIV/AIDS, diabetes, severe kidney disease, cancers of the head, neck, and blood, malnutrition or low body weight, cancer treatment (chemotherapy), drugs to prevent rejection of transplanted organs, long-term use of prescription steroids, use of unlawful injected drugs, misuse of alcohol, and smoking or using other tobacco products.
6. Age can also be a risk factor for developing active TB disease. Children under 5 years old have a high risk of a TB infection becoming active TB disease, while people aged 15 to 25 and those over 65 have an increased risk of developing more severe active TB disease in the lungs. It is important to consult with a healthcare provider if you have one or more of these risk factors.

Development

Tuberculosis can develop in three stages: primary infection, latent infection, and active disease.

1. Primary infection: This is the first stage when a person is exposed to the Mycobacterium tuberculosis bacteria. The immune system responds by capturing and destroying most of the germs. However, some germs may survive and multiply within the person's body. In many cases, people do not show symptoms during the primary infection stage. Some may experience mild flu-like symptoms.
2. Latent infection: In this stage, the immune system manages to contain the bacteria, but they do not get completely eliminated. The bacteria remain inactive and do not cause any symptoms. A person with a latent infection cannot spread the disease to others.
3. Active disease: The bacteria multiply and cause active tuberculosis when the immune system is weakened due to factors such as HIV/AIDS, diabetes, severe kidney disease, malnutrition, or long-term use of prescription steroids. Active TB disease can cause severe symptoms and can be spread to others through the air when an infected person coughs, sneezes, or talks. In some cases, the bacteria may become drug-resistant due to improper use of antibiotics or genetic changes. Drug-resistant TB strains can be more challenging to treat and can further spread among the population.

Assessment and Diagnosis

Triage

You should see a doctor if you have symptoms that don't improve with a few days of rest, or if you experience chest pain, sudden severe headache, or other severe symptoms. Additionally, if you test positive for latent TB infection, you may need to consult a healthcare provider for further evaluation and possible treatment to prevent active TB disease.

Diagnosis

To diagnose tuberculosis, your healthcare provider will typically start with a physical examination that includes listening to your breathing with a stethoscope, checking for swollen lymph nodes, and asking about your symptoms. If tuberculosis is suspected, your provider will order tests. The most common tests for tuberculosis include skin tests and blood tests. A skin test involves injecting a small amount of a substance called tuberculin under the skin on your arm, which triggers a reaction if you have an infection. Blood tests, on the other hand, analyze your blood to detect the presence of TB-specific immune system cells or the bacteria itself. Additionally, your healthcare provider may order a chest X-ray to look for irregular patches in the lungs, which can be indicative of active TB disease. They may also take a sample of your sputum (mucus coughed up from the lungs) to test for the presence of TB bacteria. It's important to inform your healthcare provider about any drugs, dietary supplements, or herbal remedies you're taking, as some may need to be stopped during treatment. If you're experiencing unusual symptoms or have a history of exposure to TB, be sure to share that information during your appointment. Remember, it's important to seek medical attention if you suspect you may have tuberculosis. Early diagnosis and treatment are crucial for effective management of the disease.

Management and Treatment

Complications

Potential complications of tuberculosis may include:

1. Spread of the infection: Tuberculosis can spread to other parts of the body, such as the kidneys, liver, or spine, causing additional complications.
2. Resistance to treatments: Some strains of the bacteria causing tuberculosis have developed resistance to antibiotic treatments, making the infection harder to treat.
3. Weakened immune system: Individuals with weakened immune systems, such as those with HIV/AIDS, diabetes, or severe kidney disease, are at a higher risk of developing active TB disease and experiencing complications.
4. Extrapulmonary tuberculosis: Tuberculosis that affects parts of the body outside the lungs can lead to specific complications related to the affected organ or system, such as kidney damage or spinal cord inflammation.
5. Nutritional deficiencies: In some cases, tuberculosis can cause malnutrition due to a lack of appetite or increased metabolic demands. This may result in weight loss and other related complications.
6. Complications from treatment: Some antibiotic treatments for tuberculosis can cause side effects or complications, such as hearing loss as a result of medication damage to the ears (ototoxicity). It is important to seek medical attention and follow proper treatment guidelines to minimize the risk of complications associated with tuberculosis.

Prevention

Tuberculosis (TB) can be prevented by taking certain precautions and following proper treatment. Here's what you can do to prevent TB:

1. Vaccination: The bacille Calmette-Guerin (BCG) vaccine helps protect against severe forms of TB, especially in children. However, it may not provide complete protection against TB in adults.
2. Early detection and treatment: Identifying and treating TB infections early can help prevent the progression to active TB disease. If you suspect you have been exposed to TB, consult a healthcare professional for testing and appropriate treatment.
3. Healthy living: Maintain a healthy lifestyle by eating a balanced diet, getting regular exercise, managing stress, and avoiding smoking and other forms of tobacco use. A strong immune system can help reduce the risk of developing active TB disease.
4. Avoiding close contact: If you have active TB disease, taking steps to prevent the spread of the disease to others is essential. This includes staying home, isolating at home, and sleeping in a separate room.
5. Preventing the spread in high-risk settings: In places where TB is common, living or working conditions can contribute to the spread of the disease. Improving ventilation, screening individuals for TB, and providing proper treatment can help reduce the risk of transmission.
6. Screening in high-risk populations: Certain populations are at a higher risk of TB infection, such as those with HIV/AIDS, diabetes, severe kidney disease, or those living in crowded conditions. Regular screening and monitoring can help detect TB infections early and prevent the progression to active disease. Remember, tuberculosis is a serious illness that requires proper treatment and precautions. Consult a healthcare professional if you suspect you may have been exposed to TB or if you have concerns about your risk factors.

Treatment

The primary treatment for tuberculosis is antibiotics. However, some forms of the bacteria have become drug-resistant, which can complicate treatment. In such cases, a healthcare provider may need to prescribe a different combination of antibiotics or treat the infection for a longer duration. The effectiveness of the treatment depends on factors such as the stage of the infection, the strain of the bacteria, and the patient's overall health. It's important to complete the entire course of antibiotics as prescribed by a healthcare professional to ensure the infection is fully treated.

Preparing for medical consultation

To prepare for an appointment for tuberculosis, you should:

1. Make a list of your symptoms, including any that may seem unrelated to tuberculosis, and when they began.
2. Gather information about key personal factors, such as recent life changes, international travel, or exposure to individuals with active TB disease.
3. Create a list of all medications, vitamins, or supplements you're currently taking, including doses.
4. Consider bringing a family member or friend to the appointment for support and to help remember important information.
5. Prepare any previous scans, X-rays, or medical records for review during the appointment. Remember to ask your doctor any questions you may have about your condition, treatment options, and potential outcomes.