Tuberculosis

Tuberculosis is a severe bacterial infection that poses a significant threat to global health. Tuberculosis continues to impact millions of people worldwide, particularly those with compromised immune systems, such as individuals living with HIV/AIDS. This overview will delve into tuberculosis's definition, types, and crucial aspects, empowering readers with the knowledge necessary to understand and prevent the spread of this infection.

What is Tuberculosis?

Tuberculosis is a contagious bacterial infection caused by Mycobacterium tuberculosis, which primarily targets the lungs but can also affect other body parts. Tuberculosis is spread through the air when an individual with active tuberculosis coughs, sneezes, talks, or sings, releasing tiny droplets containing the bacteria. However, tuberculosis is not easily transmissible and usually requires prolonged contact with an infected person in an indoor setting. Symptoms of active tuberculosis disease include chronic cough, fever, coughing up blood or mucus, chest pain, night sweats, weight loss, and fatigue. Individuals with weakened immune systems, such as those with HIV/AIDS, are at higher risk of contracting tuberculosis. Understanding the causes, transmission, symptoms, and risk factors associated with tuberculosis is crucial for early detection and effective management of the disease.

Tuberculosis can be classified into several types based on the stage and location of the infection.

• Primary tuberculosis infection is the first stage, where the immune system may destroy the bacteria. Still, some germs may survive and multiply, often presenting with flu-like symptoms or no symptoms at all.
• Latent tuberculosis infection occurs when the bacteria are present in the body but are controlled by the immune system, resulting in no symptoms and a non-contagious state.
• Active tuberculosis develops when the bacteria multiply and cause disease in the lungs or other parts of the body, leading to apparent symptoms and contagiousness.
• Extrapulmonary tuberculosis is the spread of the infection to body parts outside the lungs, such as the kidneys, spine, or brain, with symptoms varying depending on the affected area.

• Infants: Sluggishness, fussiness, vomiting, poor feeding, bulging soft spot on head, poor reflexes
• Ages 1-12: Persistent fever, weight loss
• Teenagers: Similar to adult symptoms

The stages of tuberculosis describe the progression of the disease from initial infection to its potentially severe manifestations, as follows:

1. Primary tuberculosis infection

• Initial immune response: The immune system attempts to fight off the bacteria, often succeeding in containing it. In about 95% of cases, this results in asymptomatic infection.
• Symptoms: Some individuals may experience mild, flu-like symptoms such as low fever, fatigue, and a cough.
• Transmission: At this stage, the infection is generally not contagious as the bacteria are contained within the lungs and do not spread to others.

2. Latent tuberculosis infection

• Dormant bacteria: The bacteria remain in the body but are inactive, meaning they do not cause symptoms and are not transmissible.
• Risk of reactivation: While most people remain asymptomatic, latent tuberculosis can reactivate, particularly in individuals with weakened immune systems (e.g., those with HIV/AIDS or chronic illnesses).
• Diagnosis: Latent tuberculosis can be detected through skin tests or blood tests, even though no symptoms are present

3. Active tuberculosis disease

• Active tuberculosis occurs when the immune system fails to control the bacteria, leading to symptomatic disThe most common symptoms of tuberculosis are as follows:
• Cough lasting more than 3 weeks
• Chest pain
• Coughing up blood or sputum (phlegm)
• Weakness or fatigue
• Weight loss
• Loss of appetite
• Fever
• Chills
• Night sweats
• Feeling generally unwell

Additional symptoms may occur based on the affected area:

• Swollen lymph nodes (if lymph nodes are affected)
• Bone pain (if bones are affected)
• Headache or confusion (if the brain is affected)
• Pain in the abdomen (if kidneys are affected)
• Hoarseness (if the larynx is affected)

Symptoms in childrenease

• Contagion: Individuals with active TB can spread the bacteria to others through respiratory droplets when they cough or sneeze.
• Extrapulmonary tuberculosis: In some cases, tuberculosis can spread beyond the lungs to other parts of the body, which can cause additional symptoms depending on the affected area.

• Bacterial Infection: Tuberculosis is caused by the bacterium Mycobacterium tuberculosis. This germ primarily affects the lungs but can also impact other body parts such as the kidneys, spine, and brain.
• Transmission: Tuberculosis spreads through the air when an infected person coughs, sneezes, talks, or sings, releasing tiny droplets containing the bacteria. Prolonged exposure to these droplets increases the risk of infection.

Latent vs. active tuberculosis

• Latent tuberculosis: In this state, the bacteria remain inactive in the body without causing symptoms and cannot be transmitted to others. However, latent tuberculosis can progress to active tuberculosis if the immune system weakens.
• Active tuberculosis: This occurs when the immune system fails to contain the bacteria, leading to illness and contagiousness. Symptoms typically include a persistent cough, fever, and weight loss.

Several factors can increase an individual's susceptibility to developing tuberculosis, including:

1. Weakened immune system

• People with compromised immune systems, such as those living with HIV/AIDS, undergoing chemotherapy, or taking immunosuppressive medications, are at higher risk of contracting tuberculosis.

2. Close contact with patients with tuberculosis

• Individuals who have been in close contact with someone diagnosed with active tuberculosis have a higher likelihood of becoming infected.

3. Certain health conditions

• Pre-existing health conditions, such as diabetes, chronic kidney disease, and severe weight loss, can increase the risk of developing tuberculosis.

4. Age and socioeconomic factors

• Older adults, young children, and individuals from low socioeconomic backgrounds or living in crowded conditions are more susceptible to tuberculosis infection.

5. Geographic location

• Living in or travelling to areas with high tuberculosis prevalence, such as certain developing countries, can increase the risk of exposure to the bacteria.

Preventing the transmission and development of tuberculosis involves a multi-faceted approach, including:

1. Vaccination

• The Bacille Calmette-Guérin (BCG) vaccine is commonly used in many countries to prevent severe forms of tuberculosis in children.

2. Early diagnosis and treatment

• Prompt identification and initiation of tuberculosis treatment for active tuberculosis cases can prevent further transmission of the bacteria.

3. Infection control measures

• Implementing infection control measures in healthcare settings, such as proper ventilation, wearing protective masks, and isolating infectious patients, can minimise the spread of tuberculosis.

4. Contact tracing

• Identifying and screening close contacts of individuals with active tuberculosis allows for early detection and preventive treatment of latent tuberculosis infection.

5. Public health education

• Raising awareness about tuberculosis symptoms, transmission, and prevention methods through public health campaigns can encourage early care-seeking behavior and reduce stigma associated with the disease.

Diagnosing tuberculosis involves a combination of tests to identify the infection and determine its stage:

• Skin test:
  • Tuberculin skin test injects a small amount of PPD tuberculin under the skin
  • Bump at injection site after 48-72 hours indicates tuberculosis exposure
• Blood tests:
  • Interferon-gamma release assays (IGRAs) measure immune system reaction to tuberculosis bacteria
• Imaging tests:
  • Chest X-rays and CT scans check for lung abnormalities
  • PET scans detect areas of active tuberculosis outside the lungs
• Sputum tests:
  • Samples of sputum (mucus from lungs) are tested for tuberculosis bacteria
  • Used to diagnose active pulmonary tuberculosis
• Tissue biopsy:
  • In extrapulmonary tuberculosis, a small tissue sample from the affected area is examined for tuberculosis bacteria

The management and treatment of tuberculosis involves a comprehensive approach to effectively combat this serious infectious disease. Treatment typically consists of a combination of antibiotics taken over an extended period to eliminate the tuberculosis bacteria.

1. Standard treatment regimen

• The standard treatment for medicine-susceptible tuberculosis includes an intensive phase lasting 2 months, involving a four-medication combination of isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (EMB).
• This is followed by a continuation phase of 4-6 months, during which the patient takes INH and RIF.

2. Directly observed therapy

• Directly observed therapy is a key component of tuberculosis treatment, where a doctor supervises the patient taking their medications to ensure adherence and prevent the development of medication resistance.

3. Medicine-resistant tuberculosis

• Treatment of medicine-resistant tuberculosis, such as multi-medicine resistant tuberculosis, requires individualised regimens that may include second-line medication and can last for several months or even years.

4. Monitoring and adherence

• Regular monitoring through sputum tests for acid-fast bacilli (AFB) smear and culture is crucial until negative results are obtained.
• Strict adherence to the prescribed treatment regimen is essential for successful outcomes and to prevent the emergence of medication resistance.

Living with tuberculosis requires careful management to prevent the spread of the infection and ensure effective treatment. Here are some key aspects to consider:

1. Daily life adjustments

• Isolation: During the initial weeks of treatment, stay home and minimise contact with others to prevent the spread of tuberculosis.
• Hygiene practices: Cover your mouth when coughing or sneezing, dispose of tissues properly, and wear a face mask around others.

2. Treatment adherence

• Medication compliance: Complete the full course of antibiotics as directed by your doctor to clear the infection and prevent medicine resistance.
• Regular follow-ups: Attend regular check-ups to monitor treatment effectiveness and address any side effects or concerns.

3. Lifestyle modifications

• Nutrition and health: Maintain good nutrition and overall health, especially if you have a compromised immune system. Avoid smoking and excessive alcohol consumption.
• Support network: Lean on a supportive network of family and friends to manage the psychological and emotional aspects of living with tuberculosis

Early detection and treatment of tuberculosis are crucial for preventing the spread of the disease and ensuring successful management. Here are some situations when you should contact your doctor:

Symptoms of active tuberculosis

• Prolonged cough: If you have a persistent cough lasting more than two weeks, especially if accompanied by blood or mucus.
• Chest pain and difficulty breathing: Pain in the chest or difficulty breathing can be signs of tuberculosis.
• Fever, night sweats, and weight loss: Persistent fever, night sweats, and unexplained weight loss are common symptoms of active tuberculosis.

Exposure to tuberculosis

• Contact with someone with active tuberculosis: If you have been in close contact with someone who has active tuberculosis, get tested even if you do not have symptoms.
• High-risk groups: Individuals living or working in high-risk environments such as prisons, homeless shelters, or healthcare facilities should be vigilant about tuberculosis symptoms.

• Tuberculosis is a bacterial infection that primarily affects the lungs but can also impact other parts of the body. Tuberculosis is spread through the air when an infected person coughs, sneezes, or speaks, releasing tiny droplets containing the bacteria. Not everyone infected with tuberculosis bacteria becomes sick; some may have latent tuberculosis infection without any symptoms.
• Common symptoms of active tuberculosis include a persistent cough (lasting more than 3 weeks), coughing up blood or mucus, chest pain, fever, night sweats, and weight loss. Tuberculosis is diagnosed through a combination of skin tests, blood tests, chest X-rays, and sputum samples.
• Active tuberculosis is treated with a combination of antibiotics, usually taken for 6 to 12 months. It is crucial to complete the full course of treatment to prevent relapse and medication resistance. Latent tuberculosis infection can be treated with preventive therapy, typically involving isoniazid taken daily for 6 to 9 months. Preventing the spread of tuberculosis involves isolating infectious individuals, ventilating rooms, wearing masks, and practising good hygiene when coughing or sneezing.
• If you have tuberculosis, it is essential to work closely with your doctor to manage your symptoms, adhere to your treatment plan, and prevent the spread of the disease to others.
• Attend regular checkups, participate in Directly Observed Therapy if available, and promptly report any new or worsening symptoms to your doctor.