CONDITIONS
Tuberculosis
Tuberculosis
What are the different types or forms of tuberculosis?
An TB infection does not necessarily mean a person will get sick. There are certain stages or forms of the disease as follows:
- Primary TB – First stage of TB where immune system may fight off the infection and symptoms usually do not appear, or a person gets flu-like symptoms
- Latent TB – Body has the germs of TB but immune system prevents it from spreading. While the disease is not active or contagious at this stage, it might one day become active as the infection is still present. The doctor may suggest preventive medications in case patient has HIV or past infection, unusual chest X-ray or weakened immune system.
- Active TB – Germs multiply and disease makes a person ill, while increase risk of transferring it to others.
- Active TB outside the lungs – when the TB spreads to other parts of the body
Latent or active TB could also be drug-resistant, meaning that medicines will not work against such infections.
What are the symptoms of TB?
Symptoms are causes in Active Tuberculosis are as follows:
- Cough lasting more than 3 weeks
- Chest pain
- Blood in sputum (when a person coughs blood)
- Fever and chills
- Feeling tired all the time
- Night sweats
- Not feeling hungry (loss of appetite)
- Weight loss
Along with the above symptoms, TB spread to other parts of the body may show following symptoms:
- Pain in the area affected by TB
- A general sense of being unwell
Symptoms of tuberculosis in teens, babies and children may look different. Generally teens have symptoms similar to those in adults but children (aged 1 to 12 yrs) may have weight loss and a fever that won’t go away.
What are the causes of tuberculosis?
Tuberculosis is a droplet infection; it spreads through the air like cold and flu and spreads if you come in contact with the person having it. TB spreads when some with TB bacteria coughs, sneezes, or even talks, laughs, etc., release tiny droplets containing germs in the air. When other people breath the germs, they get the disease.
Tuberculosis germs don’t live on any surfaces and that’s why people cannot get TB from –
- Shaking hands
- Kissing
- Sharing food or drink
- Sharing bed sheets, towels, or toothbrushes
- Toilet seats
Also, a person with active TB disease usually cannot transmit the disease after 2 to 3 weeks of treatment while person with a latent TB infection cannot spread the disease to others.
Causes of Drug resistant TB:
Sometimes, some form of tuberculosis bacteria undergoes changes in their genetic makeup, becoming stronger in a way and drug resistant. This means that the medicines that once worked on curing TB will no longer work. Some of the reasons for these include the following:
- Non-compliance of drug regimen by people or stopping the medicines midway through treatment.
- Wrong treatment plan was given to them
- Non-availability of drugs
- Drugs were not absorbed as expected.
What are the risk factors for tuberculosis?
Following people are more likely to get tuberculosis if :
- They live with a friend, or family member, colleague with active TB.
- They travelled to or live in common areas with high TB prevalence such as Africa, Asia, Latin America, and the Caribbean.
- Live or work in places with people more prone to TB such as homeless people, people with HIV, those in jail or prison, and those who inject drugs.
- They live or work in a hospital or nursing home
- They are a smoker.
Certain diseases or conditions also increase the risk of TB, such as:
- HIV or AIDS
- Diabetes
- Serious kidney disease
- Head or neck cancer
- Low body weight and poor nutrition
- Cancer treatments such as chemotherapy
- Medications for organ transplants
- Certain drugs to treat rheumatoid arthritis, Crohn’s disease, and psoriasis
Babies and young children might be more susceptible to active TB since their immune functions are yet to be completely developed.
How can TB be diagnosed?
The doctor usually does a physical exam that includes checking lymph nodes swelling and listening to the lungs.
Some common tests are as follows:
- Tuberculosis skin testing (Mantoux tuberculin skin test): Post injecting a small amount of fluid into the skin of your lower arm, the technician asks you to come after 2-3 days. Follow-up visit involves checking for swelling in the arm. Repeated test might be conducted for confirmed diagnoses.
- Tuberculosis blood testing: Interferon-gamma release assays (IGRAs) are tests that calculate the response when TB proteins are mixed with a small amount of your blood.
Tuberculosis test results
Positive skin test results indicate presence of TB bacteria. False positives are possible in case a person has gotten a TB vaccine called Bacillus Calmette-Guerin (BCG). These test however, do not show whether the infection is latent or active. For that, the doctor may:
- Conduct a chest X-ray or CT scan for looking for any changes in the lungs.
- Test such as Acid-fast bacillus (AFB) test: Checks for TB bacteria in the sputum (spit), that comes up when a person coughs.
How is tuberculosis treated?
Most tuberculosis cases are treated with antibiotics (bacteria killing or stopping medicines) but the duration of treatment is long. It takes atleast 6 to 9 months for complete treatment.
The treatment depends on the infection –
In Latent TB – The doctor prescribes medicines to kill the bacteria to prevent it from becoming active. Medicines such isoniazid, rifampin, or rifapentine might be taken alone or in combination for 3 months or more. The doctor should be immediately notified in case of active TB symptoms.
In Active TB – A combination of medicines such as ethambutol, isoniazid, pyrazinamide, and rifampin for around 6 to 12 months are given.
In Drug-resistant TB – The treatment may be different, and medicines might have to be taken for a longer period (up to 30 months).
How can we prevent the spread of tuberculosis?
In case of active TB disease, utmost care should be taken to prevent spread of the disease since the disease has highest transmission possibility in the first 2-3 weeks. Following these steps will help prevent spread of the disease:
- Stay at home and isolate wherever possible. Avoid going to work or school.
- Spending as little time among members in the house decreases the risk of spreading the infection. Sleep in a separate room.
- Rooms should be well ventilated as TB germs spread easily in enclosed spaces. Open the windows for fresh air, use a fan, use cross ventilation.
- Face mask should be worn strictly in presence of other people. It is advisable even for members to covert their faces in presence of the person.
- A tissue should be used, and mouth should be covered while coughing or sneezing. These tissues should be put in a bag, sealed, and thrown away.
- Vaccinations: In countries commonly known for TB prevalence, infants are generally vaccinated with the Bacille Calmette-Guerin (BCG) vaccine to protect them for the spread of active TB disease to the fluid surrounding the brain and spinal cord.
Are there any government programs to help in management of TB?
The Government of India plans to eliminate tuberculosis from India by the year 2025. This means less than 1 case of TB per 10 lakh population. The government has a nationwide program known as the Revised National Tuberculosis Control Program (RNTCP) under which it aims to achieve and maintain a cure rate of 85% and cut transmission of TB.
Key highlights of the policy important for patients:
- RNTCP provides free diagnostic and treatment services to benefit vulnerable groups of society.
- Multiple centers of proper diagnosis and testing of Drug Resistant TB is undertaken through quality assured drug susceptibility testing at 64 Culture & drug susceptibility testing (C-DST) laboratories. Machines for early diagnosis of Rifampicin resistance among TB cases have been installed at nationwide sites.
- A case-based app for patients called Nikshay was developed on a national level for monitoring the treatment of patients and the status of TB in India. More than 4 crore patients have been registered on this app till date.
- The benefit of this app is that it also includes the private sector hospitals, patients, etc.
- A patient diagnosed with TB can register on this app or via the website https://communitysupport.nikshay.in/#
References
- Sharma D C. India launches tuberculosis prevalence survey. The Lancet Respiratory Medicine. December 2019; 7(12): P1009.
- INDIA TB REPORT 2022. Coming together to end TB altogether. Ministry of Health and Family Welfare Government of India
- Tuberculosis (TB). January 2024. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/tuberculosis/symptoms-causes/syc-20351250
- Dean Shaban. Tuberculosis (TB): Causes, Symptoms, Treatment. January 2024. WebMD. https://www.webmd.com/lung/understanding-tuberculosis-basics
- Revised National Tuberculosis Control Program. January 2024. https://dghs.gov.in/content/1358_3_RevisedNationalTuberculosisControlProgramme.aspx
