Tu­ber­cu­lo­sis (TB)

Tuberculosis (TB):  Around 1.5 million people die of the disease worldwide every year
Tuberculosis (TB): Around 1.5 million people die of the disease worldwide every year

Tuberculosis is one of the world's most dangerous infectious diseases. It primarily affects the lungs, but can spread through the lymph nodes and bloodstream to any organ in the body. The bacteria causing tuberculosis are transmitted from person-to-person via droplets. Once rare in developed countries, tuberculosis infections began increasing in 1985, partly because of HIV that weakens the immune system and can’t fight the tuberculosis germs. Many strains of tuberculosis resist the most common drugs to treat TB. People with active tuberculosis have to take several types of medications for a longer period of time to exterminate the infection and prevent development of antibiotic resistance.

Symptoms of tuberculosis

People with a strong immune system usually don’t get TB even if their bodies harbor the tuberculosis bacteria.
Therefore, doctors make a difference between:

  • Latent Tuberculosis (inactive TB): The person has a TB infection, but the bacteria remain in the body in an inactive state and cause no symptoms. This condition isn't contagious. However, latent tuberculosis can turn into active TB, so treatment is imperative for the people with latent TB. In this way, the spread of TB is also under control.
  • Active Tuberculosis: The affected person gets sick, and the disease can spread to other people. This may happen in the first few weeks after infection or years later.

Symptoms of active tuberculosis might be:

  • Fever
  • Loss of appetite
  • Weight loss
  • Chest pain
  • Pain with breathing
  • Fatigue
  • Persistent cough
  • Bloody expectorations
  • Prolonged cough
  • Mucus cough
  • Drenching night sweats
  • General weakness

If the TB affects other organs, symptoms vary according to the body part involved, e.g. a patient suffering from TB of kidneys might have blood in the urine.

Causes and origin of tuberculosis

Tuberculosis is caused by a bacterium called “Mycobacterium tuberculosis” that infects one third of the world’s population according to World Health Organization. Between five and ten percent of infected people develop TB and become contagious sooner or later in their lives. However, for patients with HIV or AIDS this rate is much higher.

In general, the disease develops in the lungs. But there are extra-pulmonary cases where the bacilli infect other parts of the body, such as bones, central nervous system, lymph nodes, cardiovascular and gastrointestinal systems. Tuberculosis is passed from person to person through droplets. When a patient with tuberculosis infection talks, spits, coughs, or sneezes, tiny droplets of saliva or mucus are expelled into the air, where they can remain viable for several hours before they might be inhaled by another person.

Consequences of tuberculosis

If tuberculosis it not treated properly, it can be deadly.

Prevention and therapy of tuberculosis
Chest X-ray: Pulmonary tuberculosis
Chest X-ray: Pulmonary tuberculosis

Treatment for latent TB infection

The affected people have tuberculosis bacteria in their bodies, but they are not sick because the bacteria are not active. They don’t have symptoms, and they don’t spread TB bacteria to others. But if tuberculosis bacteria become active in the body and multiply, the person develops TB disease. Therefore, people with latent TB infection often get treatment to prevent active TB.

Treatment for latent TB is much easier in comparison with active TB because there are less bacteria in the affected person. The medications for the treatment of latent TB infection include:

  • Isoniazid
  • Rifampin
  • Rifapentine

Since people with weakened immune systems are at very high risk of developing TB disease when they are infected with TB bacteria, they should definitely get appropriate treatment and complete the entire course.

Treatment for TB disease

TB disease develops when the TB bacteria multiply in the body, and the immune system is not able to stop them from growing. The affected person becomes sick, and may spread the bacteria to others. However, the disease can be treated by taking different drugs for six to nine months with an initial phase of two months followed by a choice of options for the continuation phase of either four or seven months.

For an antibiotic combined treatment, the following drugs are primarily used:

  • Isoniazid
  • Rifampin
  • Ethambutol
  • Pyrazinamide

It’s very important that the patients with tuberculosis disease finish the medicine, and take the drugs exactly as prescribed. If not, they can become sick again. If they don’t stick to the prescription, the TB bacteria are still alive and might become resistant to those drugs. Tuberculosis that is resistant to medication is harder and more expensive to treat.

Modifications in treatment should be considered under special circumstances, e.g. if the patients are children, pregnant women, people with HIV infection or suspected drug resistance.

Preventive measures

Every person who has an increased risk of tuberculosis should be screened for latent TB infection. This may apply to people…

  • with HIV infection
  • having a disease that weakens the immune system
  • who have been infected with TB in the last two years
  • who were not treated correctly for TB in the past
  • who use IV drug
  • are addicted to alcohol
  • are homeless
  • with crowded living conditions
  • who migrated from a country with many TB cases
  • who are in contact with infected individuals
  • who treat people with a high risk of TB

…as well as babies, young children, elderly people.

It is important to remember that TB germs remain in the body unless they are killed with the right medicine.