Tuberculosis – All that you need to know

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If you are reading this post, most likely you are educated and probably living in an urban area. You probably do know about Tuberculosis (and have always struggled with it’s spelling), more commonly known as TB but at the same time, do not worry about it too much. It is a disease in rural areas and affects the lower socioeconomic groups. However, this is just a myth. Even countries like United States have cases of TB. Nelson Mandela, Ringo Starr and Carlos Santana have all suffered from tuberculosis at some point in their lives.

TuberculosisNow you must be thinking that since you got TB vaccination – Bacillus Calmette-Guérin (BCG), you are not prone to it. That again is a myth. The BCG vaccine may help protect babies and young children from developing serious forms of TB. The BCG vaccine has limited efficacy in adults. Tuberculosis remains a problem even today.

Although tuberculosis is still associated with poverty, malnutrition and crowded living conditions, the disease is endemic among rich and poor. Among the affluent, it has simply been lying in wait, only to emerge when the immune systems of the new rich are compromised by the same stress factors that are causing an increases in “lifestyle related” problems like type 2 diabetes and heart disease.

In a ctuberculosisountry where tuberculosis is more or less endemic, anyone can have latent TB present in the body that does not manifest because of a good immune system. But if the immune system goes down, the time is ripe for the TB to actually flare up.

More than the rate actually going up in affluent people, it may be just that people are realizing that TB is affecting everyone, not just the really poor. For the middle or affluent class there is a far greater taboo about accepting the fact that they have TB. These factors, too, make a disease that should be easily cured more difficult to treat.

tuberculosis CoughTuberculosis is better known as the debilitating lung ailment but India’s affluent sufferers are mainly falling victim to lesser known versions of the disease that strike the stomach, heart or even bone. That makes sufferers even less likely to think they have TB, and also makes it harder for doctors to make the right diagnosis.

India is the highest TB burden country with World Health Organisation (WHO) statistics for 2011 giving an estimated incidence figure of 2.2 million cases of TB for India out of a global incidence of 8.7 million cases.

Most TB cases can be cured easily if the victim seeks medical treatment early in the disease’s progression, and their doctors get the diagnosis right and prescribe the right treatment. But the more fear and shame associated with TB, the less likely that is to happen. So, now that you are actually thinking that you might be susceptible to TB, let us tell you more about the disease, it’s prevention and cure.

About the Disease

Tuberculosis, commonly known as TB, is a bacterial infection that can spread through the lymph nodes and bloodstream to any organ in your body. It is most often fountuberculosis 2d in the lungs. Most people who are exposed to TB never develop symptoms because the bacteria can live in an inactive form in the body. But if the immune system weakens, such as in people with HIV or elderly adults, TB bacteria can become active. In their active state, TB bacteria cause death of tissue in the organs they infect. Active TB disease can be fatal if left untreated.

Symptoms

symptoms-tuberculosisThe symptoms of active TB are very variable and depend on which part of the body has been infected, that is which type of TB it is. It is very difficult to diagnose TB just from the symptoms, because the symptoms are not usually exclusive to TB. This means that the symptoms can usually also be the symptoms of another disease as well. So to diagnose TB it is always necessary to do at least one TB test. However, these are some common symptoms.

causes-tuberculosis

  • Overall sensation of feeling unwell
  • Cough, possibly with bloody mucus
  • Fatigue
  • Shortness of breath
  • Weight loss
  • Slight fever
  • Night sweats
  • Pain in the chest

Prevention

TB prevention consists of two main parts.

  • First main part of TB prevention is to stop the transmission of TB from one adult to another. This is done through firstly, identifying people with active TB, and then curing them through the provision of drug treatment. With proper TB treatment someone with active TB disease will very quickly not be infectious and so can no longer spread the disease to others.
  • The second main part of TB prevention is to prevent people with latent TB from developing active, and infectious, TB disease.

Preventing TB transmission in households

people at risk-tuberculosisIn order to reduce exposure in households where someone has infectious TB, the following actions should be taken whenever possible:

  • Houses should be adequately ventilated;
  • Anyone who coughs should be educated on cough etiquette and respiratory hygiene, and should follow such practice at all times;
  • While smear positive, TB patients should:
    • Spend as much time as possible outdoors;
    • If possible, sleep alone in a separate, adequately ventilated room;
    • Spend as little time as possible on public transport;
    • Spend as little time as possible in places where large numbers of people gather together.

Cough etiquette and respiratory hygiene means covering your nose and mouth when coughing or sneezing. This can be done with a tissue, or if the person doesn’t have a tissue they can cough or sneeze into their upper sleeve or elbow, but they should not cough or sneeze into their hands. The tissue should then be safely disposed of.

Treatment for TB

tbThe aims of TB treatment are:

  • To cure the patient and restore quality of life and productivity;
  • To prevent relapse of TB;
  • To reduce the transmission of TB to others;
  • To prevent the development and transmission of drug resistant TB.

Drugs for TB Treatment

There are more than twenty drugs that are currently used for the treatment of TB and almost all of them were developed some years ago. The drugs are used in differing combinations in different circumstances, so that for example some TB drugs are only used for the treatment of new patients who are very unlikely to have resistance to any of the TB drugs. There are other TB drugs that are only used for the treatment of drug resistant TB.

The five basic or “first line” TB drugs are:

  • Isoniazid
  • Rifampicin
  • Pyrazinamide
  • Ethambutol
  • Streptomycin

TB drug treatment for new patients

tuberculosis 3New patients are those who have either not had any TB treatment before, or they have only had less than one month of anti TB drugs. New patients are presumed to have drug susceptible TB (i.e. TB which is not resistant to any of the drugs) unless there is a high level of Isoniazid resistance in new patients in the area, or the patient has developed active TB disease after they have had contact with a patient who is known to have drug resistant TB.

For these patients the World Health Organisation (WHO) recommends that they should have six months of TB drug treatment. This should consist of a two month “intensive” treatment phase followed by a four month “continuation” phase.

 For the two month “intensive” TB drug treatment phase they should receive Soniazid with Rifampicin and Pyrazinamide and Ethambutol This should be followed by Isoniazid with Rifampicin for the “continuation” TB drug treatment phase.

 tuberculosis_treatmentIt is essential to take several TB drugs together. If only one TB drug is taken on its own, then the patient will very quickly become resistant to that drug. It is recommended that patients take the TB drugs every day for the six months, although taking them three times a week is possible in some circumstances. It is extremely important that all the recommended TB drugs are taken for the entire time.

If only one or two of the TB drugs are taken, or the treatment is interrupted or stopped early, then the treatment probably won’t work, because the TB bacteria that a patient has develops resistance to the TB drugs. Not only is the patient then still ill, but to be cured they then have to take drugs for the treatment of drug resistant TB, and these drugs are more expensive and have more side effects.

DOTS Treatment

DOTS Treatment DoctorWe have read about it on TV and Radio. But what exactly is DOTS treatment? Directly Observed Treatment, Short Course (DOTS) is WHO recommended strategy which was launched formally as Revised National TB Control Programme in India in 1997 after pilot testing from 1993-1996. Since then DOTS has been widely advocated and successfully applied.

The five key components of DOTS are

  •  Political commitment to control TB;
  • Case detection by sputum smear microscopy examination among symptomatic patients;
  • Patients are given anti- TB drugs under the direct observation of the health care provider/community DOT provider;
  • Regular, uninterrupted supply of anti-TB drugs; and
  • Systematic recording and reporting system that allows assessment of treatment results of each and every patient and of whole TB control programme.

References:

http://www.tbfacts.org/tb-statistics-india.html

http://www.webmd.com/a-to-z-guides/understanding-tuberculosis-basics

http://www.webmd.com/a-to-z-guides/understanding-tuberculosis-symptoms

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