Tuberculosis (TB) TUBERCULOSIS by Justina April 7, 2024 written by Justina Tuberculosis (TB) is a contagious disease caused by bacteria. It usually attacks the lungs, but it can also spread to other parts of the body like your spine, brain, or kidneys. The word “tuberculosis” itself means “nodule” or “lump,” which can form in infected tissues. Not Everyone Gets Sick: While TB is contagious, not everyone who comes intoto contact with the bacteria will develop the disease. Here’s the breakdown: Latent TB Infection: If you’re infected but don’t have any symptoms, you have latent TB. The bacteria are dormant (inactive) in your body. You’re not contagious at this stage. Active TB Disease: If your immune system weakens and the dormant bacteria become active, you develop active TB disease. This form of TB is contagious and requires treatment. What’s the cause? Tuberculosis is primarily caused by a bacterium known as Mycobacterium tuberculosis. How does it spread? When individuals with active TB disease in their lungs or voice box cough, sneeze, speak, laugh, or sing, they release tiny droplets containing the bacteria into the air. Inhaling these droplets can lead to infection. The likelihood of transmission is higher in indoor settings where people spend extended periods together, such as living or working closely. Additionally, crowded gatherings facilitate the spread of the disease. It’s important to note that individuals with latent TB infection cannot transmit the disease to others. Moreover, those undergoing treatment for active TB disease typically become non-infectious after 2 to 3 weeks of treatment. Stages of TB infection Here’s a simplified breakdown of the three stages of TB infection: Primary TB: This is the first stage of a TB infection. Your immune system goes to battle against the TB bacteria. In some cases, the immune system successfully fights off the infection, and you might not experience any symptoms. However, sometimes the bacteria aren’t completely eliminated and remain dormant in your body. Latent TB: In latent TB, you have the TB bacteria living inside you, but your immune system keeps them under control. This means you don’t have any symptoms and can’t spread the disease to others. However, the infection is still present and could become active TB later if your immune system weakens. People with certain conditions, like HIV, abnormal chest X-rays, a recent TB infection, or a weakened immune system, are at higher risk of reactivation. If you fall into this category, your doctor might recommend preventive medication to prevent active TB. Active TB: Active TB occurs when the TB bacteria multiply and make you sick. This is a contagious form of the disease, and you can spread it to others through the air when you cough or sneeze. Around 90% of active TB cases in adults develop from a latent TB infection that wasn’t treated. Drug-Resistant TB: Both latent and active TB can be drug-resistant. This means the bacteria have developed resistance to certain medications used to treat TB, making it more difficult to cure the infection. How does tuberculosis become drug-resistant? Certain strains of the tuberculosis (TB) bacteria have developed resistance to drugs, rendering previously effective treatments ineffective. This resistance arises partly due to natural genetic mutations in the bacteria. Sometimes, a random genetic alteration in a bacterium provides it with traits that help it withstand the assault of an antibiotic. If the bacterium survives, it can multiply and propagate. When antibiotic medications are misused or fail to eradicate all the bacteria for various reasons, it creates favorable conditions for the emergence and proliferation of more resistant bacterial strains. If these drug-resistant bacteria are transmitted to others, they can lead to the development of new drug-resistant strains over time. There are two main ways TB bacteria become drug-resistant: Natural Mutation: Sometimes, bacteria naturally develop random genetic changes. One of these changes might allow them to survive antibiotic treatment. If these “superbugs” survive and multiply, they can spread to others. Misusing Antibiotics: When antibiotics aren’t used correctly, it creates a breeding ground for drug-resistant bacteria. This can happen if: Patients don’t finish their medication: Stopping antibiotics early allows some TB bacteria to survive and potentially mutate into a drug-resistant form. Doctors prescribe the wrong treatment: If the wrong antibiotics are used, the TB bacteria won’t be effectively targeted. Poor-quality drugs: Medications that are counterfeit or improperly stored might not be effective in killing the bacteria. Limited access to medication: In some areas, access to proper TB treatment might be limited, leading to patients not receiving the full course of antibiotics. Body’s absorption issues: In rare cases, a person’s body may not properly absorb the antibiotics, allowing the bacteria to survive. Preventing Drug-Resistant TB Combating drug-resistant TB requires a multi-pronged approach: Patients completing their full course of antibiotics, even if they feel better. Doctors prescribing the correct TB treatment regimens. Ensuring access to high-quality antibiotics for TB treatment. Developing new TB medications and diagnostic tools. Raising awareness about the importance of completing antibiotic treatment. TB Around the World: Tuberculosis remains a serious global health concern. Here are some statistics to highlight its impact: Globally, around 10 million people contract TB annually, with approximately 1.5 million deaths attributed to the disease in 2020. In the United States, TB was once a leading cause of death. However, advancements in treatment significantly reduced cases in the mid-20th century. As of 2021, the US reported roughly 7,860 TB cases, translating to a national incidence rate of 2.4 cases per 100,000 people. Different Types of Tuberculosis Tuberculosis (TB) is a bacterial infection that typically targets the lungs, known as pulmonary TB. But TB isn’t confined to the lungs! This sneaky bacteria can invade other parts of your body, causing what’s called extrapulmonary tuberculosis. Here’s a breakdown of the different types of TB you might encounter: Pulmonary TB: This is the most common form, affecting the lungs. Symptoms often include a persistent cough, fever, weight loss, and night sweats. Extrapulmonary TB: When TB spreads beyond the lungs, it can cause a variety of illnesses,, depending on the infected organ. Here are some examples: Meningitis: This serious condition involves inflammation of the membranes surrounding the brain and spinal cord. It can cause headaches, fever, and neck stiffness. Sterile pyuria: This refers to high levels of white blood cells in the urine, even though there’s no bacterial infection present. It can be a sign of TB affecting the urinary system. Pott’s disease (spinal tuberculosis): This type of TB attacks the bones and joints of the spine, causing back pain and difficulty walking. Addison’s disease: TB can damage the adrenal glands, leading to a hormonal imbalance and symptoms like fatigue, muscle weakness, and weight loss. Hepatitis (liver infection): TB can also infect the liver, causing symptoms like jaundice (yellowing of the skin and eyes), fatigue, and abdominal pain. Lymphadenitis: This is inflammation of the lymph nodes, which are part of the immune system. TB can cause swollen lymph nodes, particularly in the neck (scrofula). Miliary tuberculosis: This is a rare but serious form of TB where the bacteria spreads throughout the body through the bloodstream. It can cause widespread inflammation and affect multiple organs, leading to various symptoms. Symptoms of tuberculosis Tuberculosis (TB) is a serious infection caused by bacteria. While the germs can enter the body and cause an infection, they don’t always make you sick. Here’s a breakdown of TB infection stages and the symptoms you might experience in each: Stage 1: Primary TB Infection This is the initial stage where the bacteria enter your lungs and your immune system fights back. Most people don’t have any symptoms during this stage. However, some might experience flu-like symptoms such as: Low fever Feeling tired Cough Stage 2: Latent TB Infection In many cases, the immune system successfully surrounds the bacteria and creates a “wall” to keep them under control. This stage is called latent TB infection. There are no symptoms during this stage, and the person with latent TB cannot spread the infection to others. Stage 3: Active TB Disease Sometimes, the immune system can’t fully control the bacteria, and they become active again. This is called active TB disease. Symptoms usually develop gradually and worsen over time. Here’s what to watch out for in active TB disease, particularly in the lungs: A cough that lasts for more than three weeks Coughing up blood or mucus Chest pain, especially when breathing or coughing Fever Chills Night sweats Weight loss Loss of appetite Feeling tired and unwell Active TB Outside the Lungs TB can spread from the lungs to other parts of the body, causing extrapulmonary TB. Symptoms vary depending on the infected area. General symptoms often include: Fever Chills Night sweats Weight loss Loss of appetite Feeling tired and unwell Pain near the infected area Active TB in Children: Symptoms in children can vary based on age. Here’s a general breakdown: Teenagers: Similar symptoms to adults Ages 1-12: Fever that won’t go away and weight loss Infants: Failure to thrive (not growing or gaining weight as expected), fussiness, vomiting, poor feeding, bulging soft spot on the head, and poor reflexes Risk factors of tuberculosis Certain factors make some people more susceptible to getting infected or developing active TB disease. Here’s a breakdown of the key risk factors: Increased Risk of TB Infection: Living with someone with active TB: If you share a living space with someone who has active TB, your risk of catching the infection goes up. Travel or residence in high-risk areas: Countries in Latin America, Africa, Asia, and the Pacific Islands have a higher prevalence of TB. Living or traveling in these areas increases your risk. Crowded living conditions: Packed spaces like prisons, shelters, and nursing homes can make TB transmission easier. High-risk communities: If you live in an area identified as having a high number of TB cases, you may be at increased risk. Healthcare workers: If your job involves treating people with TB or those at high risk of TB, you have a higher chance of exposure. Increased Risk of Active TB Disease Weakened immune system: Conditions like HIV/AIDS, diabetes, certain cancers, malnutrition, and kidney disease can weaken your body’s defenses, making it harder to fight off TB infection. Medical treatments: Certain treatments like chemotherapy, medications to prevent organ rejection after transplants, and long-term steroid use can suppress the immune system, increasing the risk of active TB. Substance abuse: Using illegal intravenous drugs, misusing alcohol, and smoking (including tobacco products) all weaken the immune system and raise the risk of active TB disease. Age and active TB disease: Children under 5: Young children, especially those under 2, are highly susceptible to developing active TB disease from a TB infection. In these cases, TB often affects the fluid surrounding the brain and spine, leading to serious complications. 15-25 year olds: People in this age group are more prone to developing severe active TB in the lungs. Adults 65 and older: As we age, our immune systems naturally weaken. Older adults have a higher risk of active TB disease, and treatment can be more challenging. Diagnosis of tuberculosis Diagnosing tuberculosis (TB) involves a series of examinations and tests conducted by healthcare providers to confirm the presence of the infection. Here’s what the diagnostic process typically involves: Physical Examination: Listening to your Lungs: Using a stethoscope, your doctor will listen for abnormal sounds in your lungs that could indicate TB. Lymph Node Check: Swollen lymph nodes in your neck or chest can be a sign of TB infection. Symptom Review: Your doctor will ask you about your symptoms, such as cough, fever, night sweats, and weight loss. TB Tests: When are TB tests done? Your doctor may recommend a TB test if they suspect TB infection, you’ve had potential exposure to someone with TB, or have risk factors for developing active TB. Skin Test vs. Blood Test: Your doctor will decide if a skin test (Mantoux tuberculin skin test) or a blood test (interferon gamma release assay) is more suitable based on your individual case. Skin Test: How it works: A tiny amount of tuberculin, a substance used to detect TB infection, is injected under the skin of your forearm. Reading the results: Within 2-3 days, a healthcare professional will check your arm for swelling at the injection site. The size of the swelling determines a positive or negative test. What a positive test means: A positive skin test indicates either a latent TB infection (inactive TB bacteria present in the body) or active TB disease (active infection causing symptoms). Limitations: People who received a BCG vaccination for TB may also have a positive skin test even without an infection. What a negative test means: A negative skin test generally implies your body didn’t react to the tuberculin, but it doesn’t definitively rule out TB infection. Blood Test: Procedure: A blood sample is drawn and sent to a lab for analysis. What it checks: The test looks for specific immune system cells that can recognize tuberculosis bacteria. Positive result: A positive blood test indicates either a latent TB infection or active TB disease. Negative result: A negative blood test suggests you likely don’t have a TB infection. Chest X-ray: Purpose: An X-ray image of your chest can reveal abnormal areas in your lungs, which might be a sign of active TB disease. Sputum Tests: Sample collection: If you have active TB in your lungs or airways, your doctor may collect a sample of mucus (sputum) produced when you cough. Lab tests: The sputum sample is tested in a lab to detect TB bacteria. Quick Test: A rapid test can provide preliminary results to see if the sputum likely contains TB bacteria. However, it may not differentiate TB from similar bacteria. Confirmation Test: Another lab test is needed to confirm the presence of TB bacteria and may take several weeks. This test can also determine if the bacteria is resistant to medications. This information helps your doctor choose the most effective treatment. Additional Tests: In some cases, your doctor may order other tests depending on your specific situation, such as: Breath test: This test measures your body’s response to certain inhaled substances to detect TB infection. Bronchoscopy: A thin tube with a camera is inserted into your airways to collect a sample of lung tissue or fluid for further analysis. Urine test: In rare instances, a urine test might be used to detect TB. Spinal Tap: A sample of fluid surrounding your spinal cord and brain (cerebrospinal fluid) may be tested for TB in specific situations. By combining the findings from the physical examination, TB tests, chest X-ray, and potentially other tests, your doctor can accurately diagnose TB infection and determine the best course of treatment. Treatments of tuberculosis Tuberculosis (TB) can be a serious infection, but with proper treatment, it’s curable. This article highlights the treatment options for both latent TB infection and active TB disease. Treating Latent TB Infection: If you have a latent TB infection, meaning you have the bacteria but aren’t sick, your doctor might recommend medication. This is especially true for people with weakened immune systems, such as those with HIV/AIDS. Treatment for latent TB infection typically lasts for 3-4 months. Treating active TB disease: Active TB disease requires a longer treatment regimen, lasting 4-6 months or even 9 months in some cases. TB specialists will determine the specific drugs and duration of treatment best suited for you. Regular doctor appointments are crucial to monitor your progress and check for any side effects. Taking medication seriously: Completing the entire course of medication is critical. Skipping doses or stopping treatment early can allow the bacteria to develop resistance to the drugs, making it harder to treat the infection in the future. Directly observed therapy (DOT) programs offered by public health departments can help ensure you take your medication as prescribed. A healthcare worker will witness you taking your dose at home. For those who don’t require DOT, the Centers for Disease Control and Prevention (CDC) offers printable trackers to help you keep track of your daily doses. Common TB Medications Depending on whether you have latent TB or active disease, you might be prescribed one or two medications for latent TB or a combination of several drugs for active TB. Some common TB medications include: Isoniazid Rifampin (Rimactane) Rifabutin (Mycobutin) Rifapentine (Priftin) Pyrazinamide Ethambutol (Myambutol) Potential Treatment Side Effects Most people tolerate TB medications well, but some may experience side effects. Talk to your doctor if you experience any of the following: Upset stomach, vomiting, or diarrhea Changes in appetite, stool color, or urine color Yellowing of the skin or eyes Vision problems, dizziness, or balance issues Tingling in hands or feet Easy bruising or bleeding Unexplained weight loss, tiredness, or mood changes Rash or joint pain It’s essential to communicate any side effects experienced during treatment to your healthcare provider, as some may indicate potential liver damage. Your provider can assess the severity of the side effects and make adjustments to your treatment plan if necessary. Monitoring for adverse reactions is an integral part of TB treatment to ensure the best possible outcomes and minimize risks to your health. Medication Interactions It’s important to disclose all medications, supplements, and herbal remedies you take to your doctor. Some may interact with TB medications and need to be adjusted or stopped during treatment. Prevention of tuberculosis Preventing tuberculosis (TB) involves measures to address both latent TB infection and active TB disease. Here’s what you need to know about TB prevention: Latent TB Infection (LTBI) Prevention: If you test positive for latent TB infection, you may require medication to prevent the development of active TB disease. Preventing the Spread of Active TB Disease: If diagnosed with active TB disease, it’s crucial to take prescribed medications for the specified duration (four, six, or nine months) without interruption. During the initial 2 to 3 weeks of treatment, when you’re still infectious, certain precautions should be followed: Stay home and avoid going to work or school to prevent spreading the disease to others. Isolate yourself within your home, minimizing contact with household members and sleeping in a separate room. Ventilate your living space by opening windows or using fans to improve airflow, as TB bacteria spread more readily in enclosed spaces. Wear face masks when in the presence of others to reduce the risk of transmitting the bacteria. Cover your mouth with a tissue when sneezing or coughing, and properly dispose of used tissues to prevent contamination. Vaccinations: In regions where TB is prevalent, infants may receive the bacille Calmette-Guerin (BCG) vaccine, which offers protection against severe forms of TB, particularly those affecting the brain and spinal cord. However, the BCG vaccine may not provide adequate protection against TB of the lungs, which is more common in some countries like the United States. Ongoing research is focused on developing and testing new TB vaccines to enhance prevention efforts worldwide. Sources Sources: U.S. Preventive Services Task Force Recommendation Statement – “Screening for Latent Tuberculosis Infection in Adults.” Cedars-Sinai – “Tuberculosis (TB).” MedlinePlus – “Acid-Fast Bacillus (AFB) Tests.” UpToDate – “Treatment of drug-resistant pulmonary tuberculosis in adults,” “Treatment of drug-susceptible pulmonary tuberculosis in HIV-uninfected adults.” Medscape – “Isoniazid,” “Pyrazinamide,” “Rifampin.” Children’s Hospital of Philadelphia – “A Look at Each Vaccine: Tuberculosis Vaccine.” TB Alert – “Treatment.” Brian W. Christman, MD – Professor and Vice-chair, Vanderbilt University Medical Center; Volunteer National Spokesperson, American Lung Association. Centers for Disease Control and Prevention (CDC) – “Tuberculosis,” “History of World TB Day.” American Lung Association – “Learn About Tuberculosis,” “How We Conquered Consumption,” “Tuberculosis (TB),” “How We Conquered Tuberculosis.” Mayo Clinic – “Tuberculosis,” “Ethambutol (Oral Route).” World Health Organization (WHO) – “Tuberculosis,” “Smoking and tuberculosis: a dangerous combination.” April 7, 2024 0 comment 0 FacebookTwitterPinterestLinkedinEmail
