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Tuberculosis (TB)

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Overview of Tuberculosis (TB)

TB Meaning in Urdu

ٹی بی ایک بیکٹیریل انفیکشن ہے جو کہ پھیپھڑوں کو متاثر کرتا ہے۔ یہ مرض جسم کے دوسرے اعضاء جیسا کہ گردوں، ریڑھ کی ہڈی، اور دماغ پر بھی اثر انداز ہو سکتا ہے۔ یہ ایک متعدی بیماری ہے جو کہ ٹی بی کے مریض کے چھینکنے یا کھانسنے کی وجہ سے دوسرے شخص میں منتقل ہو سکتی ہے۔ ٹی بی کو تین اسٹیجز میں تقسیم کیا جاتا ہے۔ اس مرض کی بنیادی علامات میں تین ہفتوں سے زیادہ کھانسی، کھانستے وقت خون یا بلغم کا اخراج، سینے میں درد، کھانستے وقت سینے میں درد، وزن میں کمی، تھکاوٹ، بخار، رات کو پسینہ آنا، سردی لگنا، اور بھوک میں کمی شامل ہے۔

Tuberculosis or TB (دق/Daq) is a life-threatening infectious disease that mainly damages your lungs. Tuberculosis is caused by the bacterium Mycobacterium tuberculosis. TB can also spread to other parts of the body such as the brain and spinal cord. Bacteria causing TB can be easily transferred from one person to another via droplets that are released into the air during coughing and sneezing.

The tuberculosis bacterium mostly attacks a person having a weak immune system due to certain diseases (AIDS, diabetes, liver or kidney damage), chemotherapy and drugs for autoimmune disorders. Due to weak immunity, the patient can’t fight the TB germs. The main hurdle in the eradication of TB is the development of drug-resistant strains of the bacterium. However, it can be treated by taking several types of medications by a doctor’s prescription for a certain period.

Occurrence of Tuberculosis

Pakistan is among the top 20 countries that have a high rate of tuberculosis prevalence and mortality. Pakistan shares a total of 80% of the global burden of tuberculosis. According to WHO, the incidence of tuberculosis in Pakistan is 230 per 100,000. While the estimated prevalence rate is 39 per 100,000. This indicates 410,000 incident cases of tuberculosis and 69,000 TB deaths in Pakistan every year.

As per studies, SINDH has a higher number of cases as compared to other provinces in Pakistan. Mostly, males aged 15 or above are affected by TB as compared to females.

Signs and Symptoms of Tuberculosis (TB)

Common signs and symptoms of active TB are:

  • Coughing that lasts three or more weeks
  • Chest pain, or pain with breathing or coughing
  • Coughing up blood
  • Unintentional weight loss
  • Night sweats
  • Fatigue
  • Fever
  • Chills
  • Loss of appetite

The signs and symptoms vary when tuberculosis is spread to other parts of your body. You may experience back pain in the spine TB and if it spreads to the kidneys, you will notice blood in your urine.

Types of Tuberculosis (TB)

Tuberculosis classification is based on:

  • State of bacteria (active or inactive)
  • Site of infection

Types of Tuberculosis Based on Activity

  • Latent TB- In this condition, the TB bacterium has infected your body but is in an inactive form and causes no signs and symptoms. Latent TB is also termed inactive TB or TB infection. This type of tuberculosis is not contagious. However, a person with latent TB needs proper treatment to prevent bacterial activation and spread. Approximately, 2 billion people suffer from latent TB. 

  • Active TB- This condition starts rapidly after infection with the TB bacteria (in the first few weeks). It can make you severely ill and spread to others.  

Types of Tuberculosis Based on Infection Site

Pulmonary TB- This condition develops when the TB bacterium infects the lungs. It is an active form of TB and is spread to others by bacteria in the air. TB bacteria can persist in the air for several hours. Pulmonary tuberculosis symptoms are:

  1. Persistent cough lasting three weeks or longer
  2. Chest pain
  3. Coughing up blood and phlegm
  4. Shortness of breath

 

Extrapulmonary TB- Extrapulmonary TB is a type of TB that spread to other parts of the body outside the lungs. Symptoms vary with the type of organ affected.

Causes of Tuberculosis (TB)

Tuberculosis is caused by TB bacteria that spread from one person to another through tiny droplets released by an infected patient during coughing, sneezing, and spits.

HIV and TB

Mostly, TB germs attack a person whose immune system has been weakened by HIV (AIDS). Therefore, people with AIDS are more likely to be affected by TB bacteria and rapidly changed to an active form.

Drug-resistant TB

  • Another reason for tuberculosis's rapid prevalence is the emergence of antibiotic-resistant strains of Mycobacterium. The first antibiotic for TB has developed about 60 years ago, some TB bacterial strains develop resistance to the drug that is passed on to the next generations. 
  • Antibiotic resistance emerges when all the bacteria except one or two are killed by a particular drug. The surviving TB germ develops resistance against that particular drug and frequently to other drugs as well. 
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Risk Factors of Tuberculosis (TB)

Anyone can be affected by tuberculosis but some factors increase the risk of developing TB such as:

Weakened Immune System due to certain diseases or medicines:

  • AIDS(HIV)
  • Severe kidney damage
  • Diabetes
  • Certain cancers
  • Chemotherapy
  • Some drugs for the treatment of rheumatoid arthritis, Crohn's disease and psoriasis
  • Very young or advanced age
  • Malnutrition

Poverty and Substance Use

  • Lack of proper medical care due to low income
  • Use of tobacco
  • Use of intravenous drugs and alcohol

Living in Certain Areas

People living in areas where the incidence rate of tuberculosis is higher are more susceptible to TB:

  • Africa
  • Eastern Europe
  • Asia
  • Russia
  • Latin America
  • Caribbean Islands

Health-Related Complications of Tuberculosis

If tuberculosis is not treated properly, it can result in health-related complications. Untreated TB can spread from the lungs to other parts of the body. TB complications include:

 

  • Spinal pain
  • Joint damage (TB arthritis affects hip and knee bones)
  • Swelling of membranes surrounding meningitis (brain)
  • Liver and kidney damage (affect the filtration of waste from the blood)
  • Heart problems (affect heart tissues and interfere with the heart’s pumping ability)

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Prevention

Tuberculosis is an infectious disease that spreads rapidly, therefore it's necessary to take measures to prevent its spread. TB is spread from the lungs of an infected person to another. Its spread can be prevented by the following actions:

  • If you have active or even latent TB stay at home and take medicines for 6-12 months as per the doctor’s prescription.
  • Always cover your mouth tissue, while coughing, sneezing, or talking. After that, seal the tissue in a bag and throw it away. 
  • Wash your hands properly after coughing and sneezing.
  • Avoid the use of public transportation
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Diagnosis

TB is diagnosed by your doctor in the following way:

Physical examination: After inquiring about your symptoms the doctor will physically examine you. During the physical exam, your physician will check your lymph nodes for swelling. Further, the sounds of your lungs while you breathe will be checked by a stethoscope.

Skin Test: The most common diagnostic test for tuberculosis is the skin test. In this test, PPD Tuberculin is injected in a small amount under your skin. Within 48-72 hours, your healthcare will check for swelling at the injection site. If a raised, red bump appears it confirms the TB infection. The size of the bump determines the significance of the test.

  • Results of skin tests can be wrong such as false positives and false negatives.
  • A false-positive test occurs if you have been recently vaccinated with the Bacillus Calmette-Guerin (BCG) vaccine. 
  • False-negative results mostly occur in children, older people, and people with AIDS. A false-negative result can also occur in people who've been infected with TB, but their immune system has not recognized the bacteria yet. 

Blood Tests: Blood tests may be used to differentiate between latent or active tuberculosis. These tests are used to measure your immune system's reaction to mycobacterium. For blood tests, you have to visit the lab only once. A useful test when you are at high risk of TB infection, but the skin test gives negative results.

Imaging Tests: If your skin test was positive your doctor will ask for a chest X-ray or a CT scan. This test will show the white spots on the lungs where TB has been walled off by the patient’s immune system or changes caused by active TB. 

Sputum Tests: If signs of TB are confirmed by the chest X-ray test, your sputum samples will be further checked by culturing, microscopy, and susceptibility test to confirm the TB bacteria.

Other tests include the TB Infection test. 




Treatment of Tuberculosis (TB) | When to Consult a Doctor

Proper medication is necessary for the complete treatment of tuberculosis. Treatment of tuberculosis takes longer than treatment of other infectious diseases. For active tuberculosis, you may have to take antibiotics for 6-9 months. TB is a completely curable disease. The type of drugs and duration of treatment depends on:

  • Overall health
  • Age
  • Possible drug resistance
  • Organ of infection

Most Common Drugs for TB

The most common drugs for the treatment of TB are:

  • Ethambutol (Myambutol)
  • Isoniazid
  • Pyrazinamide
  • Rifampin (Rifadin, Rimactane)

For antibiotic-resistant TB, a combination of antibiotics such as fluoroquinolones and injectable medications i.e. amikacin or capreomycin (Capastat), are usually prescribed for 20-30 months. 

If you experience symptoms of TB seek medical care as soon as possible. If the serious side effects of the already prescribed medicines appear, consult your doctor immediately. 

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