Tuberculosis - Types, Causes, Symptoms, Diagnosis, Treatment and Prevention


Embrace and count your every breathe! You Can Stop TB!



Background


In the 20th century, TB was a leading cause of death in the United States. It is a contagious, infectious disease that occurs due to Mycobacterium tuberculosis (MT), which usually lasts throughout the life course and determines the formation of tubercles in different parts of the body.


Mycobacterium tuberculosis (MT) has very ancient origins as it has survived over 70,000 years and it currently infects nearly 2 billion people worldwide with around 10.4 million new cases of TB each year, almost one third of the world's population are carriers of the TB bacillus and are at risk for developing active disease


The tuberculosis infections began increasing in 1985, partly because of the emergence of HIV, the virus that causes AIDS. HIV weakens a person's immune system so it can't fight the TB germs so people with HIV are more likely to get TB. The World Health Organization (WHO) describe it as an “epidemic.” They report that it is among the top 10 causes of death globally and “the leading cause of death from a single infectious agent.”


Ending the TB epidemic by 2030 is a health target under the Sustainable Development Goals, following a global failure to achieve the Millennium Development Goal of reversing the TB epidemic by 2015.


Meaning


Development of tuberculosis


Tuberculosis (TB) is a contagious infection that usually attacks your lungs. It can also spread to other parts of your body, like your brain and spine. It can

develop when bacteria spread through droplets in the air


Tuberculosis Types


Latent TB


In this condition, you have TB infection, but the bacteria remain in your body in an inactive state and has no symptoms. But the infection is still alive and can one day become active. So treatment is important for the person with latent TB and to help control the spread of TB. An estimated 2 billion people have latent TB.


Active TB. 


In this condition, the germs multiply and make you sick and can spread the disease easily to others. Without medical intervention, TB becomes active in 5–10% of people with the infection. In about 50% of these people, the progression occurs within 2–5 years of getting the infection, according to the CDC.

The risk of developing active TB is higher in:

  • anyone immune system is weak

  • anyone who first developed the infection in the past 2–5 years

  • older adults and young children

  • people who use injected recreational drugs

  • people who have not received appropriate treatment for TB in the past

  • anyone who is health care worker for patients at high risk of TB

  • anyone who is smoker

  • anyone is part of a group in which TB is more likely to spread which includes homeless people, people who have HIV, people in jail or prison, and people who inject drugs into their veins etc.

  • Healthcare workers who come in contact with high-risk populations


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Causes -

tuberculosis








It is caused by infection with Mycobacterium tuberculosis (Mtb) bacteria that spread from person to person through microscopic droplets released into the air. This can happen when someone with the untreated, active form of tuberculosis coughs, speaks, sneezes, spits, laughs or sings.


Although it spreads in a similar way to a cold or flu but it is not as contagious.

For example, TB infections usually spread between family members who live in the same house. It would be highly unlikely for you to become infected by sitting next to an infected person on, for instance, a bus or train.


Other common causes -

  • Travelling/ living in places where TB is prevalent

  • People with substance abuse problem

  • People with weak immunity system and those suffering from grave illness such as HIV

  • Health care workers who are exposed to patients with active TB

  • People suffering from diabetes, kidney disease, malnutrition

  • People who have been using steroids for a long time

  • Pregnant women and people undergoing radiotherapy are at a higher risk than others


Symptoms


TB disease usually develops slowly, and it may take several weeks before you notice you're unwell or sometimes there are no symptoms i.e in case of Latent TB but if you find general symptoms like -


Lack of appetite and weight loss







A high temperature

high temperature






Night sweats

Night sweats










Extreme tiredness or fatigue

tiredness and fatigue








Prolonged cough lasting weeks

prolonged cough









Coughing blood or sputum

coughing blood






How is TB diagnosed?


TB infection is often diagnosed by

- Reviewing medical history of patient and perform physical examination which involves listening to the lungs and checking for swelling in the lymph nodes.

- A skin or blood test.

- Chest X-ray

- CT scan,MRI scan,ultra sound scan

- Sputum test


However diagnosis is different to every person as it is decided on the basis of symptoms and vulnerability of tuberculosis disease.



Treatment


The treatment depends on vulnerability of infection. But general precautions taken by medical practitioner include -

  • Short term hospital stay

  • In case of latent TB often a 3- to 9-month course of 1 or 2 antibiotics will be given to kill off the TB organisms in the body. The most common antibiotics prescribed are isoniazid, rifapentine, and rifampin.

  • A combination of medicines treats Active TB. The most common drugs are ethambutol, isoniazid, pyrazinamide, and rifampin. You’ll take them for 6 to 12 months. People often begin to improve within a few weeks of starting treatment provided medicine must be finished for the greatest chance of cure, as prescribed by a healthcare provider.

  • If you have drug-resistant TB, your doctor might give you one or more different medicines. You may have to take them for much longer, up to 30 months, and they can cause more side effects.



Prevention/ Precautions


To help stop the spread of TB -

  • Early diagnosis and prompt effective treatment of infectious cases

  • Usage of Bacillus Calmette-Guerin (or BCG) vaccine, Isoniazid preventive therapy (IPT) and Antiretroviral therapy (ART) for people with HIV.

  • It is important to take medications as per the doctor’s instructions. It is crucial to understand that if the medications are stopped in between the prescribed course, TB infection can recur.

  • If you have a latent infection, take all of your medication so it doesn’t become active and contagious.

  • If you have active TB, limit your contact with other people and take precautions like covering your mouth when you laugh, sneeze, or cough. Wear a surgical mask when you’re around other people during the first weeks of treatment.

  • If you’re traveling to a place where TB is common, avoid spending a lot of time in crowded places with sick people.

  • People with TB often have a poor appetite initially so having more frequent balanced diet intake can be helpful to avoid malnutrition. Balanced diet includes -Vegetable oils, ghee, butter ,nuts and oil seeds,milks & milk products, meat, fish, poultry, Green leafy vegetables and other vegetables & fruits. Also include eggs, milk & milk products and flesh foods.

  • Daily exercise is must for TB patients to improve appetite to avoid weight loss

  • TB patient to avoid foods like Alcohol in any form, as it increases the risk of drug toxicity, Carbonated drinks, excess of tea and coffee, or their intake with food, tobacco and tobacco products.

  • The vaccine called Bacillus Calmette-Guerin (BCG) was first developed in the 1920s. It is part of the national childhood immunization programme and is generally used to protect children, rather than to interrupt transmission among adults

  • TB education is also necessary as precautionary/preventive measure for the general public so that they are well versed with basic information about TB.

  • TB drug treatments like chemoprophylaxis is great precautionary measure to reduce the risk of a first episode of active TB occurring in people with latent TB

  • Houses should be adequately ventilated

  • Educate people on cough etiquette and respiratory hygiene, and should follow such practice at all times

  • Doctors and other health care workers must follow infection control procedures as precautionary measures to prevent spread of TB. Besides,infection control guidance must not only be written but also implemented systematically.



TB Infection- Control Measures


The TB infection-control measures includes -

  1. Administrative controls

  2. Environmental controls

  3. Use of respiratory protective equipment


Administrative Controls


Administrative controls are intended to reduce the risk or exposure to persons with infectious TB.  These control measures consist of the following activities:

  • Assigning someone the responsibility for TB infection control, conducting risk assessment and applying epidemiology based prevention principles in the health care setting

  • Developing and implementing a written TB infection-control plan;

  • Ensuring the availability of recommended laboratory processing, testing, and reporting of results;

  • Ensuring proper cleaning, sterilization, or disinfection of equipment that might be contaminated (e.g., endoscopes);

  • Educating, training, and counseling health care workers, patients, and visitors about TB infection and disease;


Environmental Controls


Environmental controls are used to prevent the spread and reduce the concentration of infectious droplet nuclei.  This includes two types of environmental control.

  • Primary environmental controls consist of controlling the source of infection by using local exhaust ventilation (e.g., hoods, tents, or booths) and diluting and removing contaminated air by using general ventilation.

  • Secondary environmental controls consist of controlling the airflow to prevent contamination of air in areas adjacent to the source airborne infection isolation (AII) rooms; and cleaning the air by using high efficiency particulate air (HEPA) filtration, or ultraviolet germicidal irradiation.


Respiratory Controls


Respiratory-protection control consists of the use of personal protective equipment in situations that pose a high risk of exposure to TB disease through control measures such as -

  • Implementing a respiratory protection program;

  • Training health care workers on respiratory protection; and

  • Educating patients on respiratory hygiene and the importance of cough etiquette procedures


Conclusion -


Tuberculosis proves to be a disease that is quite hard to get, yet hard to cure as well. Besides, treatment for tuberculosis can be successful if the infected person takes all the medication as directed and has access to proper medical care.


Medicine will be harder to acquire in most low- to middle-income countries, and lower quality of health-care, diagnosis and regulation due to which diagnosis in these countries will be less accurate and often misdiagnosed as TB as lung cancer or pneumonia thus incorrect treatment will be used.


A lot of research is focusing on TB presently trying to cure the world that includes everyone from low income countries to high income countries of this disease. Nevertheless progress at the moment is progressing slow but steady and if the steady pace is maintained then Tuberculosis might have disappeared from the list of leading diseases of most deaths annually within a few decades.


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https://www.webmd.com/lung/understanding-tuberculosis-basics