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Tuberculosis

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What is tuberculosis?

Tuberculosis: is a highly infectious disease which primarily affects the lung however it can occur in any part of the body. It is caused by mycobacterium tuberculosis bacteria.

It is chronic, serious, and sometimes life-threatening in nature.

According to WHO, around 1.5 million people died due to tuberculosis in 2018 which includes 251,000 people who had HIV also. It is one of the top 10 caused of death and leading cause from a single infectious agent.In 2018, there were 10 million people who fell ill with tuberculosis(TB) worldwide, among them 5.7 million were men, 3.2 million women and 1.1 million were children.

Statistics shows that the 30 high TB burden countries accounted for 87% of new TB cases and 8 countries account for 2/3rd of the total, with India leading, followed by China, Indonesia, the Philippines, Pakistan, Nigeria, Bangladesh and South Africa.

Multidrug-resistant TB (MDR-TB) remains a public health crisis and a health security threat. WHO estimates that there were 484 000 new cases with resistance to rifampicin – the most effective first-line drug, of which 78% had MDR-TB.

How does it all happen?

• It is a very infectious disease hence it can easily spread from one person to another through microscopic droplets present in the air.

• The microscopic droplets are released into the air when an infected person sneezes, coughs, while talking, spitting, laughing, singing or even he/she cries without covering mouth.

• Approximately 3000 infective droplets can be generated by a cough of person with active TB.

• It is caused by agent called mycobacterium tuberculosis.

• Immunity of an individual plays an important part in prevention of the disease. A person with strong immune system may not experience the symptoms even when infected with the bacteria. (inactive/ latent TB). When the immune system cannot resist the mycobacterial growth inside their body, it leads to development of Active TB.

• Generally 85 % of TB cases are of lungs rest of them are extra-pulmonary (outside the lung), regions of high blood supply like bones, brain, kidneys, eyes, GI tract, choroids and others.

Causes:

• Causative agent: Mycobacterium tuberculosis.

• Transmission: caused by sneezing, coughing, talking or laughing of the infected individual.

• Weak immune system: people with compromised or low immunity can’t fight against the bacterial growth hence become infected with it.

Risk factors:

• Age: People of older and very young age are more prone to develop TB.

• Chronic health issues: Diabetic patient and severe kidney disease

• Cancer: people with head and neck cancer and those with on going chemotherapies are more prone to develop TB.

• Drugs: used for rheumatoid arthritis,psoriasis, Crohn’s disease, lupus and immunosuppressant drugs used in transplant cases.

• Low immune system: People suffering from HIV are at risk of developing opportunistic infection.

• Tobacco smoking

• Malnourishment / low body weight

• Drug abuse disorders

• Healthcare workers: They work with people suffering from TB hence are at high risk of suffering from it themselves.

• Travel: Going to places like Africa, Asia, Eastern Europe, Latin America and Caribbean, increases the risk of developing TB since these places have higher number of cases of TB.

Types:

Latent, Active and Miliary Tuberculosis are the different types of TB.

Latent: When the immune system is very strong of an individual, it fights back against the bacterial manifestation. They generally have no symptoms and appear normal. They have a clean X-ray however can show some reaction to tuberculin test or to interferon gamma release assay (IGRA).

Active: When the immune system is weak of an individual and it is not able to fightback against the bacteria. The bacterial multiplications increase inside the body leading to development of symptoms like cough, chest pain and weight loss. It can spread to others by air droplets.

Miliary: It is form of active disease when the bacteria enter the bloodstream hence they spread quickly over the entire body affecting all organs and prove to be fatal very rapidly.

Symptoms:

• Cough lasting for more than 3 weeks

• Chest pain

• Blood in cough or sputum

Latent TBActive TB
No symptomsLow grade fever, evening rise of temperature
Cough for more than 3 months.
Fatigue or weakness
Blood in cough or sputum
Weight loss
Loss of appetite
Night sweats
Spread
Infection can not spread to othersInfection spread to others via infected air droplets.
X-ray
Normal x-ray filmAbnormal x-ray film
Skin and Blood test
PositivePositive

Alarming signs:

• Massive blood loss through cough or sputum

• Alteration of mental status

• Bluish discolouration of skin or nails

• Marked difficulty in breathing

• Tightness in chest

• Racing heart rate

Complications:

• Massive haemoptysis

• Pneumothorax – air collects between the pleura and the lungs.

• Pleural effusion – fluid fills ups the lungs

• Tuberculosis empyema- when infected fluid collects between the pleura.

• Corpulmoale and Pulmonary hypertension- when there is severe lung scarring and damage it results in destroying the lung vessels as well.

Diagnosis:

• Proper patient history: it is most essential to know the duration, elicit history of rise of temperature in the evening, ask about amount of blood in cough or sputum and to look out for alert signs.

• Physical examination – auscultation of the chest being an important one.

Prevention:

• Avoid cigarette smoke. Quit cigarette smoking and avoid being a passive smoker as well.

• Vaccines: get Bacille Calmette Guerin (BCG) vaccine

• Use N-95 mask- prevents you aerosols and micro droplets from an infected person.

• Exercise regularly – helps in boosting your immune system

• Controlled diabetes – Prevents more being vulnerable to the risk of developing TB.

• Avoid substance abuse – Quit taking or doing drugs to lower down your risk of developing TB.

Treatment:

The line of treatment for active cases is using combination of drugs for a certain period of time.

• Isoniazid (Liver function test should be monitored)

Living with Tuberculosis

• Follow the line of treatment: defaulters are prone to develop multiple drug resistant TB , which is more fatal.

• Cover mouth while talking, sneezing, coughing or laughing, to avoid spreading of infection to others.

• Good ventilation: Keep the room airy and well ventilated. The bacteria spread more in a closed small room where there is lack of air movement.

• Keep a check of your symptoms: its duration and severity.

• Get good sleep: if your symptoms are disturbing you to sleep, see a doctor and discuss.

• Pregnancy: if you conceive, contact your doctor and discuss the risk related to pregnancy.

• Avoid emotional stress and society taboo.

• Quit smoking

• Avoid places which are over crowded, room with too many people or work place in order to prevent the disease from spreading to others.

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