What is Tuberculosis (TB)?
Tuberculosis (also known as TB) is one of the deadliest infectious diseases in the world. Most prevalent in developing countries, this condition affecting the functionality of the lungs is highly infectious. In its worst state, TB can spread through the bloodstream to other areas of the body, such as the spine, kidneys and brain.
Infections are generally preventable and can be cured with careful and committed treatment. Antibiotic treatment and recovery takes some time, often many months.
There are many known strains of TB which can be resistant to medications used to treat the condition. Several types of medications will likely be prescribed for several months in an effort to combat and kill off the infection, as well as prevent the development of any drug resistance.
What causes TB and how does it spread?
Tuberculosis occurs as a result of a type of bacteria known as Mycobacterium tuberculosis. This bacterium can be spread from one person to another. It is possible to carry the bacteria in your system and not experience signs of the disease. This is known as inactive or latent tuberculosis. The infection is active but may not be contagious, and thus will not likely be transmitted to others.
Transmission occurs through tiny (microscopic) droplets that become airborne through coughing, sneezing and even speaking, laughing or singing. Anyone nearby capable of inhaling these droplets (containing bacteria germs) may fall ill with tuberculosis.
That said, catching a tuberculosis infection is not so easy as germs typically grow slowly. In general, transmitted infections typically occur as a result of spending a fair amount of time in the company of an infected person. Transmitted infections are therefore common amongst family members, close circles of friends and co-workers.
Bacteria thrives in the body and once airborne and in contact with surfaces, cannot cause further infection. It is not likely you will catch the disease through touching contact with an infected person.
A person with active tuberculosis will likely no longer be contagious after at least 2 weeks of treatment.
What are the signs and symptoms of TB?
Signs of tuberculosis typically affect a person’s respiratory system (the lungs, in particular), but can also have adverse effects on other organs such as the spine, brain and kidneys too.
Symptoms typically vary depending on the organs infected at the time. If TB is directly affecting kidney function, a sufferer may notice blood in their urine. Back pain is a common complaint in those where tuberculosis is affecting the spine. Treatment will also directly correlate with symptoms experienced.
Common symptoms include:
- Coughing (usually accompanied by the presence of blood or sputum (mucus and phlegm) and lasting more than 3 weeks)
- Chest pain (typically occurs with a persistent cough)
- Pain with breathing
- Fatigue (unexplained)
- Loss of appetite and weight loss
- Night sweats and the chills
How does TB affect the body?
Not every case of TB means you will fall ill or even transmit the disease.
Tuberculosis is classified in two different forms:
- Latent TB: A person may be able to carry the bacteria causing infection for years, but won’t spread the infection. Bacteria germs are inactive and non-contagious, and don’t show up with any signs or symptoms. Latent TB is also known as TB infection. This does not mean that it is impossible for the infection to become active at a later stage. A small percentage of latent (dormant) infections can switch to an active infection. It is thus still important to seek medical treatment so that a doctor can help to prevent it from becoming contagious with the use of antibiotics.
- Active TB: An active infection means that bacteria causing germs multiplies in the body causing you to experience symptoms and feel ill. Once contracted symptoms will occur within the initial few weeks of infection.
Diagnosing and Treating TB
Whether you suspect TB or not, if you experience any related symptoms, a visit to your primary health care provider (general practitioner / GP) is necessary. From there, if required, you may be referred to an infectious diseases specialist or a pulmonologist (specialist in lung conditions).
It is important that when you make the appointment, and you suspect a contagious infection, that you ask if there is anything you need to be mindful of or can do before your appointment.
At your consultation, you will need to discuss with your doctor all symptoms (and their level of severity) you are experiencing, possible life changes, recent trips you have taken (local and international), and medications and supplements you may be taking.
Your doctor is likely to ask you a series of questions during your consultation. This is to get a better idea of what is going on with your body and also to potentially rule out other kinds of conditions, narrowing down what is causing you to feel ill. It is important that you answer accurately and honestly as it will form part of your diagnosis and treatment plan.
Questions that may come up include:
- Describe your symptoms. When did they begin?
- Where do you currently reside?
- Have you recently travelled in another country? If so, where have you been?
- Have you ever been tested for and been diagnosed with HIV or AIDS?
- Have you been in contact with anyone displaying similar symptoms?
- Are you aware of anyone who has been diagnosed with active tuberculosis?
- Have you ever lived with someone who was diagnosed with tuberculosis?
- What is the nature of the work that you do?
- Have you ever been diagnosed with and treated for tuberculosis?
- What vaccinations have you had (since childhood)?
How is TB diagnosed?
Following a thorough discussion of your symptoms and medical history, your doctor will want to perform a physical exam. At this point, high on your doctor’s list of checks will be to assess your lymph nodes and see if you are experiencing any signs of swelling.
He or she will also use a stethoscope to listen to your lungs. An infection in the lungs will cause abnormal sounds as you breathe (inhale and exhale).
Based on your discussion and physical exam, it is likely that your doctor will recommend one or a series of tests to make a final diagnosis.
What tests are involved?
The most common test used to diagnose tuberculosis is a skin test. Blood tests are also common practice for diagnosis. It is highly likely these will both be recommended.
- PPD skin test: Your doctor will inject a small amount of purified protein derivative (PPD) beneath the top layer of your skin. You will then be asked to make a follow-up appointment in 2 to 3 days’ times to assess the reaction of this injection. A welt that develops on the surface of the skin where the PPD was injected will be a positive indication of TB. This test essentially tells your doctor that you have been exposed to someone else with the infection. It may not necessarily indicate active tuberculosis.
- Blood tests: The next step is an analysis of a sample of blood. This test can confirm or rule out any form of TB (latent or active). In the laboratory, your immune system’s reaction to TB bacteria (Mycobacterium tuberculosis) will be measured.
- Chest X-ray or CT scan: If your skin test reflects a positive result, your doctor may want to back up their findings with imaging tests, which will show more detail of your lungs (from the inside). Your doctor will be looking for white spots on your lungs. This will indicate the body’s reaction (i.e. immune system) by attempting to ‘wall off’ or isolate the presence of bacteria. Image tests can also show distinct changes in your lung function which is caused by an active infection.
- Sputum tests (mucus and phlegm): Following an imaging test, your doctor may wish to take samples of the substance you cough up. Mucus and phlegm will be tested for the presence of Mycobacterium tuberculosis bacteria. If necessary, a laboratory will also check for any drug-resistant strains of the disease. This will help your doctor to determine which available medications will be more effective in your treatment plan.
Testing may take some time. For this reason, it is not uncommon for your doctor to ask you to wear a special mask until you begin active treatment.
Treatment for TB
If tuberculosis is diagnosed, it is a given that recovery is going to be a fairly long path. Treating the condition effectively takes some time and your doctor will explain this to you in detail once a diagnosis is made.
Most bacterial infections will clear within a few weeks of treatment. Tuberculosis is treated over a period of 6 to 9 months. Factors that your doctor or specialist will take into consideration before prescribing any medication include your age, potential signs of drug resistance, overall health condition, the form of TB that has been determined through testing (active or latent) and where the infection is causing trouble in your body.
If it is determined that you have the latent form of the disease, it is likely that only one medication may be prescribed for a period of time (often 4 months) to try and prevent the infection from becoming active. An active form of the disease, as well as medication-resistant strains, will be treated with courses of multiple medications / antibiotics (all at once).
Your doctor will explain the medications and their dosages to you when giving you a prescription. He or she will also detail common side-effects you may experience when taking the medications (orally or as injections). Medications for TB typically affect the liver. Common adverse reactions as a result include a loss of appetite, dark urine, nausea and / or vomiting, jaundice (a yellow colour change of the skin) and fever (which may last at least 3 days). If you experience any of these symptoms it is important that you keep your doctor in the loop. As the side-effects relate to your liver function, your doctor will want to monitor this during your treatment period.
It is vital that you complete each and every course of prescribed medication during your treatment period. TB is a bacterial infection and if treatment is stopped or altered without the express consent of your physician the bacteria in your body will not clear. It will thrive and also become resistant to the types of medications you were taking. This will make a TB infection more complicated to treat effectively, which can be dangerous as it is an infectious disease. After a few weeks, you will no longer be contagious.
Who is at greater risk?
Being an infectious condition, certain situations may pose a higher risk of catching the disease. These include:
- Exposure to a family member, friend or co-worker whom you spend a lot of time with, who has an active TB infection.
- Travelling to places in the world where TB is particularly common (high risk areas). These include parts of Africa, Asia, India, Latin America, the Caribbean, Eastern Europe and Russia.
- You potentially work with individuals who are homeless, imprisoned, are being cared for in a hospital facility, reside in a nursing home, have HIV infections or are active IV drug users. Infections typically spread easily among such groups of people.
You may also be at greater risk if you have an impaired immune system and are already living with conditions such as:
- HIV / AIDS
- Kidney disease (severe or advanced)
- Malnutrition and low body weight
- Cancers of the head and neck
Immune-suppressant medications can also make some individuals more susceptible to infection. On the list of treatments with increased risk are:
- Chemotherapy (a treatment for cancer)
- Medications taken to treat psoriasis, rheumatoid arthritis and Crohn’s Disease, as well as those prescribed for individuals having undergone an organ transplant (to prevent organ rejection).
Infants and young children with developing immune systems are also at greater risk of infection.
Tips for coping while receiving treatment
The time required to completely kill off a bacterial infection can take its toll on you. You need not feel you have to hibernate or isolate yourself from normal activity and society, but you must take care. You merely need to be aware of your condition, understand how it affects your body and what it is capable of doing, especially during the period you are contagious.
Armed with this knowledge, you can make an effort to maintain normal activities as best you can without completely losing connection with loved ones (especially family and friends). This will be easier once you are no longer contagious.
During the contagious period, it is best to:
- Keep away from crowds and spaces inhabited by people. You will likely be booked off work or school by your doctor. You can also protect loved ones by not sleeping in a room with someone else.
- Ventilate your home. This will also help to prevent the spread of bacteria germs (which thrive in closed spaces with little air movement). Open windows or use a fan to create air movement.
- Use your mask and keep your mouth and nose covered. You may need to change masks every time you sneeze, cough or even laugh.
The months of treatment may affect your mental health and cause emotional reactions. If you struggle to deal with emotions such as anger, despair or frustration, seek assistance from a medical professional trained in helping you cope. Therapists, counsellors and behavioural psychologists all offer positive coping strategies that can help you deal with the mental and emotional effects of your physical illness.
What is the outlook for a person being treated for TB?
Tuberculosis is a treatable condition and if an infected person has access to proper medical care, can make a full recovery.
If an infected person is battling with or treating other existing conditions, treatment can be a little more complicated. Generally other conditions will show signs of a damaged or impaired immune system. When an immune system is already compromised, effectively treating a bacterial infection such as TB can become more complex and difficult to clear.
The best chance anyone with a TB infection has though, is a full course of antibiotics. The condition cannot be cleared otherwise.
Are there ways you can prevent TB?
High risk areas around the world typically vaccinate children against the disease from a young age. The vaccine used is known as Bacillus Calmette-Geurin (BCG) and has also been known to be highly effective when administered to adults too.
Those who are merely carriers of the TB bacteria and have the latent form may be given a course of preventative antibiotic medications to curb the development of the bacteria in the body from becoming active (showing contagious symptoms).
Spreading the disease can be controlled once a diagnosis is made. If you have been diagnosed with active TB, your doctor will insist that you avoid crowds of people while you are contagious (this may be for up to several weeks). You may even be given a surgical mask (or respirator) to wear for added protection against spreading microscopic droplets in the air.
Another preventative measure concerning those already diagnosed with the disease is medication use. All courses of medication must be taken exactly as directed by a doctor and for the full length of prescribed treatment. This protects both the person infected with TB and others around them. Skipping doses or stopping altogether allows Mycobacterium tuberculosis to multiply, becoming stronger, which in turn makes the bacteria more resistant to medications used to treat it, as well as current vaccinations used to help prevent outbreaks. Once stronger and more resistant, TB becomes increasingly difficult to treat and thus, more deadly.
Did you know?
This day is important for raising awareness about the condition and understanding why it happens. In this way, armed knowledge, the broader public can help to prevent the spread of the infectious condition.