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). A chest X-ray may also be done as one of the very first tests during the diagnosis process. 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.