TB is an abbreviation for Tuberculosis, formerly known as consumption. It is an infectious lung disease and the world’s 13th largest cause of mortality. Tuberculosis is usually treatable and preventive but can be fatal if not treated on time. Tuberculosis bacteria travel from person to person in tiny droplets sprayed into the air by coughs and sneezes. Once uncommon in wealthy nations, TB infections began to rise by around 1985, owing in part to the advent of HIV, the virus that causes AIDS. HIV impairs a person’s immune system, making it incapable of fighting TB bacteria.
When individuals exhibit tuberculosis symptoms, they have active tuberculosis or tuberculosis illness. TB has three stages: (a) primary infection, (b) latent tuberculosis infection, and (c) active tuberculosis sickness.
TB can be traced back to early Egypt, more than 5,000 years ago, although the bacteria that causes TB called mycobacterium tuberculosis may have been around for as long as 3 million years. TB is also mentioned in the biblical books of Deuteronomy and Leviticus under the Hebrew term “schachepheth”, and Hippocrates refers to it as “phthisis” in his writings. M. tuberculosis has the potential to kill more people than any other germ. It was an epidemic in industrialised Europe and North America during the 18th and 19th centuries. Streptomycin is considered to be the first antibiotic to effectively cure tuberculosis. It was developed in the 1940s and helped drastically reduce the number of cases of tuberculosis cases found in industrialised countries, like the United States.
On 24 March 1882, Dr. Robert Koch reported the discovery of Mycobacterium tuberculosis, the germ that causes tuberculosis. The disease killed one out of every seven people in the United States and Europe during this time. Dr. Koch’s discovery was the most critical step in managing and eventually eliminating the disease. A century later, 24 March was designated as World Tuberculosis Day.
In 2020, over 10 million were infected with tuberculosis, and approximately 1.5 million died from the disease. According to WHO, the incidences of TB cases in India in 2021 is 2,590,000 million cases. Last year, with almost 534 cases per 100,000 persons, Delhi was reported to have the highest number of TB cases reported in India. Also, TB is the primary cause of death among HIV-positive patients.
TB can be mistaken for lung cancer
Tuberculosis is characterised as a diagnostic chameleon because it can mimic a malignancy. TB is frequently misdiagnosed in low-incidence nations with a high prevalence of lung cancer and varied clinical presentations due to delayed treatment. Cough, expectoration, fever, haemoptysis, weight loss, and dyspnea are all indications of pulmonary TB and lung cancer. However, a thorough history and examination can clarify the presence of TB.
The bacteria that cause TB is called Mycobacterium tuberculosis. Some who get mycobacterium TB do not develop symptoms. The bacteria primarily affect the lungs, but depending on where the germs develop, they can attack any part of the body, including organs or the spine. Not everyone who contracts TB becomes sick. There are two types of illnesses: latent tuberculosis infection and TB illness. TB illness can be lethal if not treated appropriately. Tuberculosis can remain latent for years before becoming active.
You may encounter additional tuberculosis symptoms due to a malfunctioning organ or system if you have tuberculosis. Coughing up blood or mucus (sputum) is a pulmonary TB symptom, but bone discomfort may suggest that the bacteria have penetrated your bones. Tuberculosis symptoms like weight loss and weakness may coexist with other conditions.
Active tuberculosis patients may have any of the following symptoms:
• Fits of coughing (for over two weeks)
• You are having chest pains
• Coughing up blood or sputum (mucus)
• Weakness or exhaustion
• No appetite
• Chills & fever
• Night-time sweating
How you can get infected
When a person with active tuberculosis coughs, sneezes or talks or spits, germs are released into the air, and you might get infected. Only people with lung infections are infectious. Most people who breathe in the TB bacteria are immune. In others, the germs become dormant, resulting in a latent TB infection.
If a patient who has never been exposed to tuberculosis inhales the bacterium, they develop a first TB infection, also known as a primary infection. Some people have no TB symptoms at this stage, while others may have fever or pulmonary problems. The immune system instantly kicks in in most people who have breathed the germs, and you recover with no additional symptoms of the sickness. Or the bacteria may become latent or inactive in your system, remaining there but not causing illness. However, in certain circumstances, the bacteria reawaken and grow, resulting in active tuberculosis–when the individual becomes sick and infectious.
It is essential that you should not overlook latent tuberculosis because the illness might become active at any time if your immune system is compromised. Experts say that around 5-10% of persons infected with latent TB will acquire active TB in the future if they are not treated in time.
Tuberculosis is an infectious disease that requires long-term TB treatment and care and carries a social stigma. The frequency of TB varies according to living conditions and social and economic variables. Tuberculosis has always been more frequent among the economically disadvantaged. Studies have found a link between TB and poverty, illiteracy, and unemployment. Some causes of TB spread include poor access to health care, poor diet and living conditions. Furthermore, food scarcity, inadequate food quality, overcrowding, and homelessness contribute to TB transmission. Potential TB carriers are often travellers who have flown to densely populated countries like Africa, Pakistan, Indonesia, South Asia, India, Russia, and China.
How you can be at risk:
•If a friend, coworker, or family member has active tuberculosis, you are more likely to get it.
• You reside in or have gone to a TB-endemic region, such as Russia, Africa, Eastern Europe, Asia, Latin America, or the Caribbean.
• You work or live with someone who has TB–this includes persons who are homeless, have HIV, are in jail or prison, and inject narcotics into their veins.
• You work in a hospital or a nursing home.
• You work as a doctor or nurse for patients who are at substantial risk of tuberculosis.
Tuberculosis can develop complications
Tuberculosis can be lethal if not treated. The untreated active illness primarily affects the lungs, although it can also affect the following areas.
• Back: Spinal discomfort is one of the effects of tuberculosis. Back pain and stiffness are frequent TB consequences.
• Joints: Damage to the joints. Tuberculous arthritis (arthritis caused by TB) often affects the hips and knees.
• Brain: The membranes that cover your brain swell (meningitis). This might result in a persistent or intermittent headache that lasts for weeks, as well as mental disturbances.
• Other organs: Problems with the liver or kidneys. Your liver and kidneys aid in the removal of waste and pollutants from your circulation. Tuberculosis can damage the operation of these organs.
• Heart: TB can infect the tissues around your heart, producing inflammation and fluid accumulations that can impair your heart’s capacity to pump, although it is rare. The disease, known as cardiac tamponade, is potentially fatal.
How you do not get infected
It is essential to know that you cannot contract TB by sharing drinking or eating utensils. Also, smoking with others or sharing cigarettes, shaking hands, swapping meals, touching bed sheets or toilet seats.
Your doctor will first take down your medical history to assess if you have been exposed. During a pulmonologist consultation, they examine your lungs and check the lymph nodes in your neck for swellings. Depending on the kind of tuberculosis suspected, several tests are carried out for a diagnosis. During a pulmonologist consultation, your doctor will inform you about the following types of TB screening tests: (1) The Mantoux tuberculin skin test (TST) and, (2) The interferon-gamma release assay (blood test) (IGRA) and, (3) a comprehensive CBC test. The doctor will inject an amount of purified protein derivative (PPD) beneath the skin of your forearm for the TST. After two to three days, you must return to the healthcare practitioner to examine the injection site. The doctor will take blood for the IGRA and submit the sample to the lab.
Additional tests to establish if an infection or whether the infection has affected the lungs, include:
• Sputum and lung fluid testing
• X-ray of the chest
• CT scans (computed tomography) or MRI scan
• Urine and blood test (including a comprehensive CBC test)
• Biopsy, if required
Management & treatment
It is essential for patients to complete their medication course as directed by the doctor during a pulmonologist consultation. If you discontinue the medications too soon, you may become ill again and even infect others. Furthermore, TB germs still alive may become drug-resistant due to poor treatment administration, making it more difficult to recover the next time. Generally, four medications are used: isoniazid, pyrazinamide, ethambutol, and rifampin to treat tuberculosis. The four-drug cocktail is still the most often used therapy for drug-resistant tuberculosis.
• Latest TB: If you have tuberculosis but do not have active TB illness, you should receive preventative medication. If you have latent tuberculosis, you are not infectious. The treatment eliminates bacteria that may aggravate your health if the disease becomes aggressive. Daily antibiotic dosage for six to nine months is a common preventative medication treatment. Latent tuberculosis occurs when you are infected but do not have any TB symptoms of active illness. Your specialists at a pulmonologist consultation will advise therapy if you have latent tuberculosis and are under age 65. However, medicines used to treat tuberculosis can induce liver damage in older people.
• Pulmonary or active TB: The doctor will prescribe a tuberculosis treatment for six to twelve months using a mix of antibiotic drugs after a pulmonologist consultation. Although you may feel better within a few weeks of taking the medications, treating tuberculosis takes significantly longer than treating other bacterial diseases. You must take your medicines as recommended for the entire period specified by your doctor, or you may relapse, have a more difficult time battling the disease in the future, and transmit the sickness to others. Failure to complete your medication course may also contribute to drug-resistant tuberculosis, which is potentially dangerous since it is difficult to treat and will need a longer course of therapy with other, more toxic, medicines. It might take several weeks before you feel better. Your overall health and the severity of your tuberculosis will determine the length of time. Most patients are no longer infectious and feel better after two weeks of medication. However, it is critical to continue taking your medicines as advised and to finish the entire course of antibiotics.
• DR-TB: Drug-resistant tuberculosis occurs when germs grow resistant to the medications used to treat the disease. The type of TB implies that the tuberculosis treatments used are no longer effective against the TB bacteria in your body. Drug-resistant tuberculosis (DR TB) spreads in the same way as drug-susceptible TB does. Treatment for this kind of tuberculosis takes longer, 20 to 30 months, and you may experience more adverse effects.
You will be infectious for the first 2 to 3 weeks of tuberculosis treatment if you have pulmonary TB. Take some basic precautions to keep tuberculosis from spreading to your family and friends.
It is vital to follow the following guidelines:
• Stay indoors: Stay away from work, school, or college. Do not socialise with other people during the first few weeks of treatment.
• Keep mouth covered: Use a face mask when you are around other people during the first three weeks of treatment, which may help lessen the risk of transmission. Always cover your mouth while coughing, sneezing, or laughing, preferably with a disposable tissue.
• Hygiene: Place any used tissues in a tightly sealed plastic bag and throw it away.
• Ventilation: Keep the windows open for better ventilation in indoor spaces so there are fewer bacteria in the air
• Isolation: Avoid sleeping in the same room as others since you may cough or sneeze while sleeping.