Tuberculosis (TB)

Symptoms: Feeling weak, weight loss, cough, cough with blood, fever, and night sweats
Causes: Caused by the bacterium Mycobacterium tuberculosis, it spreads from one individual to another.
Risk Factors: Individuals with diseases that weaken the immunity system, individuals who have recently been infected with TB, and individuals who stay near those affected by the bacteria.
Prevalence: The estimated pooled prevalence of TBI was 41 % (95% CI: 19-65%) among the male population and in the female population, it was 31%
Severity: Mild to severe
Which doctor to consult: Infectious Disease Specialist, Pulmonologist

Overview:

The word 'tuberculosis' comes from the Latin word 'tuberculum', which means slight swelling or lump. Tuberculosis (TB), caused by the bacteria Mycobacterium tuberculosis, is a bacterial infection that affects the lungs as well as other body parts, including the brain, abdomen, bones, kidneys, and spine. The disease spreads through tiny droplets released into the air through coughing or sneezing by affected individuals. If a person comes in contact with the infected droplets, he/she is at risk of contracting TB. People of all ages can be affected by the infection.

Types of TB:

Tuberculosis (TB) can be classified as active or latent. The most common type of active tuberculosis is lung disease, but it can also invade other organs, a condition known as "extrapulmonary TB."

Active TB disease:
Active tuberculosis is a disease in which the TB bacteria multiply rapidly and infiltrate various organs of the body. Active tuberculosis symptoms include coughing, phlegm, chest pain, weakness, weight loss, fever, chills, and night sweating. A person with active pulmonary tuberculosis can spread the disease to others via airborne transmission of infectious particles coughed into the air. If you are diagnosed with active tuberculosis, you should be prepared to provide a detailed history of everyone with whom you have had contact. Because the active form is potentially contagious, these individuals will also need to be tested.
To treat active tuberculosis, a multidrug regimen is used. Depending on state or local public health regulations, you may be required to take antibiotics with the supervision of a physician or other healthcare professional. This program is known as "Directly Observed Therapy" and is intended to prevent abandonment or erratic treatment, which may result in "failure" with continued risk of transmission or acquired resistance of the bacteria to medications, including the infamous multi-drug resistant tuberculosis (MDR-TB).

Miliary tuberculosis:
Miliary tuberculosis (MTB) is a rare form of active disease caused by TB bacteria entering the bloodstream. In this form, the bacteria rapidly spread throughout the body in tiny nodules, affecting multiple organs at once. This type of tuberculosis can kill you quickly.

Latent tuberculosis:
Many TB infections do not result in overt disease. They show no symptoms, and their chest x-ray may be normal. The only symptom of this encounter may be a reaction to the tuberculin skin test (TST) or interferon-gamma release assay (IGRA). However, there is a risk that the latent infection will progress to active disease. Other illnesses, such as HIV, or medications that impair the immune system, increase the risk. To combat this, the United States uses preventive therapy or treatment of latent tuberculosis infection.

Symptoms:

People with latent tuberculosis do not feel sick and are not contagious. Only a small percentage of people infected with tuberculosis will develop TB disease and symptoms. Babies and children are particularly vulnerable. Certain conditions can increase a person's risk of tuberculosis disease.
Risk factors include diabetes, weakened immune systems (e.g., HIV or AIDS), malnutrition, and tobacco use.
 

Causes: 

Tuberculosis is caused by a bacterium called Mycobacterium tuberculosis. (Mycobacterium bovis and Mycobacterium africanum are related bacteria that can cause tuberculosis.) The body's response to an active tuberculosis infection causes inflammation, which can damage the lungs. Areas affected by active tuberculosis gradually fill with scar tissue.

TB is a contagious, infectious disease. It is transmitted from person to person. Inhaling germs is often how people become infected. These germs were sprayed into the air when someone with the active disease coughed.  However, inhaling the germ does not guarantee that you will develop active disease. A person's natural body defences can often control the infection and prevent it from causing disease. In this case, the person is infected but has no active disease. Only about 10% of those infected develop tuberculosis in their lifetime.

Active disease can develop in an infected person when the body's resistance is low or there is a large or prolonged exposure to germs that overcome the body's natural defences. The body's response to an active tuberculosis infection causes inflammation, which can damage the lungs. Even if the symptoms are minor, the extent of the damage can be significant.
 

Risk Factors of TB:

You are at risk of getting tuberculosis if you are around people who have active tuberculosis and cough, releasing bacteria into the air. Intravenous drug users, healthcare workers, and people living or working in a homeless shelter, migrant farm camp, prison or jail, or nursing home are at a higher risk of infection. Most people infected with tuberculosis-causing bacteria do not develop active disease. The following factors increase the risk that latent disease will progress to active disease: 
HIV infection, that weakens the immune system and causes AIDS;
Diabetes mellitus; 
Low body weight; 
Leukaemia;
Hodgkin's disease;
or head and neck cancer;
Some medical treatments, such as corticosteroids or medications used to treat autoimmune or vasculitic diseases like rheumatoid arthritis or lupus, suppress the immune system;
Silicosis, a respiratory condition caused by breathing in silica dust.
 

Possible complications:

Complications associated with TB are:
Massive lung destruction;
Damage to the cervical sympathetic ganglia causes Horner's syndrome;
Acute respiratory distress syndrome;
Milliary spread (disseminated tuberculosis), which includes TB meningitis;
Empyema;
Pneumothorax;
Systemic amyloidosis;
 

Prevention:
 

Follow these steps to reduce tuberculosis infection and spread:

Seek medical attention if you have symptoms such as a persistent cough, fever, or unexplained weight loss, as early treatment for tuberculosis can help prevent the disease from spreading and improve your chances of recovery.
Get tested for tuberculosis if you are at an increased risk, such as if you have HIV or come into contact with people who have TB in your household or workplace.

Completing the entire course of anti-TB treatment is recommended. 
If you have tuberculosis, practice good cough hygiene, such as avoiding contact with others, wearing a mask, covering your mouth and nose when coughing or sneezing, and properly disposing of sputum and used tissues.
 

When to Consult a Doctor?

If an individual suspects that he/she has TB, visiting a general physician for a check-up is a must. Most primary healthcare providers can identify and diagnose tuberculosis.
Coughing is the most common symptom, often confused with a cold or common cough. In most cases, individuals with TB cough up blood. In common cough, the phlegm or mucus produced by the body is clear, but in the case of TB, the colour is slightly green or yellow.
Specific individuals are more at risk of getting TB. They should get tested frequently. These individuals include:
Individuals who have come in recent contact with someone diagnosed with TB
Individuals with HIV or any medical condition that weakens the immunity system
Individuals coming from an area where TB is common
 

Diagnosis:

General physicians may recommend an individual to an Infectious Disease specialist if they suspect the person has TB. The doctor performs chest X-rays and laboratory tests and considers health and medical history before diagnosis.
Lab Tests: Doctors usually administer two types of lab tests to detect the bacteria in the body and establish the diagnosis.
TB Skin Test (TST): This is the most common test to diagnose TB. The doctor injects a substance called tuberculin into the skin. The patient will feel a slight prick. If the injected site is swollen within a day or two, it indicates the individual has the bacteria in the body. This is also called the Mantoux test.
Blood Test: Since a TST test only reveals if a person has been infected with TB, a blood test is followed to identify the type of TB infection. Blood tests identify the body's reaction to the infection. It can confirm if the infection is latent or active TB.
Sputum Test: In this test, sputum is collected from cough and placed under the microscope to look for germs of TB. If the test comes positive, it usually indicates TB of the throat or lungs.
Imaging Tests: X-rays are used in the diagnosis of TB. A chest X-ray can reveal if the TB bacteria has caused any damage. Sometimes, the X-ray can show white spots in the report indicating the damage done by the bacteria.
 

Treatment:

TB can be completely cured with a proper treatment plan. Depending on the severity of the disease and the patient's medical history, the doctor recommends the most effective treatment regime. Treatment of TB can take several months.
Home Care: Similar to other diseases, TB requires adequate home care for the patient to recover completely and lead a healthy life.
Following are some home care tips for TB patients:
An individual should take the dose of antibiotics as prescribed and complete the entire medicine course without missing a single dosage.
Regular antibiotics often cause gastric issues. Patients are advised to stay hydrated and take gastric medicine daily with lunch.
Patients can drink peppermint, ginger, and tulsi tea to ease congestion and cough and clear the mucus in the lungs.
Diet is an essential component of recovery. So, patients are advised to eat a balanced diet rich in all vitamins and protein.
Patients should avoid going out in public areas until the doctor provides clearance. Wearing a mask is advised if the patient has to step out during an emergency.
Getting plenty of rest and sleep is recommended for every patient.
 

Medication: Tuberculosis is treated with antibiotics. Treatment is advised for both TB infection and disease.

Treatment options include Isoniazid, Rifampicin, Pyrazinamide, Ethambutol, and Streptomycin.
To be effective, these medications must be taken daily for 4-6 months. It is dangerous to discontinue medications prematurely or without medical advice. This can cause TB, which is still alive, to develop resistance to the drugs.

Tuberculosis that does not respond to standard drugs is known as drug-resistant tuberculosis and necessitates more toxic treatment with various medications.

Surgical Treatment: Although surgery is not the most preferred choice for TB patients, doctors might perform thoracic surgery to treat pulmonary TB.
Alternative Management: Individuals with TB must take several medicines as part of their treatment course. However, there are different alternative management techniques that, when accompanied by primary treatment, can yield great results.
Homoeopathy: Many studies and research have shown the effectiveness of homoeopathy in treating and managing the symptoms of TB effectively. Experts of homoeopathy usually adopt multiple treatments for tuberculosis. Calcarea carbonica and Arsenicum album are commonly used for treating cough, chest discomfort, chills, night sweats and other similar symptoms.
Yoga and Meditation: Yoga does not cure tuberculosis. But it can help maintain overall health and prevent the infection from causing further damage to the body. Several yoga poses can help improve respiratory health or neurological functioning and strengthen the body's immune system. Meditation improves mental health and can help in managing stress related to the disease. Patients can develop a positive outlook on their health condition through these practices.
Acupuncture: Acupuncture is one of the ancient Chinese medicine techniques that improve the overall physical and mental health of individuals.