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Tuberculosis, commonly known as TB, is a respiratory infection that is very contagious and can easily spread from an infected person to a healthy person.
It is caused by bacteria called Mycobacterium tuberculosis, and while it mainly affects the lungs, it can also affect other parts of the body such as the gastrointestinal system. (1) Even children can get tuberculosis, with one million cases reported in 2015.
The bacterium that causes tuberculosis is different from other bacteria and can be hard to diagnose or treat with antibiotics.
People around the world have been working together to fight tuberculosis and have made progress in decreasing the number of new cases, but tuberculosis remains a big problem, especially in developing countries such as India, Indonesia, China, Nigeria, Pakistan, and South Africa. (1)
Take a deeper look into tuberculosis and learn more about it.
What Causes Tuberculosis?
When a person inhales the tiny droplets containing the Mycobacterium tuberculosis bacteria, they can develop tuberculosis.
The body’s response decides whether you develop tuberculosis or not, and the type of infection depends on several factors such as the person’s immune system and the type of exposure. (2)
- Immediate clearance: The body successfully eliminates the bacteria, without causing infection.
- Primary disease: Active tuberculosis develops immediately after infection.
- Latent infection: The bacteria remain inactive in the body but can cause infection later on in life.
- Reactivation disease: Active tuberculosis occurs years after a period of latent infection.
What Are the Symptoms of Tuberculosis?
Over the years, experts and researchers have shared various symptoms associated with tuberculosis. The main symptom of pulmonary tuberculosis is a persistent cough, often accompanied by coughing up phlegm or blood.
Other common symptoms include:
- Weight loss
- Swollen glands
- Night sweats
Tuberculosis can also affect other parts of the body, causing various symptoms depending on the affected area. These symptoms may include pain, swelling, or problems with the specific body part involved. (2)
Treatment for Tuberculosis
Treatment for tuberculosis usually involves antibacterial drugs and other medicines. A proper drug regimen is followed by the patient.
Medicines for regular tuberculosis
The treatment for tuberculosis in adults involves a combination of different medications taken for a specific duration consisting of an intensive phase and a maintenance phase.
1. Intensive phase treatment
During the intensive phase, a combination of four drugs (rifampin, isoniazid, pyrazinamide, and ethambutol) is taken for 2 months. This phase helps to quickly reduce the number of tuberculosis bacteria in the body. (3)
2. Maintenance phase treatment
After the intensive phase, the treatment continues with the maintenance phase, which lasts for 4 months. During this phase, two drugs (rifampin and isoniazid) are taken to further eliminate the remaining tuberculosis bacteria.
Note: In some cases, the treatment duration may be extended, such as for individuals with certain conditions such as HIV/AIDS. (3)
Medicines for drug-resistant tuberculosis
If the tuberculosis bacteria show resistance to the drugs, a different treatment regimen called multidrug-resistant tuberculosis (MDR-TB) may be required. (4)
This regimen includes capreomycin as the injectable drug, ethionamide as a replacement for ethambutol, and levofloxacin. Pyrazinamide is still used in the intensive phase, even if resistance is detected. (3)
Directly observed therapy (DOT) for tuberculosis
Directly Observed Therapy (DOT) is a strategy endorsed by the World Health Organization to improve adherence to tuberculosis treatment.
It involves having a healthcare employee, volunteer, or caretaker (family/friend) observe and document patients taking their medication. It aims at ensuring that tuberculosis patients complete their treatment successfully and discouraging the growth of drug resistance in society. (5)
There have been criticisms of DOT, particularly in studies where it did not show significant additional benefits, (3) but researchers argue that as of now, DOT remains the best strategy available for tuberculosis control. (5)
How is DOTS performed?
- A caretaker ensures that the patient takes every dose of tuberculosis medication.
- Medication is observed and recorded at healthcare facilities or at home.
- The process of DOTS continues for at least 6 months.
- Regular follow-up is done to monitor progress and provide support.
How Is Tuberculosis Diagnosed?
Tuberculosis can be diagnosed by: (1)
- Tuberculin skin testing (Mantoux test): It helps determine the possibility of exposure to tuberculosis. A positive result is considered significant if the induration (swelling) is 10 mm or more in a person without BCG vaccination and 15 mm or more in someone who has received BCG. The results of the Mantoux test should be considered along with the patient’s symptoms and medical history. This test can also be helpful in detecting tuberculosis outside the lungs and in identifying latent tuberculosis in children. (6)
- Interferon release assays (IGRA, QuantiFERON Assays): These are done to provide a more specific and sensitive evaluation compared to the Mantoux test.
- Sputum tests to check the presence of tuberculosis bacteria.
- Chest X-ray or CT scan to look for spots on the lungs.
- DNA-based techniques for rapid and precise diagnosis.
Note: Revolution in diagnosis
In India, there is a reliable and easy test called cartridge-based nucleic acid amplification test (CBNAAT) that can diagnose tuberculosis in just a few hours and determine if it is resistant. This test is done for free at the National Tuberculosis Elimination Program (NTEP), which is available throughout the country. (7)
To make the best use of CBNAAT considering cost and benefits, (7) it is recommended to also use chest radiography, which should be available for every 100,000 people either through new machines or by partnering with the private sector. (8)
Tips for At-Home Management of Tuberculosis
In India, a significant number of active patients with tuberculosis experience moderate to severe undernutrition, with adults having a median BMI of 15.0-16.5 kg/m². (9)
So, proper nutrition is crucial for individuals with tuberculosis. Here are some guidelines to follow:
- It is recommended that carbohydrates make up 55%–75% of the total energy intake. For that, you can eat pulses, cereals, and vegetables.
- Protein intake should be approximately 1.2–1.5 grams per kilogram of ideal body weight per day. You can get protein from milk, eggs, and fish.
- Fats should account for 15%–30% of the daily energy intake. Healthy fat sources include oils, nuts, milk, milk products, and meat. (9)
Follow these expert tips for a fast and good recovery from tuberculosis: (4)
- Complete the full course of treatment and take all your medicines at the scheduled time.
- Get plenty of rest and sleep.
- Attend all medical appointments and follow-up visits.
- Practice regular hand hygiene.
Precautions to Avoid the Spread of Infection
To make sure that your friends and family remain safe from tuberculosis, observe these measures: (4)
- Stick to your medication regimen as instructed by your healthcare provider.
- Whenever you cough or sneeze, be sure to cover your mouth with a tissue. Dispose of the tissue in a sealed bag and toss it away.
- Wait for the approval of your healthcare provider before returning to work or school.
- Keep your distance from others, and try to have your own sleeping space.
- Regularly ventilate your room to help disperse any tuberculosis germs.
Who Is at Increased Risk for Tuberculosis?
Tuberculosis is very contagious, and the following may have an increased risk of catching it easily: (1)
- People with a weak immune system
- Poverty-stricken population
- Those who suffer from HIV/AIDS, are 20–30 times more susceptible to suffer from tuberculosis
- People with conditions that compromise immunity such as diabetes, cancer, or problems requiring dialysis (10)
- Those who suffer from malnutrition
- Construction workers
What Are the Complications of Tuberculosis?
While most people with tuberculosis have a relatively mild experience, there can be complications, especially for those with certain risk factors.
Some complications associated with tuberculosis include: (1)
- Extensive lung damage leading to breathing difficulties
- Horner’s syndrome, a disorder that leads to drooping of the eyelid, decreased sweating, and changes in the pupil size
- Acute respiratory distress syndrome (ARDS), which is a severe lung condition that causes rapid breathing, low oxygen levels, and organ failure.
- Disseminated tuberculosis, wherein tuberculosis spreads throughout the body and can affect multiple organs, including the brain
- Empyema, or the formation of pus in the space around the lungs, which can cause chest pain, coughing up blood or pus, and difficulty breathing
- Pneumothorax (rare), which is the collapse of a lung
- Organ dysfunction
- Reproductive complications in both men and women, probably because the bacteria causing tuberculosis (M. tuberculosis), often originating from the lungs, can spread through the blood to the genital organs. In females, this causes chronic symptoms similar to other gynecological conditions. (11)
Little Known Facts About Tuberculosis
Here are some things about tuberculosis you may not be aware of:
- Diagnosing tuberculosis can be challenging as its symptoms are similar to those of other diseases. Therefore, it is important to undergo at least one tuberculosis test for an accurate diagnosis.
- Active tuberculosis refers to having symptoms of the disease, while latent tuberculosis means having the tuberculosis bacteria in the body without any symptoms.
- Common symptoms of active tuberculosis include a persistent cough lasting more than 3 weeks, fatigue or extreme tiredness, unexplained weight loss, loss of appetite, chills, high fever (38°C or above), and night sweats.
Good News for Patients and Doctors in India
The Indian government has introduced a scheme called “Nikshay Poshan Yojana” to provide nutritional support to patients with tuberculosis.
This scheme is applicable to all patients with tuberculosis who have been notified on or after April 1, 2018, including those who were already undergoing treatment. To be eligible, patients must be registered or notified on the NIKSHAY portal. (12)
Under this scheme, each notified patient with tuberculosis will receive a financial incentive of Rs 500 per month for the duration of their antituberculosis treatment. For patients who were already on treatment before April 1, 2018, incentives will be provided for the remaining treatment period after that date, as long as it is more than or equal to 1 month.
However, incentives will only be given for the full months of the remaining treatment period, and any partial months will not be considered. (12)
Private sector doctors providing tuberculosis care will receive Rs 500 when they notify a case that meets the tuberculosis care standards in India, and another Rs 500 when the treatment is successfully completed. This means that doctors with private practices will receive a total of Rs 1,000 for each patient. Patients can choose to buy their medicines from different pharmacies or receive them for free from government centers. (12)
Additional tips for tuberculosis patients:
- Providing enablers to travel when necessary
- Mechanisms for sputum collection and transportation
- Administration of drugs at home
- Early identification of malnutrition and preventive and therapeutic nutrition
- Support for airborne infection control in households
- Early detection and management of commodities
Most-Asked Questions About Tuberculosis
What happens if tuberculosis is not treated?
Untreated tuberculosis can be life-threatening and fatal because the tissue in the infected organ dies. Millions of people die from tuberculosis, so proper medical treatment for this condition is a must and non-negotiable.
What are latent and active tuberculosis?
Latent tuberculosis is when you have an infection but the bacteria are inactive and therefore do not cause symptoms. Latent tuberculosis can later turn into active tuberculosis. So, it is important to still treat it.
Active tuberculosis, on the other hand, is a tuberculosis condition that will make you sick, and it can spread to healthy people. (2)
Is there a vaccination for tuberculosis?
In places where tuberculosis is very common, babies are immunized with the BCG vaccine. The vaccine is not very effective in adults but is good for infants.
What is the relationship between HIV and tuberculosis?
There is no such relationship between HIV and tuberculosis except both diseases frequently occur together due to the weakened immune system.
One study has shown that there is a relationship between natural history of HIV and adults who suffer from tuberculosis. (13)
What are the nutritional discrepancies in those who suffer from tuberculosis?
Those who suffer from tuberculosis tend to have significantly lower levels of copper and iron.
If I am diagnosed with latent tuberculosis, how can I avoid active tuberculosis?
Without treatment, latent tuberculosis can progress to the active form. If you have latent tuberculosis, you should get treated immediately, and this is because treatment will significantly reduce your chances of active tuberculosis.
The treatment for latent tuberculosis will last for 3–4 months depending upon your health status. Most pulmonary cases last for 6 months, while extrapulmonary cases last for more than 6 months.
What are the side effects of tuberculosis medications?
Side effects of tuberculosis medications include:
- Loss of appetite
- Shortness of breath
- Brown urine
- Joint pain
- Stomach ache
Tuberculosis is a very dangerous infection that can be latent at first without any symptoms but becomes active later on. After a few weeks of getting tuberculosis treatment, you will stop being contagious and you will start feeling better.
Tuberculosis can be fatal if not treated properly, so it is important to complete your treatment and take all the medication given to you by a doctor. Stopping the treatment before it is complete can cause the bacteria to stay in your system, leading to a much more dangerous condition to deal with.