Guide to managing tuberculosis
Tuberculosis is an infectious disease that is contagious and can spread from person to person easily through the air through the microscopic droplets released into the air by actively infected people through their common actions of coughing, sneezing, spitting or even speaking, laughing or singing. Tuberculosis or TB, in short, can be a life-threatening condition if left unattended, people having symptoms like chronic cough with blood containing sputum that lasts for three weeks or more, loss of appetite, weakness or fatigue, fever, night sweats, and significant weight loss would need an immediate diagnosis for any early treatment to control the disease.
Tuberculosis may infect any part of the body but most commonly the lungs get infected, to be known as Pulmonary tuberculosis. Extrapulmonary TB occurs when tuberculosis develops outside of the lungs and can affect people with a weakening immune system and in children. There are a number of factors for people to be susceptible to develop TB, HIV being the highest risk factor globally, particularly in the sub-Sahara African region where HIV rate is most prevalent. TB is also linked closely to malnutrition and overcrowding, making it one of the principle Disease of Poverty. People at high risk include those who inject illicit drugs and places with inhabitants where vulnerable people gather like in a prison and homeless shelters etc., medically underprivileged and communities with poor resources and also include health care personnel’s serving these patients.
Diagnosing active tuberculosis based on simple signs and symptoms are difficult as in diagnosing the disease in those with a weak immune system.
A typical visit to a doctor involves physical examination of the lymph nodes and careful listening to sounds in the lungs with a stethoscope. Another common diagnostic tool is a simple skin test, though blood tests are also becoming more a commonplace and a small portion of PPD tuberculin substance which is injected just under the skin of the inside forearm to observe swelling in the injected site. A hard raised red bump would mean likely infection with TB bacteria. Chest X-rays, multiple sputum cultures, an Interferon y-release assays, and tuberculin skin tests, however, are of little use in the developing world. A definitive diagnosis of TB is done by identifying M. Tuberculosis in a clinical sample of the sputum, pus or a tissue biopsy, this difficult culture process of the slow-growing organism may take two to six weeks for the blood or sputum culture, however, treatments commence before the cultures are confirmed.
Prevention of tuberculosis and control efforts rely primarily on the vaccination of infants and the detection and appropriate treatment of active infected cases. The World Health Organization has achieved some success through improved treatment regimens, showing a small decrease in the infected numbers. The US Preventive Services Task Force (USPSTF) recommends screening with either tuberculin skin test or interferon gamma release assays with people who are a high risk of latent TB.
Best efforts to kill all the bacteria that infect is the only way out, though it is a challenge to wipe off all, due to the immune bacteria that have developed resistance to familiar antibiotics. An effective TB treatment can be difficult due to the unusual structure of the chemical composition of the mycobacterial cell walls that obstruct the entry of drugs making many antibiotics ineffective. People with latent TB are treated to prevent infection from progression to active TB disease with effective treatment. Active TB is best treated with combinations of several antibiotics to reduce the risk of bacteria developing into antibiotic resistance.