TUBERCULOSIS

INTRODUCTION

Tuberculosis (TB) is an infectious disease that most often damages your lungs, but can affect any part
of your body such as kidney, spine, brain etc.,
TB is caused by the bacterium mycobacterium tuberculosis.
TB is primarily spread from person to person in an airborne manner, such as when an infected person
coughs or sneezes.
It can also cause an active infection after a period of not being active in someone who was exposed at
an earlier time.
 ETIOLOGY
TB is caused by mycobacterium and spread via aerosolised droplets.
Those capable of causing TB in humans are referred to as the mycobacterium complex (MTc)
and comprises of:
Mycobacterium tuberculosis: main cause of TB in humans.
Mycobacterium bovis: main cause of TB in cattle and other mammals, can cause human
disease.
Mycobacterium africanum: primarily seen in west Africa.
Mycobacterium microti: mainly affects other mammals.
Mycobacterium tuberculosis is the main cause of TB. Humans serve as its only host and it is
highly efficient at spreading.
People with active TB disease in the lungs or voice box can spread the disease. They release
tiny droplets that carry the bacteria through the air. This can happen when they're speaking,
singing, laughing, coughing or sneezing. A person can get an infection after inhaling the
droplets.
The disease is more likely to spread when people spend a lot of time together in an indoor
space. So the disease spreads easily in places where people live or work together for long
periods. Also, the disease spreads more easily in crowded gatherings.
A person with a latent TB infection cannot pass the disease to other people. A person taking
drugs to treat active TB disease usually can't pass the disease after 2 to 3 weeks of treatment.
 TYPES OF TUBERCULOSIS
◦ Broadly classified, there are two types of tuberculosis infections.

◦ In active tuberculosis, the individual who is carrying the organism has active symptoms and can
transmit the infection to other people.

◦ In latent tuberculosis, the individual carries the bacteria but does not exhibit any symptoms
whatsoever. This is because immunity fights the infection and is able to suppress it to an extent.
Individuals suffering from latent tuberculosis cannot transmit the illness to others. However, at
some point in their life, the bacteria can get reactivated and the infection can become active
tuberculosis.
 TYPES OF TUBERCULOSIS
Another way of classifying tuberculosis is based on the organs affected. For example, if the bacteria affects the
lungs, it results in a condition called pulmonary tuberculosis. If the bacteria affects the bladder, it can cause
bladder tuberculosis. Similarly, if it affects the spine, it can lead to tuberculosis of the spine which is also
called Potts disease or Potts’s spine. Tuberculosis can also affect the skin, brain and even the heart. Namely,
• Pulmonary Tuberculosis
• Pleural Tuberculosis
• Skeletal Tuberculosis
• Brain Tuberculosis
• Bladder and Kidney Tuberculosis
• Joint Tuberculosis
• Gastrointestinal Tract Tuberculosis
• Miliary Tuberculosis
 CLINICAL MANIFESTATION

People with latent TB infection don’t feel sick and aren’t contagious. Only people with active TB
infection will get TB disease and symptoms. Babies and children are at higher risk.

Certain conditions can increase a person’s risk for tuberculosis disease:

• diabetes (high blood sugar)
• weakened immune system (for example, HIV or AIDS)
• being malnourished
• tobacco use.
Common symptoms include:
• A cough that lasts more than 3 weeks – you may cough up mucus (phlegm) or mucus with blood
in it
• Feeling tired or exhausted
• A high temperature or night sweats
• Loss of appetite
• Weight loss
• Feeling generally unwell
Children may also have difficulty gaining weight or growing.
If TB has spread to another part of your body such as your glands (lymph nodes), bones or brain, you
may also have other symptoms, including:
• swollen glands
• body aches and pains
• swollen joints or ankles
• tummy or pelvic pain
• constipation
• dark or cloudy pee
• a headache
• being sick
• feeling confused
• a stiff neck
• a rash on the legs, face or other part of the body
 DIAGNOSIS
There are two kinds of screening tests for TB: the Mantoux tuberculin skin test (TST) and the blood test, called the
interferon gamma release assay (IGRA).

• Skin test. This is also known as the Mantoux tuberculin skin test. A technician injects a small amount of fluid into the skin
of your lower arm. After 2 or 3 days, they’ll check for swelling in your arm. If your results are positive, you probably
have TB bacteria. But you could also get a false positive. If you’ve gotten a tuberculosis vaccine called bacillus Calmette-
Guerin (BCG), the test could say that you have TB when you really don’t. The results can also be false negative, saying
that you don’t have TB when you really do, if you have a very new infection. You might get this test more than once.

• Blood test. These tests, also called interferon-gamma release assays (IGRAs), measure the response when TB proteins are
mixed with a small amount of your blood.

Those tests don’t tell you if your infection is latent or active. If you get a positive skin or blood test, your doctor will learn
which type you have with:

• A chest X-ray or CT scan to look for changes in your lungs

 RISK FACTORS
Generally, persons at high risk for developing TB disease fall into two categories:
1) Persons who have been recently infected with TB bacteria
2) Persons with medical conditions that weaken the immune system
Persons who have been Recently Infected with TB Bacteria. This includes:
 Close contacts of a person with infectious TB disease
 Persons who have immigrated from areas of the world with high rates of TB
 Children less than 5 years of age who have a positive TB test
 Groups with high rates of TB transmission, such as homeless persons, injection drug users, and persons
with HIV infection
 Persons who work or reside with people who are at high risk for TB in facilities or institutions such as
hospitals, homeless shelters, correctional facilities, nursing homes, and residential homes for those with
HIV.
Persons with Medical Conditions that Weaken the Immune System
 Babies and young children often have weak immune systems. Other people can have weak immune
systems, too, especially people with any of these conditions:
 HIV infection (the virus that causes AIDS)
 Substance abuse
 Silicosis
 Diabetes mellitus
 Severe kidney disease
 Low body weight
 Organ transplants
 Head and neck cancer
 Medical treatments such as corticosteroids or organ transplant
 Specialized treatment for rheumatoid arthritis or Crohn’s disease.
 COMPLICATION
◦ If TB of the lung is not treated early or if treatment isn’t followed, long-lasting (permanent)
lung damage can result. TB can also cause infection of the bones, spine, brain and spinal
cord, lymph glands, and other parts of the body.
Tuberculosis infection can cause complications such as:
• Back pain and stiffness.
• Joint damage due to tuberculous arthritis especially in the hips and knees.
• Meningitis, due to swelling of the membranes that cover the brain.
• The liver or kidney functions are impaired if they are affected by tuberculosis.
• In rare cases, tuberculosis can infect the tissues surrounding the heart, causing inflammation
and fluid collection that may interfere with the heart’s ability to pump effectively.
 TREATMENT
Your treatment will depend on your infection.
• If you have latent TB, your doctor will give you medication to kill the bacteria so the infection
doesn’t become active. You might get isoniazid, rifapentine, or rifampin, either alone or
combined. You’ll have to take the drugs for up to 9 months.
• A combination of medicines also treats active TB. The most common are ethambutol, isoniazid,
pyrazinamide, and rifampin. You’ll take them for 6 to 12 months.
• If you have drug-resistant TB, your doctor might give you one or more different medicines. You
may have to take them for much longer, up to 30 months, and they can cause more side effects.
Most common Tb drugs
First Line
• Rifampin MDR-TB
• Isoniazid
• Pyrazinamide
• Bedaquiline
• Ethambutol
Second Line
• Delamanid
• Kanamycin (discontinued use in the USA) • Linezolid
• Streptomycin
• Capreomycin • Pretomanid
• Amikacin
• Levofloxacin
• Moxifloxacin
• Gatifloxacin
 PREVENTION
To help stop the spread of TB:
• If you have a latent infection, take all of your medication so it doesn’t become active and contagious.
• If you have active TB, limit your contact with other people. Cover your mouth when you laugh, sneeze, or
cough. Wear a surgical mask when you’re around other people during the first weeks of treatment.
• If you’re traveling to a place where TB is common, avoid spending a lot of time in crowded places with
sick people.
VACCINATION
• Bacillus Calmette–Guérin vaccine is a vaccine primarily used against tuberculosis. It is named after its
inventors Albert Calmette and Camille Guérin. This vaccine is not widely used in the United States, but it
is often given to infants and small children in other countries where TB is common.