What is Tuberculosis?
Tuberculosis (TB) is a potentially serious infectious disease that mainly affects the lungs. The bacteria that causes tuberculosis are spread from person to person through tiny droplets released in the air via coughs and sneezes.
Is The Gambia high risk for Tuberculosis (TB)?
There is a high incidence of TB in The Gambia (40 to 499 cases per 100,000). We should screen people including children for TB according to the guidelines and refer to TB services promptly if screening is positive.
Symptoms
Although your body can harbour the bacteria that causes tuberculosis, your immune system usually can prevent you from becoming sick. For this reason, doctors make a distinction between latent and active TB.
Latent TB is when you have a TB infection, but the bacteria in your body are inactive and cause no symptoms. Latent TB, also called inactive TB or TB infection, isn’t contagious. Latent TB can turn into active TB, so treatment is important.
Active TB is also called TB disease and this condition makes you sick and, in most cases, can spread to others. It can occur weeks or years after infection with the TB bacteria.
Signs and symptoms of active TB include
o Coughing for three or more weeks, Coughing up blood or mucus.
o Chest pain, or pain with breathing or coughing, unintentional weight loss.
o Fatigue, fever, night sweats, chills, loss of appetite.
Tuberculosis can also affect other parts of your body, including the kidneys, spine or brain. When TB occurs outside your lungs, signs and symptoms vary according to the organs involved. For example, tuberculosis of the spine might cause back pain, and tuberculosis in your kidneys might cause blood in your urine.
When to see a doctor
See doctor if you have a fever, unexplained weight loss, drenching night sweats or a persistent cough. These are often indications of TB but can also result from other conditions. Also, see a doctor if you think you’ve been exposed to TB. The US Centers for Disease Control and Prevention recommends that people who have an increased risk of tuberculosis be screened for latent TB infection. This recommendation includes people who:
o Have HIV/Aids, are in contact with infected people, live or work in areas where TB is common, such as prisons or nursing homes, work in health care and treat people with a high risk of TB, are children who are exposed to adults at risk of TB
Causes
Tuberculosis is caused by bacteria that spreads from person to person through microscopic droplets released into the air. This can happen when someone with the untreated, active form of tuberculosis coughs, speaks, sneezes, spits, laughs or sings. Although tuberculosis is contagious, it’s not easy to catch. You are much more likely to get tuberculosis from someone you live or work with than from a stranger. Most people with active TB who’ve had appropriate drug treatment for at least two weeks are no longer contagious.
HIV and TB
Since the 1980s, tuberculosis cases have increased dramatically because of the spread of HIV. The virus that causes Aids. HIV suppresses the immune system, making it difficult for the body to control TB bacteria. As a result, people with HIV are much more likely to get TB and to progress from latent to active disease than are people who aren’t HIV positive.
Risk factors
Anyone can get tuberculosis, but certain factors can increase your risk including weakened immune system. A healthy immune system often successfully fights TB bacteria. However, several conditions and medications can weaken your immune system, including:
o HIV/AIDS, diabetes, severe kidney disease, certain cancers, cancer treatment, such as chemotherapy, drugs to prevent rejection of transplanted organs.
o Some drugs used to treat rheumatoid arthritis, Crohn’s disease and psoriasis, malnutrition or low body weight, very young or advanced age.
Complications
Without treatment, tuberculosis can be fatal. Untreated active disease typically affects your lungs, but it can affect other parts of your body, as well.
Tuberculosis complications include:
o Spinal pain. Back pain and stiffness are common complications of tuberculosis.
o Joint damage. Arthritis that results from tuberculosis (tuberculous arthritis) usually affects the hips and knees. Swelling of the membranes that cover your brain (meningitis). This can cause a lasting or intermittent headache that occurs for weeks and possible mental changes.
o Liver or kidney problems. The liver and kidneys help filter waste and impurities from the bloodstream. Tuberculosis in these organs can impair their functions. Heart disorders. Rarely, tuberculosis can infect the tissues that surround your heart, causing inflammation and fluid collections that might interfere with your heart’s ability to pump effectively. This condition, called cardiac tamponade, can be fatal.
Prevention
If the test is positive for latent TB infection, the doctor might advise you to take medications to reduce your risk of developing active tuberculosis. Only active TB is contagious.
Protect your family and friends
If you have active TB, it generally takes a few weeks of treatment with TB medications before you are not contagious anymore. Follow these tips to help keep your friends and family from getting sick:
o Stay home. Don’t go to work or school or sleep in a room with other people during the first few weeks of treatment.
o Ventilate the room. Tuberculosis germs spread more easily in small closed spaces where air doesn’t move. If it’s not too cold outdoors, open the windows and use a fan to blow indoor air outside.
o Cover your mouth. Use a tissue to cover your mouth anytime you laugh, sneeze or cough. Put the dirty tissue in a bag, seal it and throw it away.
o Wear a facemask. Wearing a facemask when you are around other people during the first three weeks of treatment may help lessen the risk of transmission.
Vaccinations
In countries where tuberculosis is more common, infants are often vaccinated with bacilli calmette-guérin (BCG) vaccine.
Diagnosis
During the physical exam, your doctor will check your lymph nodes for swelling and use a stethoscope to listen to the sounds your lungs make when you breathe.
The most commonly used diagnostic tool for tuberculosis is a skin test, though blood tests are becoming more commonplace. A small amount of a substance called tuberculin is injected just below the skin on the inside of your forearm. You should feel only a slight needle prick.
Within 48 to 72 hours, a health care professional will check your arm for swelling at the injection site. A hard, raised red bump means you’re likely to have TB infection. The size of the bump determines whether the test results are significant.
Blood tests
Blood tests can confirm or rule out latent or active tuberculosis. These tests measure your immune system’s reaction to TB bacteria.
These tests require only one office visit. A blood test might be useful if you are at high risk of TB infection but have a negative response to the skin test, or if you’ve recently received the BCG vaccine.
Imaging tests
If a positive skin test is performed, the doctor is likely to order a chest X-ray or a CT scan. This might show white spots in your lungs where your immune system has walled off TB bacteria, or it might reveal changes in your lungs caused by active tuberculosis.
Sputum tests
If your chest X-ray shows signs of tuberculosis, your doctor might take samples of your sputum — the mucus that comes up when you cough. The samples are tested for TB bacteria.
Sputum samples can also be used to test for drug-resistant strains of TB. This helps your doctor choose the medications that are most likely to work. Getting results of these tests can take four to eight weeks.
Treatment
If you have latent TB, your doctor might recommend treatment with medication if you’re at high risk of developing active TB. For active tuberculosis, you must take antibiotics for at least six to nine months.
The exact drugs and length of treatment depend on your age, overall health, possible drug resistance and where the infection is in your body.
Duration of tuberculosis
A person can have latent TB for years, without having symptoms or becoming sick. But if the bacteria are detected, a course of treatment over three to four months is recommended by the CDC.
Treatment for active TB disease can take six to nine months. It’s vital that people with TB disease complete their full course of medication exactly as prescribed. Otherwise, the disease can return and be more resistant to treatment.
Complications of tuberculosis
If left untreated TB can affect other parts of the body, beyond the lungs. Back pain, joint damage, and liver or kidney problems, can result, as can swelling of the membranes around your brain. Ultimately, untreated TB can be fatal.
While most people are able to tolerate the drugs well during treatment, TB medication can lead to some complications, as well. It can be hard on the liver. Doctors will monitor your liver function on regular checkups to make sure you’re not in danger of complications.
The following symptoms are considered serious side effects and should be reported to your doctor:
o Loss of appetite, nausea or vomiting, yellowing of skin or eyes (a sign of liver damage), fever that lasts longer than three days, fatigue, dark-coloured urine, pain the in the abdominal area, tingling in the fingers or toes, Feeling itchy with no known cause, rash on the skin, dizziness, muscle weakness or aching joints, changes in vision, changes in hearing, like hearing loss or ringing in the ears
Improving your diet, drinking plenty of water, and getting regular exercise can also help your body recover and avoid adding extra strain on the liver.
Prevention of tuberculosis
Keeping your immune system healthy and avoiding exposure to someone with active TB is the best way to prevent a TB infection. Identifying and treating cases of latent TB, before the disease becomes active, is important, particularly in high-risk populations. To prevent the transmission of tuberculosis in healthcare settings, we should follow the CDC’s latest guidelines that require most healthcare personnel be screened for tuberculosis when they’re hired.
For further information, email to Gambian TB Association, [email protected]
The author, Dr Hassan Azadeh, is a senior lecturer at the University of The Gambia, and clinical director at Medicare Health Services.
