Tuberculosis

Summary on tuberculosis

Tuberculosis is an infectious disease that remains a major public health problem in the world, especially in third world countries.
Tuberculosis can be fatal if not diagnosed and treated. However, it is a disease that can be prevented. Identification and treatment of those infected is the main means of preventing the infection from spreading in the community.
This disease is caused by the bacteria Mycobacterium tuberculosis and transmitted through droplets of saliva from coughing or sneezing from infected people. But a South African study published in October 2021 (more information in Causes below) estimates that the simple act of breathing can be one of the main means of transmission of tuberculosis.
Not all people who come into contact with the bacteria develop the disease, usually people manage to eliminate the bacteria without being infected.
There are cases where the person does not expel the bacteria but manages to control it and does not manifest the disease (latent tuberculosis). But this tuberculosis can be reactivated, leading to the manifestation of the disease, this occurs in cases of incomplete treatments and in people with a weakened immune system, such as AIDS patients , diabetics and people who use immunosuppressive drugs.

Smokers, the elderly, people living in shelters or asylums, prisoners and health professionals are also at a higher risk of developing the disease.

The main symptoms are: cough (with or without catharus and blood), low fever, night sweats, loss of appetite, weight loss, fatigue , chest pains and difficulty breathing.

Diagnosis is usually made through the patient’s history, symptoms, direct microscopic examination, and chest X-ray.

Tuberculosis treatment consists of using several antibiotics , usually 3 or 4, which must be taken every day and for at least 6 months. Treatment done correctly cures practically 100% of cases.

Definition

Tuberculosis is an infectious disease caused by bacteria that primarily affects the lungs, but can also affect other organs.

There are two stages/types of tuberculosis, latent and active:
– Latent tuberculosis: The infected person manages to control the bacteria, does not show symptoms and does not transmit the disease. If treated at this stage, active tuberculosis can be prevented. Approximately 1/3 of the world’s population is infected with latent tuberculosis.

– Active tuberculosis: Runs when there is reactivation of tuberculosis, in cases where latent tuberculosis is not completely treated or in cases where the individual is immunosuppressed (as in the case of AIDS ). Reactivation occurs in 5 to 10% of cases of latent tuberculosis.

Extra-pulmonary cases (outside the lung), with the exception of patients with compromised immunity, usually occur due to a reactivation of the disease and not a primary infection. Tuberculosis can cause meningitis , kidney, liver, adrenal gland, pleural and bone infections. In children, the incidence of extra-pulmonary tuberculosis is higher, occurring in 20% of cases.

Tuberculosis is well controlled in the most industrialized countries (USA, Canada, Japan, some European countries), but it is much more problematic in developing countries, such as in Africa, where the AIDS epidemic combines with tuberculosis and makes eradication difficult. of the disease.

Another problem causing the increase in cases of tuberculosis in the world is the development of resistance to  antibiotics in anti-tuberculosis treatments.

History:
The Greek physician Hippocrates (about 400 years before Christ) believed that tuberculosis was the most widespread disease of his time.

Epidemiology

– In 2020, TB-related deaths increased for the first time in over a decade, according to the WHO. A total of 1.5 million people died in 2020, about 100,000 more in one year. Among them, approximately 215,000 were infected with HIV1 .
In 2020, the number of people diagnosed with tuberculosis went from 1.3 million to 5.8 million. According to WHO estimates, more than 4 million people contracted tuberculosis unknowingly, against less than 3 million a year earlier.

Causes

Most cases of tuberculosis come from the bacterium Mycobacterium tuberculosis (Koch’s bacillus). This bacteria usually affects the lungs, but it can affect other parts of the body.

Transmission
Tuberculosis transmission is carried out, for example, through fine droplets of saliva from a cough or sneeze of a person affected by tuberculosis, this bacterium is distributed throughout the lung, mainly in the upper portion (at the apex).
But a South African study published on October 19, 2021 by the University of Cape, South Africa, estimates that the simple act of breathing can be one of the main means of transmission of tuberculosis. Its authors advocate a fundamental change in strategies to contain this disease, which until now have focused on coughing. If the hypothesis of transmission of tuberculosis through breathing is confirmed, it means that the treatment of people who have already developed symptoms is insufficient to block the spread of the disease. The South African researchers evaluated the transmission of this bacterium by 39 affected people. To do so, they measured the amount of this bacteria emitted by infected people when they breathed normally, deeply and when they coughed. After 5 minutes, Particle clouds containing the bacteria were produced in all three cases. Coughing produced three times more bacteria than breathing. But, according to the researchers, the fact that we breathe continuously can mean that 90% of the bacteria emitted by an infected person are emitted in this way. Hence the importance of adequately ventilating places that potentially contain infected people, according to the researchers. On October 19, 2021, this work had not yet been peer-reviewed, it was presented at an international online conference dedicated to lung health the fact that we breathe continuously can mean that 90% of the bacteria emitted by an infected person are emitted in this way. Hence the importance of adequately ventilating places that potentially contain infected people, according to the researchers. On October 19, 2021, this work had not yet been peer-reviewed, it was presented at an international online conference dedicated to lung health the fact that we breathe continuously can mean that 90% of the bacteria emitted by an infected person are emitted in this way. Hence the importance of adequately ventilating places that potentially contain infected people, according to the researchers. On October 19, 2021, this work had not yet been peer-reviewed, it was presented at an international online conference dedicated to lung health2.

Generally, in people with a fully functioning immune system, the bacteria are expelled from the body, many without becoming infected.

There are cases in which the person develops an immune response that controls the bacteria, in these cases the person does not develop active tuberculosis and does not get sick, we speak of latent tuberculosis. But the disease can progress leading to active tuberculosis, often silently, and can even lead to death.

Bacteria Remains Hidden
One of the reasons why the bacteria ( Mycobacterium tuberculosis ) has survived for hundreds of years and why it is difficult to treat is that it has evolved a sophisticated mechanism to hide in the body. The bacteria actually reside in white blood cells called macrophages, cells that would normally kill them. These observations come from a study published August 14, 2017 in the scientific journal PLoS Pathhog   (10.1371/journal.ppat.1006551).

Groups of risk

Children and people over 60 are the hardest hit by tuberculosis. We observed that both women and men are equally affected by the disease.

People with weaker immune systems, such as AIDS patients, diabetics, patients under treatment with immunosuppressants, people suffering from lung diseases, among others, are the most affected by tuberculosis, as their defense against the bacteria is limited.

Smoking is also associated with a higher risk of acquiring the disease, having a relapse and higher mortality from the disease.

Other risk groups are communities with a high prevalence of tuberculosis, people who have had contact with tuberculosis patients, residents of shelters or asylums, prisoners and health professionals.

Symptoms

The first infection, or primary infection (first contact between the patient and Koch’s bacillus) almost always occurs without manifestation of symptoms, and is more frequent in children. In general, a tuberculous cancer forms in the lungs.

However, when symptoms do appear, they are mainly:

– A cough (often dry)

– A feeling of being unwell (general)

– Irritability

– night sweats

– low fever

If the disease progresses, usually about 2 to 6 weeks after the first infection, the symptoms that tend to appear are as follows:

– A productive cough with sputum or phlegm that may be yellowish or greenish and may also have blood mixed in.

– Pains in the chest region, especially in case of strong inspiration.

– Breathing difficulty

– shortness of breath after exertion

– Fever  (afternoon and usually not above 38.5°C)

– Lack of appetite and weight loss

– Excessive sweating (night sweats)

– Fatigue

When tuberculosis is not well treated, other organs besides the respiratory system can be affected, such as the heart and brain, this makes tuberculosis a dangerous disease that absolutely needs therapy (antibiotics).

We emphasize that the symptoms and their names may vary (eg tuberculous pleurisy, miliary tuberculosis,…), here we only offer you a summary, as it is difficult to mention all the symptoms of tuberculosis (only a doctor can provide you with detailed information on the subject ).

Diagnosis

The diagnosis of tuberculosis is always made through the microscopic examination of sputum, it allows detecting 60 to 80% of cases of pulmonary tuberculosis, this test seems to be unreliable and dates back over a hundred years. Therefore, it would be important that in the coming years simpler diagnostic tests appear, which can quickly detect tuberculosis (source: ATS, March 10, 2008), especially in poorer countries, where lung X-rays are very expensive.

Culture for mycobacteria is an exam that increases the diagnosis of tuberculosis by 30%, but it is little used because it is a more expensive and time-consuming method.

We must consider that the doctor will also examine the patient’s main symptoms, which may eventually lead him to the tuberculosis trail. He may also order X-rays to supplement the diagnosis.

In the case of the diagnosis of latent tuberculosis, the tuberculin test is used, which injects parts of the bacteria into the skin, and if the person develops a reaction with the formation of aloe red larger than 15 mm, the test is positive. The positive test means that the person is or has been infected by the bacteria.

Note: it is always difficult to summarize the doctor’s diagnostic tools, they are information that can evolve and vary from one country to another, therefore, only a doctor can make the diagnosis.

Complications

The main complications of tuberculosis are, in particular, pleural effusion (fluid in the pleural cavity) and pneumothorax (gas in the pleural cavity).

Treatments

The treatment of tuberculosis consists of the use of several antibiotics , in general 3 or 4. They are the following molecules: rifampicin, ethambutol, isoniazid and/or pyrazinamide. These antibiotics must be taken every day and for at least 6 months. Treatment done correctly cures practically 100% of cases.

These antibiotics can lead to certain side effects (change in urine color, drug-induced hepatitis,…), but in general they are well tolerated. Your doctor will give you more information about this.

It is also important to note that more and more tuberculosis patients are developing resistance to these antibiotics, especially in the case of monotherapy (administration of a single antibiotic). When patients are treated by tri- or tetratherapies, resistance is much weaker.

In cases of some complications and adverse reaction to drugs, surgery may be an option.

During treatment it is important to avoid the consumption of alcohol and paracetamol, as both can increase the risk of liver problems.

In cases where there is no resistance to treatment, the patient is no longer at risk of transmission after 15 days of treatment. The patient’s progress should be checked.

History of Tuberculosis Treatments:
In 1947, the antibiotic streptomycin was identified by clinical trials as an effective treatment for tuberculosis.

Tips

– If you suffer from tuberculosis, it is very important that you correctly follow the drug treatment (based on several antibiotics) and above all, it is important that you respect the duration of the treatment prescribed by the doctor (in general, at least 6 months), as otherwise you could develop resistance to antibiotics and therefore put your health and the health of others in danger.

Prevention

– Tuberculosis prevention is done mainly through vaccination. The BCG vaccine (Bacillus de Calmette and Guérin) is not 100% effective, but it has reduced the number of cases of tuberculosis worldwide.

BCG protects against severe manifestations of primary infection with the spread of some complications, but it does not prevent infection. It is indicated for children up to 4 years old, being mandatory for children under 1 year old, newborns must weigh 2 kg or more. It is contraindicated in cases of dermatological diseases, either at the site of vaccination or generalized, use of immunodepressants or steroids and patients with HIV.

– If a person is afflicted with tuberculosis, it may be useful to put him on forty, until he is no longer contagious (from the third week of antibiotic treatment).

Jeanne Kenney
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I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

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