Tuberculosis

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at January 28, 2016
StartDiseasesTuberculosis

It is estimated that nearly two billion people in the world have some form of the tuberculosis infection. Tuberculosis, formerly known as consumption, generally affects people with a weakened or compromised immune system. The United States saw a dramatic resurgence of the disease in 1985, with the rise of HIV, a disease that can destroy a person’s immune system.

Contents

Definition & Facts

Once a devastating plague, tuberculosis was nearly eradicated by the 1960's in America due to the development of effective antibiotic medications. However, its rate of decline in the United States has slowed due to drug-resistant strains.

There are two main types of tuberculosis: latent tuberculosis and active tuberculosis. People with latent tuberculosis exhibit no symptoms of the disease and are not contagious to others. 90% of people with latent tuberculosis never develop the actual disease.

In an active tuberculosis infection, a person exhibits symptoms and is considered contagious. With this type of infection, the bacteria spreads throughout the body. Most of the time, a compromised immune system, often from diseases such as HIV can become the main reason a latent infection becomes active.

Symptoms & Complaints

For the most common type of tuberculosis, that which affects the lungs, symptoms can include a bad cough lasting three weeks or longer. This may be accompanied by pain in the chest or coughing blood or sputum. Other symptoms include unintentional weight loss and loss of appetite. Active tuberculosis also can cause the patient to have a fever, experience chills, or experience severe sweating at night.

When tuberculosis is present in other parts of the body, symptoms usually directly affect the infected body part. For example, tuberculosis centered in the spine can cause back pain, while tuberculosis active in the kidney can cause blood to be present in the urine.

Causes

Tuberculosis is caused primarily by a bacterium called Mycobacterium tuberculosis. It is spread between people through the air. Small moisture droplets containing the bacteria are released into the air when an infected person coughs, sneezes, or speaks. Tuberculosis is not spread through sharing food or drinks, physical contact such as shaking hands or kissing, or from touching the bed linens or toilet seat of an infected person.

A latent infection typically becomes active when a person’s immune system is compromised such as from HIV or diabetes. Some people are at a higher risk for having an active tuberculosis infection. Risk factors include alcohol abuse or drug abuse, or if a person was not properly treated for a tuberculosis infection in the past.

Diagnosis & Tests

There are two main tests performed by a health care professional used to tell if a person is infected with tuberculosis. One test is the PPD skin test. In this test, a small amount of PPD tuberculin is injected into the person’s inner forearm just below the skin. After 48-72 hours the skin is checked. Swelling in the form of a hard, raised bump indicates a likely infection. The bigger the reaction on the skin the more definite the tuberculosis infection is.

The second test that can be performed is a blood test which directly searches for the presence of tuberculosis in the patient’s system. If a person tests positive on either the skin or blood test, further testing is then performed to determine if the person has latent or active tuberculosis.

Treatment & Therapy

While active tuberculosis requires direct medical treatment, it is often recommended that those with latent tuberculosis also receive treatment. The treatment administered to those with latent tuberculosis is intended to prevent the latent form of the infection from becoming active.

For both types of tuberculosis infection, treatment usually consists of six to nine months of antibiotic treatment. It is extremely important for a person to take his/her medication exactly as prescribed and to continue taking the medication for the full duration. Ending treatment early, even though symptoms may improve or disappear completely, can cause the infection to come back stronger and resistant to further treatment.

Current research has indicated that a shorter course of antibiotics, lasting only four months, combined with other medications may be sufficient in eliminating latent tuberculosis from a person. It is the hope of researchers that the shorter, yet equally effective, treatment will ensure that a person stays on the full course of medication for the entire time period it is prescribed.

Prevention & Prophylaxis

One way to prevent tuberculosis infection is to stop a latent infection from becoming an active infection. By early diagnosis and receiving proper treatment, latent infection can be cured before it becomes an active infection.

If a person has an active tuberculosis infection, he/she can easily prevent infection to others by practicing personal hygiene. One way to prevent the spread of the disease is to stay at home where the infected person is not a threat to others. A well ventilated room also helps prevent the spread of tuberculosis because it will circulate the air and help remove the bacteria ridden droplets of moisture responsible for spreading the disease.

In some countries where tuberculosis is rampant a vaccine, Bacillus Calmette–Guérin (BCG) is administered to children. This vaccine can help protect young children from severe outbreaks of tuberculosis. This vaccine is not normally used in the United States because it is not as effective in preventing the disease with adults.