What is Tuberculosis and How to treat it ?

Fundamentally, tuberculosis is a disease of the lungs. However, from the lung disease can spread through the blood to all organs of the body. This means that tuberculosis may appear in the pleura (the lining of the lungs), bone, urinary tract and sexual organs, intestines and even skin. Also infect the lymph nodes in the neck and lung hila. Sometimes children get as initial infection tuberculous meningitis: this form of infection is potentially fatal.

How do you get tuberculosis?

The bacteria responsible for the disease is inhaled through microscopic droplets that come from a person with tuberculosis. When coughing, talking or sneezing droplets are ejected outside. Although dry quickly, the bacillus itself may remain floating in the air for hours. However, tubercle bacilli die when exposed to ultraviolet light (including sunlight itself).

How does the bacillus in the body?

Once the tuberculosis bacteria have been inhaled into the lungs and in about six weeks appears a small infection that usually does not cause symptoms, known as primary infection. Then, the bacteria can spread to the blood. If the immune system is competent, in most cases the infection remains latent showing no apparent damage. However, several months or even years later, if the immune system is depressed, the disease can be reactivated in different organs. The lungs are the preferred site for the disease to start its inception.

What are the symptoms?

Typical signs of TB are:

Tuberculosis can mimic many forms of disease, and it should always be suspected when there is no clear diagnosis. There are other non-tuberculous mycobacteria in soil and water that can cause disease in susceptible patients with a history of cystic fibrosis , chronic lung disease , alcoholism , and immunosuppression (defense suppression due to disease or certain drugs). These atypical mycobacteria may also exist as colonizing organisms without necessarily causing disease.

  • cough with expectoration chronic or persistent
  • If the disease is advanced blood appears in the sputum
  • fatigue
  • Lack of appetite
  • Weight loss
  • Fever
  • Night sweats

When to see a doctor?

You should consult with your doctor when coughing lasts more than three weeks.

How does the doctor make the diagnosis?

The doctor can not simply diagnose tuberculosis with stethoscope auscultation. If your doctor suspects that something is wrong and is not just a cold, you may be referred to the lung specialist, or prescribe a radiograph . Chest radiography is the most important. If pulmonary changes are taking a sputum sample for microscopic examination and culture. Tubercle bacilli crops take to grow from 4 to 12 weeks. Therefore, to reach accurate diagnosis can take a while. Methods are being developed which use faster DNA techniques. Sometimes the Mantoux skin reaction may be useful, in this test was injected into the tuberculin skin, a substance extracted from the bacterium tuberculosis. If 72 hours appears to severe skin reactions in the skin, because there tuberculin hypersensitivity which may be caused by BCG, or suspected active infection.

Are there other diseases with similar symptoms?

Both bronchitis as pneumonia , the smoker’s lung (chronic bronchitis) and lung cancer may have almost the same symptoms as tuberculosis. When suspected tuberculosis tests are to rule out these other diseases. If the chest X-ray there is any suspicion of lung cancer in sputum analysis adds an extra test to check.

Is indicated tuberculosis vaccine?

While other countries are routinely administered BCG (tuberculosis bacteria with live, weakened) in Spain is not routinely indicated vaccination. However, you may be offered individually to children and youth in intimate contact and prolonged irreducible positive patients and employees contact with TB patients or biological samples.

How is tuberculosis?

Currently, TB treatment uses three or four different antibiotics, administered together for a period of six to nine months. Several drugs are needed to prevent the emergence of resistance, which would lead to treatment failure and a disaster for the emergence of multiresistant organisms to drugs. Never add a single drug to a failing regimen. Treatment should be directed by a pulmonologist, who has the knowledge of their specialty on complications and side effects of antituberculosis drugs.

The details of treatment are essential. The main cause of treatment failure is the failure of what is perceived as “a demanding and lengthy treatment program.” Patients with positive sputum culture and are contagious and, if possible, should avoid contact with others for a period of two weeks. No hospitalization is necessary to begin treatment. There are other patients with lower bacterial load whose sputum is negative but culture positive. Although less infectious patients should meet conventional treatment.

In individuals without evidence of disease, but with the tuberculin skin test positive, and no history of BCG vaccination to justify this reaction can be performed with a single drug prophylaxis, isoniazid for 6 to 12 months, in order to prevent the onset of the disease in the future.

Should be addressed urgently to pregnant women with tuberculosis, because the disease can progress rapidly with serious risk to the mother and child.

Is it possible to become resistant to drugs?

Yes, if you do not take the medication every day and in the manner prescribed by the doctor. In some areas of the world there are problems with resistance, and even multiple drug resistance. This situation is very serious, as has happened on a large scale in the Baltic countries, in several Eastern European countries, in some American cities and regions of the Third World. Treating these patients can be a long and costly. When patients fail treatment may be required adherence monitoring in a hospital, or at home by a nurse. This program is known as DOTS (Directly Observed Treatment) and is recommended by the World Health Organization (WHO).

How treatment can be controlled?

A patient with TB infection undetected infect, on average, another 10 people a year, which in turn can spread the germ. According to WHO and the International Union Against Tuberculosis (IUAT), all countries should have a national program against it, and the authorities should be notified TB cases.

The treatment itself is prescribed under the supervision of pulmonologists, who make sure that the patient has received the correct treatment course. A negative sputum culture at 6 to 12 months at diagnosis is synonymous with healing. Clinicians also ensure that you carefully examine the environment where the patient lives. Chest radiography is asked all the relatives. Sometimes also examines the patient’s coworkers.

What are the world’s regions most at risk?

Infection can occur anywhere, but tuberculosis occurs primarily in sub-Saharan Africa and Southeast Asia. It is more common in Eastern Europe than in the West, and Scandinavia has the lowest number of cases in the world.

Do you associate HIV and AIDS with tuberculosis?

Yes It is becoming more endemic and the HIV in some African countries and in many areas of Southeast Asia. In areas where TB is endemic in the population, a depressed immune system increases the risk of contracting it. This situation is extremely worrying, and WHO and IUAT are doing everything possible to prevent the spread of the disease.

Can you prevent tuberculosis?

Yes The most important objective is to detect, isolate and treat all carriers of the disease, until they pose a risk of infection to others. It is always advisable not to get too close to people coughing, similarly, people who cough should be sensitive to those around you and cover your mouth with your hand or a tissue to do.

Good advice

When traveling to countries where tuberculosis is a problem related to avoid people who are coughing. Be sure to eat well and enjoy plenty of sunshine and exercise. Consult your doctor if you develop a cough that persists for more than three weeks.

Dr. Gunnar Pallisgaard , Infectious Disease Specialist, Dr. Gavin Petrie , Pulmonology specialist