Your quick guide to tuberculosis

More than 40% of the Indian population carry tuberculosis infection in their body, yet only 10% develop the disease. Read to know more about tuberculosis including its symptoms, diagnosis, treatment and prevention.

What is tuberculosis?

Tuberculosis (TB) is a bacterial infection caused by Mycobacterium tuberculosis and most commonly affects the lungs (although other organs such as the spine, kidneys, and brain can also be involved).

Tuberculosis can be present in two different forms –

Latent TB – You are infected with TB-causing bacteria but your immune system is able to arrest its spread. You are neither contagious nor do you exhibit any symptoms. There is a possibility that the infection can get activated though
Active TB – The bacteria increases in number and spreads to different body parts. You will experience the symptoms of TB

How does tuberculosis spread?

TB spreads through infected droplets released in the air that are carrying the invisible TB bacteria. When a person with active TB coughs or speaks and this air is inhaled by another healthy person, the bacteria enters the lungs, settle there, multiply, cause symptoms of the disease and spread through the blood to other parts of the body such as lymph nodes, spine, brain, kidney etc.

Who is at the risk of developing TB?

People who come in contact with those infected with TB. This includes those living with infected persons, healthcare workers who treat people with TB etc.
HIV positive persons
Substance abuse – alcohol, narcotics
Those under medicines that suppress their immune system
People who live in places with a high risk of TB transmission such as slums, prisons etc.

What are the symptoms of tuberculosis?

Persistent cough for more than 3 weeks
Chest pain
Coughing up blood or phlegm
Fever and chills
Night sweats
Loss of appetite
Weight loss
Tiredness

When the bacteria spread to other parts of the body, it causes other symptoms such as –

Back pain if the spine is involved
Headache and confusion due to brain involvement
Swelling of lymph nodes
Blood in the urine, burninig sensation while urinating, abdominal pain etc. if the kidneys are involved
Painless ulcers on the skin, tongue etc.

How is tuberculosis diagnosed?

If you’re experiencing persistent cough, fever and night sweats for more than 2-3 weeks, you must consult a doctor for TB. After evaluating your symptoms and physically examining you, your doctor may advise you to undergo certain tests –

Blood tests
Sputum test – Your phlegm will be examined under the microscope to see if there are any bacteria
Chest X-ray
Culture – The TB bacteria from the patient are grown in the lab to find out which antibiotics are effective against them
Skin test (Mantoux tuberculin test) – Your skin is injected with a small quantity of a fluid that contains purified proteins derived from the tuberculosis bacteria. After 48 to 72 hours, you will be asked to report back for measuring the size of redness and swelling in the area of injection to determine whether you are positive or negative. If your test comes back positive, further testing may be required. While Mantoux is useful in detecting exposure to tuberculosis, it is not very reliable in India, since it shows a positive result with BCG vaccine as well.

How is tuberculosis treated?

Tuberculosis is treated aggressively through medicines taken through the mouth. In India, directly observed treatment (DOT) is a strategy used to ensure that all the patients diagnosed with TB are taking their full course of medicines.

Patients will report at a DOT centre daily and take the medicines under the direct observation of the DOT provider. There are 5 primary medicines used for the treatment of TB. These are –

Isoniazid
Rifampin
Pyrazinamide
Ethambutol
Streptomycin

All these medicines are combined as one tablet. Your duration of treatment may vary between 6 to 8 months depending on the severity of the infections. Additional medicines may be added if you are infected with drug-resistant TB, since it does not respond to normal treatment (flouroquinolones, amikacin, kanamycin etc.).

How will tuberculosis impact my pregnancy?

If you develop tuberculosis during pregnancy, it may give rise to complications in pregnancy such as –

Spontaneous abortion
Premature delivery of the baby
Low birth weight baby
Increased risk of infant death
Rarely, the baby may be born with TB

The medicines used for treatment are generally safe for the baby. However, some medicines may be harmful (streptomycin, kanamycin, amikacin, capreomycin, and fluoroquinolones) and hence, you need to let your doctor know if you are pregnant.

Is tuberculosis deadly?

If untreated, TB can spread to different parts of the body and create multiple complications, ultimately leading to death. However, it can be completely cured if detected early and treated aggressively.

I have TB. How can I prevent the infection from spreading to others?

Seek medical care and complete the full course of medicines fully
Cover your mouth properly while you cough or sneeze
Do not spit in public places
Refrain from visiting others and do not invite people to your home until you are
completely cured of the infection
Wash your hands properly with soap after you cough and sneeze

What is BCG vaccine?

Bacillus Calmette–Guérin (BCG) vaccine is given to all infants born in India within a few days after birth. This vaccine protects babies from developing severe complications of tuberculosis such as brain and spine infections. The vaccine is given as an injection. It is not found to be of much effect in adults.

What are the complications of tuberculosis?

Spinal tuberculosis – TB involving the spine resulting in back pain and stiffness
Tuberculous arthritis – Joint damage affecting hips and knees
Liver or kidney problems
TB meningitis due to brain infection resulting in headache, confusion etc
Heart problems