Understanding Tuberculosis
Tuberculosis (TB) is a contagious bacterial infection caused by Mycobacterium tuberculosis, primarily affecting the lungs but capable of spreading to other parts of the body such as the brain, kidneys, and spine. It is one of the top 10 causes of death globally and a significant public health threat, especially in developing countries and among immunocompromised individuals.
Types of Tuberculosis
1. Latent Tuberculosis Infection (LTBI)
The bacteria remain in the body in an inactive state.
The individual shows no symptoms and is not contagious.
LTBI can reactivate later in life, especially if the immune system weakens.
2. Active Tuberculosis
The bacteria are active and multiplying, causing illness.
Symptoms are evident, and the disease is contagious.
Requires immediate medical intervention to prevent spread and complications.
3. Drug-Resistant Tuberculosis
Occurs when TB bacteria no longer respond to standard medications.
Includes Multidrug-resistant TB (MDR-TB) and Extensively drug-resistant TB (XDR-TB).
Treatment is longer, more expensive, and often less effective.
Causes and Transmission of Tuberculosis
TB is spread from person to person through airborne droplets released when an infected person coughs, sneezes, or talks. Key risk factors include:
Close contact with a TB-infected person
HIV infection or other immunocompromised states
Poor ventilation and overcrowded living conditions
Substance abuse (alcohol, drugs)
Malnutrition
Lack of access to healthcare
TB does not spread by touching surfaces, sharing food or drinks, or shaking hands.
Signs and Symptoms of Tuberculosis
Pulmonary TB (Affecting the Lungs)
Persistent cough lasting more than 3 weeks
Coughing up blood or sputum
Chest pain during breathing or coughing
Unexplained weight loss
Fatigue and weakness
Fever and chills
Night sweats
Loss of appetite
Extrapulmonary TB (Affecting Other Organs)
Spinal TB: Back pain, stiffness, or neurological symptoms
Kidney TB: Blood in urine, flank pain
Meningeal TB: Headaches, mental changes, neck stiffness
Lymphatic TB: Swollen, tender lymph nodes
Early detection is critical. Delayed diagnosis increases the risk of severe complications and transmission.
Diagnostic Methods for Tuberculosis
Diagnosis involves a combination of clinical evaluation, imaging, and laboratory testing:
1. Tuberculin Skin Test (TST/Mantoux Test)
A small amount of tuberculin is injected into the skin.
A raised bump after 48–72 hours indicates exposure.
2. Interferon-Gamma Release Assays (IGRAs)
A blood test measuring immune response to TB bacteria.
Preferred for those vaccinated with BCG (Bacille Calmette-Guérin).
3. Chest X-Ray
Used to detect lung abnormalities associated with TB.
4. Sputum Microscopy and Culture
Microscopic examination of sputum for acid-fast bacilli (AFB).
Culture confirms diagnosis and checks for drug sensitivity.
5. Molecular Testing (NAATs)
Rapid identification of TB DNA and resistance patterns.
Treatment Options for Tuberculosis
TB treatment requires strict adherence to multi-drug regimens over extended periods to ensure complete eradication and prevent resistance.
1. First-Line TB Medications
Isoniazid (INH)
Rifampin (RIF)
Ethambutol (EMB)
Pyrazinamide (PZA)
2. Treatment Duration
6 to 9 months for most drug-susceptible TB cases.
Can extend to 18–24 months for drug-resistant TB.
3. Directly Observed Therapy (DOT)
A healthcare worker supervises medication intake to ensure compliance.
Recommended for high-risk populations and drug-resistant cases.
Side Effects and Monitoring
While effective, TB drugs can cause side effects that require monitoring:
Liver toxicity (especially INH and RIF)
Visual disturbances (Ethambutol)
Nausea and gastrointestinal upset
Skin rashes
Joint pain
Regular follow-ups, liver function tests, and patient education are essential for successful treatment outcomes.
Preventing Tuberculosis
1. Vaccination
BCG vaccine offers protection, especially against severe TB in children.
Less effective in preventing adult pulmonary TB, but still widely used in endemic regions.
2. Infection Control Measures
Improve ventilation in living and working spaces.
Use of masks and respiratory precautions in healthcare settings.
Early diagnosis and treatment to reduce transmission.
Isolation of active TB cases until non-contagious.
3. Preventive Therapy
Isoniazid preventive therapy (IPT) for latent TB, especially in HIV-positive individuals.
Regular screening for at-risk groups such as healthcare workers and prisoners.
Tuberculosis and HIV: A Dangerous Duo
TB is the leading cause of death among people with HIV/AIDS. HIV weakens the immune system, increasing the risk of reactivating latent TB or acquiring active TB. Co-infection requires integrated care, combining:
Antiretroviral therapy (ART)
TB treatment with careful drug interaction monitoring
Nutritional support and counseling
Global Statistics and TB Burden
In 2023, TB caused approximately 1.3 million deaths worldwide.
Over 10.6 million new TB cases were reported globally.
India, China, Indonesia, the Philippines, and Pakistan account for the highest burden.
Only 60% of TB cases are diagnosed and reported, leaving millions untreated.
Challenges in TB Control
Despite being curable, TB remains a global challenge due to:
Drug resistance and treatment non-compliance
Limited access to healthcare
Social stigma and misinformation
Poverty, malnutrition, and urban overcrowding
Efforts must focus on universal health coverage, innovation in diagnostics, and community education to eliminate TB.
Conclusion:
Tuberculosis continues to pose a significant threat to global health. With early detection, rigorous treatment protocols, and strong preventive strategies, TB is both preventable and curable. Raising awareness, ensuring healthcare access, and promoting compliance are critical in ending the TB epidemic.
