Prevention, Diagnose, Treatment
Understanding
Tuberculosis -- the Basics
November
12 commemorates the day in 1882 when Dr Robert Koch astounded the scientific
community by announcing to a small group of scientists at the University of
Berlin’s Institute of Hygiene that he had discovered the cause of tuberculosis,
the TB bacillus According to Koch’s colleague, Paul Ehrlich, “At this memorable
session, Koch appeared before the public with an announcement which marked a
turning-point in the story of a virulent human infectious disease. In clear,
simple words Koch explained the ethology of tuberculosis with convincing force,
presenting many of his microscope slides and other pieces of evidence.” At the
time of Koch’s announcement in Berlin, TB was raging through Europe and the Americas,
causing the death of one out of every seven people. Koch’s discovery opened the
way toward diagnosing and curing tuberculosis.
What
Is Tuberculosis?
Tuberculosis,
commonly known as TB, is a bacterial infection that can spread through the
lymph nodes and bloodstream to any organ in your body. It is most often found
in the lungs. Most people who are exposed to TB never develop symptoms because
the bacteria can live in an inactive form in the body. But if the immune system
weakens, such as in people with HIV or elderly adults, TB bacteria can become
active. In their active state, TB bacteria cause death of tissue in the organs
they infect. Active TB disease can be fatal if left untreated.
Because
the bacteria that cause tuberculosis are transmitted through the air, the
disease can be contagious. Infection is most likely to occur if you are exposed
to someone with TB on a day-to-day basis, such as by living or working in close
quarters with someone who has the active disease. Even then, because the bacteria
generally stay latent (inactive) after they invade the body, only a small
number of people infected with TB will ever have the active disease. The
remaining will have what’s called latent TB infection -- they show no signs of
infection and won’t be able to spread the disease to others, unless their
disease becomes active.
Because
these latent infections can eventually become active, even people without
symptoms should receive medical treatment. Medication can help get rid of the
inactive bacteria before they become active.
TB
was once a widespread disease. It was virtually wiped out with the help of
antibiotics developed in the 1950s, but the disease has resurfaced in potent
new forms -- multidrug-resistant TB and extensively drug-resistant TB. Today,
these new and dangerous forms of the disease -- resistant to some of the
commonly used drug treatments -- have created a public health crisis in many
large cities worldwide. If you have TB -- in its active or latent state -- you
must seek medical treatment.
World
Tuberculosis Day, falling on March 24 each year, is designed to build public
awareness about the global epidemic of tuberculosis and efforts to eliminate
the disease. Today tuberculosis causes the deaths of about 1.7 million people
each year, mostly in the Third World.
World
Tuberculosis Day 2017
On
the occasion of World TB Day 2010, the International Committee of the Red Cross
declared that attempts to stem the spread of tuberculosis across the globe are
likely to fall well short of what is needed unless authorities in affected
countries significantly increase their efforts to stop the deadly disease from
breeding inside prisons. As a result of overcrowding and poor nutrition, TB
rates in many prisons are 10 to 40 times higher than in the general public. The
ICRC has been fighting TB in prisons in the Caucasus region, Central Asia,
Latin America, Asia Pacific and Africa for more than a decade, either directly
or by supporting local programmers.
Tuberculosis
or TB is a common, and in many cases lethal, infectious disease, usually cause
by bacteria. Tuberculosis typically attacks the lungs, but can also affect
other parts of the body. It is spread through the air when people who have an
active TB infection cough, sneeze, or otherwise transmit their saliva through
the air. Most infections does not show symptoms and is latent, but about one in
ten latent infections eventually progresses to active disease which, if left
untreated, kills more than 50% of those so infected.
The
classic symptoms of active TB infection are a chronic (long-standing) cough
with blood-tinged sputum, fever, night sweats, and weight loss (the latter
giving rise to the formerly prevalent term “consumption”). Infection of other
organs causes a wide range of symptoms. Diagnosis of active TB relies on
radiology (commonly chest X-rays), as well as microscopic examination and
microbiological culture of body fluids.
Diagnosis
of latent TB relies on the tuberculin skin test (TST) and/or blood tests.
Treatment is difficult and requires administration of multiple antibiotics over
a long period of time. Social contacts are also screened and treated if
necessary. Antibiotic is a growing problem in multiple drug-resistant
tuberculosis (MDR-TB) infections. Prevention relies on screening programs and vaccination
with the vaccine.
One
third of the world’s population is thought to have been infected with M.
Tuberculosis, with new infections occurring at a rate of about one per second.
In 2007, there were an estimated 13.7 million chronic active cases globally,
while in 2010, there were an estimated 8.8 million new cases and 1.5 million
associated deaths, mostly occurring in developing countries. The absolute
number of tuberculosis cases has been decreasing since 2006, and new cases have
decreased since 2002. The distribution of tuberculosis is not uniform across
the globe; about 80% of the population in many Asian and African countries test
positive in tuberculin tests, while only 5–10% of the United States population
tests positive. More people in the developing world contract tuberculosis
because of compromised immunity, largely due to high rates of HIV infection and
the corresponding development of AIDS
HOW
DANGEROUS IS TUBERCULOSIS (TB) DISEASE?
We
find this lethal disease tuberculosis (TB) also in the Gambia and it killing
these people who have not been diagnosed and not been treated due to their luck
of awareness of the disease and possible their negligence not to visit any of
the health facilities throughout the country. Diagnose and treatment of tuberculosis
is one of the highest Health care priorities of the Gambian Health Ministry
with sufficient facilities and specialist in the major Government Hospitals
including the EFSTH, MRC and number of Health Clinics throughout the country.
Signs
and symptoms
The
main symptoms of variants and stages of tuberculosis are given,] with many
symptoms overlapping with other variants, while others are more (but not
entirely) specific for certain variants. Multiple variants may be present
simultaneously.
About
5–10% of those without HIV, infected with tuberculosis, develop active disease
during their lifetimes. In contrast, 30% of those co infected with HIV develop
active disease. Tuberculosis may infect any part of the body, but most commonly
occurs in the lungs (known as pulmonary tuberculosis)General signs and symptoms
include fever, chills, night sweats, loss of appetite, weight loss, and
fatigue, and significant finger clubbing may also occur.
Pulmonary
(Lungs)
If
a tuberculosis infection does become active, it most commonly involves the
lungs (in about 90% of cases). Symptoms may include chest pain and a prolonged
cough producing sputum. About 25% of people may not have any symptoms (i.e.
they remain (“without symptoms”).Occasionally, people may cough up blood in small
amounts, and in very rare cases, the infection may erode into the pulmonary
artery, resulting in massive bleeding. Tuberculosis may become a chronic
illness and cause extensive scarring in the upper lobes of the lungs.
Extra
pulmonary (out site the lungs)
In
15–20% of active cases, the infection spreads outside the respiratory organs,
causing other kinds of TB. These are collectively denoted as “extra pulmonary
tuberculosis”. Extra pulmonary TB occurs more commonly in immune suppressed
persons and young children. In those with HIV, this occurs in more than 50% of
cases. Notable extra pulmonary infection sites include the central nervous
system (in tuberculosis meningitis), the lymphatic system (in scrofula of the
neck), the genital system, and the bones and joints, among others. When it
spreads to the bones, it is also known as “osseous tuberculosis”
TUBERCULOSIS
Causes
The
primary cause of TB, ‘’Mycobacterium tuberculosis’’, is a small aerobic
non-motile bacillus. It divides every 16 to 20 hours, an extremely slow rate
compared with other bacteria, which usually divide in less than an hour.
Risk
factors
Persons
with chronic kidney failure who are on haemodialysis also have an increased
risk: 10—25 times greater than the general population. Persons with diabetes
mellitus have a risk for developing active TB that is two to four times greater
than persons without diabetes mellitus, and this risk is likely greater in
persons with insulin-dependent or poorly controlled diabetes. Low body weight
is associated with risk of tuberculosis as well. Patients with diabetes millet
are at increased risk of contracting tuberculosis, and they have a poorer
response to treatment, possibly due to poorer drug absorption
Other
conditions that increase risk include IV drug abuse; recent TB infection or a
history of inadequately treated TB; chest X-ray suggestive of previous TB,
(30-40% of AIDS patients in the world also have TB), such as leukaemia and
Hodgkin’s disease; end-stage kidney disease; intestinal bypass; chronic absorption
syndromes; vitamin D deficiency; and low body weight.
Transmission
When
people with active pulmonary TB cough, sneeze, speak, sing, or spit, they expel
infectious aerosol droplets 0.5 to 5.0 µm in diameter. A single sneeze can
release up to 40,000 droplets. Each one of these droplets may transmit the
disease, since the infectious dose of tuberculosis is very low (the inhalation
of fewer than 10 bacteria may cause an infection).
People
with prolonged, frequent, or close contact with people with TB are at
particularly high risk of becoming infected, with an estimated 22% infection
rate.
A
person with active but untreated tuberculosis may infect 10–15 (or more) other
people per year. Transmission should only occur from people with active TB -
those with latent infection are not thought to be contagious. The probability
of transmission from one person to another depends upon several factors,
including the number of infectious droplets expelled by the carrier, the
effectiveness of ventilation, the duration of exposure, the virulence of the M.
tuberculosis strain, the level of immunity in the uninfected person, and
others.
Diagnosis,
Active tuberculosis
A
chest X-ray and multiple sputum cultures for acid-fast bacilli are typically
part of the initial evaluation. A definitive diagnosis of TB is made by
identifying M. tuberculosis in a clinical sample (e.g. sputum, pus, or a tissue
biopsy). However, the difficult culture process for this slow-growing organism
can take two to six weeks for blood or sputum culture. Thus, treatment is often
begun before cultures are confirmed.
Prevention,
Vaccines
(BCG)
is the most widely used vaccine worldwide, with more than 90% of all children
being vaccinated. However, the immunity it induces decreases after about ten
years. Tuberculosis prevention and control efforts primarily rely on the
vaccination of infants and the detection and appropriate treatment of active
cases. The World Health Organization has achieved some success including in the
Gambia with improved treatment regimens.
In The Gambia you can get further information about diagnose and treatment from
EFSTH, MRC and number of other Government’s Hospitals and Health clinics, or e
mail azadehhassan@yahoo.co.uk or text only to 7774469/ 3774469 during working
days from 3-6pm.
Author
DR Azadeh Senior Lecturer at the University of the Gambia and Senior Consultant
in Obstetrics & Gynaecology. Clinical Director Medicare Health Service.
