Tuberculosis Diagnosis And Treatment

Diagnosis

Tuberculosis (TB) is a contagious bacterial infection that most frequently affects the lungs. In addition, TB involves other areas of the body, such as the lymph nodes, genitourinary tract, bones, joints, the membranes covering the brain (meninges), and the membranes covering the digestive organs (peritoneum).
Transmission of TB usually occurs as a result of prolonged contact with an infected person. Most people who are exposed to TB do not develop an active infection. Older people and those with HIV or cancer are more likely to develop an active infection. People with a history of TB exposure have about a 10% lifetime risk of developing the active disease. People with HIV and a history of TB exposure have about a 10% yearly risk of developing the active disease.
Tuberculosis infection can be either active or latent. Tuberculosis can exist as a latent infection, usually in the lungs. If you have a latent infection, you will not feel ill, and in most cases will not be contagious to others. If your immune system becomes compromised, the latent infection may become active, and you will feel ill and become contagious.
Tuberculosis is caused by airborne bacteria spread most commonly from person to person by inhaling contaminated droplets of coughs and sneezes. Mycobacterium tuberculosis is the bacterium that most commonly causes TB. Air becomes contaminated when a person with active tuberculosis coughs out the bacteria, which may then remain in the air for several hours. Once inhlaled by another person, the infection will usually gravitate towards the base of the lungs. There, the bacteria multiply slowly and spread to nearby lymph nodes (a sort of drainage system for the body). If the bacteria spread from the lymph nodes to the blood, the infection may then travel to other organs in the body.
Other closely related organisms, such as Mycobacterium bovis (transmitted in unpasturized milk in developing countries) and Mycobacterium africanum, can cause the disease; however, they are less common, especially in the United States. Casual, one-time exposure to TB bacteria rarely causes an infection. Rather, one must experience prolonged exposure to an individual with an active infection (for example, living with an infected family member, or working in close proximity to someone with an active infection) in order for transmission to occur.
In the early stages, you may have very mild, coldlike symptoms—a cough or a general feeling of malaise—or no symptoms at all. At this stage, you may not even know that you have TB unless a skin test or chest x-ray are performed.
If TB persists beyond the initial stages, you may experience mild cough, fever, night sweats, poor appetite, and problems gaining weight Table  01. In many cases, your immune system will fight off TB in its preliminary stages, and you will have no further symptoms. If, however, your body is unable to fight the infection efficiently (as often happens with immune-compromised or elderly individuals), further symptoms will appear. These additional symptoms include difficulty breathing, chest pain, and a cough that may produce discolored mucus (which may be bloody or blood-streaked).
TB can affect many different areas in the body, such as the bones, skin, and heart, causing an array of symptoms Table 01

Treatment

Call your doctor if you develop any of the symptoms of TB [Table 1]. Early case recognition and early prevention will increase the likelihood that treatment will be effective, and will reduce the risk of damage to the lungs or other areas in the body.
It is very important to follow your doctor's treatment plan closely in order to prevent the disease from worsening. TB treatment will be ineffective unless you adhere strictly to your drug regimen. Regularly missing drug doses can allow the bacteria that cause TB to recover or become resistant to treatment.
Reduce or eliminate alcohol intake while taking antituberculosis drugs (especially isoniazid). Alcohol use puts you at risk for serious liver-related side effects from these drugs.
Your doctor is the best source of information on the drug treatment choices available to you.
Surgery is sometimes necessary to drain pus from wherever it has accumulated, or to correct a bone deformity that has resulted from the infection. In extreme and rare cases (generally in cases where the patient has failed to follow the drug treatment plan), surgery is required to remove a portion of the lung.
Patients are usually cured if they follow an effective drug regimen very closely. Without proper treatment, however, more than half of TB patients will die within five years. Drug-resistant strains of TB are becoming more common in certain parts of the world. Being infected with drug-resistant TB can lead to serious infection and death. The severity of active TB depends on several factors, including a person's age, and the presence or absence of other complications such as coexisting disease or a weakened immune system.
Once a healthy adult's immune system has controlled a primary TB infection, the dormant bacteria will usually live in their lungs for life without causing disease unless the infection is reactivated.
Your doctor should evaluate your progress monthly after discharge to make sure that your treatment is working. Call your doctor immediately if you experience recurring symptoms of TB. Directly observed therapy may be required if complications arise. In directly observed therapy, which is endorsed by the World Health Organization, healthcare workers observe patients take every round of medication for the entire treatment course to ensure compliance.
If you experience any adverse drug reactions, you must contact your physician immediately and undergo further testing. Patients taking isoniazid, rifampin, or pyrazinamide may experience liver complications. Report to your doctor immediately if you experience nausea, loss of appetite, dark urine, malaise, or unexplained fever. In addition, patients taking ethambutol should be alert for any changes or problems in their vision.
Chest x-rays can be done periodically during therapy, and after therapy is complete, in order to monitor recovery. X-rays are helpful for tracking the progress of recovery; however, changes in the lungs may lag behind bacteriologic response, and therefore may not be absolutely accurate.