What is Tuberculosis (TB)?

What is Tuberculosis (TB)? 

Tuberculosis is an infectious disease caused by a bacterium called Mycobacterium tuberculosis, and in rare cases, Mycobacterium bovis, and Mycobacterium africanum. Infected individuals can be contagious, spreading TB to others. TB usually affects the lungs, but can affect other organs or tissues in the human body. TB can be classified in two forms:

1) Active TB, when infection caused the disease; and

2) Latent TB, when the bacteria inside the 

body are inactive, but the person is at risk of becoming ill because the bacteria are alive. Active TB disease in a person does not mean that the infected individual was infected recently. It is not uncommon for individuals to become ill with active TB disease even after being infected 1 to 2 decades earlier. If left untreated, active TB disease can be spread to others. Tuberculosis is very contagious, and TB is transmitted through the air when a person breathes. It is important to note that you can sometimes be infected with TB even if you do not become sick.

2. How TB is transmitted

TB is transmitted through the air when an infected person coughs, sneezes, laughs, or talks. TB is NOT transmitted when a person touches a surface, shakes hands, or shares food or drink. Being in a close space with an infected person for an extended period of time can put you at risk of exposure.

Key Points:

Airborne transmission

Prolonged, close contact

Not spread through casual contact

3. Common Signs and Symptoms of TB

Understanding signs and symptoms of TB in the early stages will allow for prompt treatment and reduce the risk of transmission. Depending on whether the person has latent TB or active TB, symptoms may vary.

Active TB Symptoms:

Persistent cough lasting three weeks or more

Bloody cough

Chest pain

Fatigue

Fever and chills

Night sweats

Unexplained weight loss

Loss of appetite

Latent TB Symptoms:

Latent TB displays no symptoms and can remain dormant for years. However, it can become active without treatment.

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4. Types of Tuberculosis

There are two main types of TB:

1. Latent TB Infection (LTBI):

No symptoms

Not contagious

May become active with no treatment

2. Active TB Disease:

Has symptoms

Contagious to other individuals

Requires immediate treatment

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5. Who is most at Risk?

TB can impact anyone remarkably a few groups are at more risk of TB, especially in developed countries where TB is less common. 

at-risk groups in the US, UK, and Canada:

People with immunocompromised situations (such as a person in HIV/AIDS treatment)

The elderly

Healthcare workers

People who live and work in close proximity (like jails and shelter situations)

People who come from areas that have high rates for TB.

People with chronic medical conditions (like diabetes)

6. Diagnosing Tuberculosis

The process of diagnosing TB involves various tests. The earlier TB is diagnosed, the better it can be treated.

Common Tests for Diagnosing TB:

Tuberculin Skin Test (TST) - this skin test provides an indicator of immune response

Interferon-Gamma Release Assays (IGRAs) - this is a blood test that screens for TB infection

Chest X-ray - chest X-rays can show changes in the lungs that might indicate TB

Sputum Test - this test will identify the TB bacteria present in the sputum.

Physicians may want to request more advanced imaging or a biopsy, if TB is suspected in organs outside of the lungs.

7. How to Prevent TB

Prevention techniques are important to minimize the infection cycle and limit the spread of TB, particularly where urban density is high.

Prevention tips include:

Avoid close contact with people known to have active TB

Wear protective mask in identified high-risk environments

Be aware and utilize environmental modalities, such as ventilation and airflow, while living in confined spaces

Get regular medical visits for checkups, known history of TB exposure, and for those in high-priority TB risk populations

Complete TB treatment fully, to ensure mitigation of spreading the TB infection

7. TB Vaccination BCG Vaccination

Two alternative forms of BCG vaccination exist, and are routinely used worldwide. The BCG is antiquated compared to the new TB vaccines, however, the BCG remains one of the best means available to manage a range of serious TB conditions notably for children.

8.TB Vaccination: The BCG Vaccine

The BCG (Bacillus Calmette-Guérin) vaccine is the most widely used vaccine for serious forms of TB, especially in children.

Some important facts about BCG:

It is routinely given in countries with a high prevalence of TB.

It is not routinely given in the USA and Canada because the rates of TB are lower.

The UK routinely provides BCG vaccination to healthy infants and healthcare workers, but in the context of risk assessment.

The BCG would not be able to effectively prevent adult pulmonary TB, but could protect children from meningitis caused by TB infection or military TB.

9. Treatment for Active and Latent TB

Treatment for TB is a long-term commitment, however, when correctly adhered to treatment is very effective.

Latent TB treatment:

One or two antibiotics (e.g., isoniazid, rifampin)

3 to 9 months, depending on the regimen

Active TB treatment:

Multi-drug therapy, usually four drugs (isoniazid, rifampin, pyrazinamide, ethambutol).

6 months (minimum).

There would be regular doctor visits, liver tests, support for taking medications as directed.

After weeks of taking the right medications, patients would be considered non-contagious, but they must complete the course of treatment to prevent relapse or resistance.

10. Tuberculosis Drug Resistance: A Growing Challenge

Although drug-resistant TB can be found in MDR-TB (multi-drug resistant TB) and XDR-TB (extensively drug resistant), these are aberrations of TB because they do not respond to standard TB treatments.

Agents of drug-resistance:

Incompleteness or misuse of antibiotics

Use of inadequately formulated drugs

No medical supervisor

Treatment:  

Longer courses of treatment (18-24 months)

More side effects

More expensive treatment

More limited second-line drugs

The only way to fight drug resistance is through strong public health measures, intensive surveillance, and patient education.

11. Co-infection of TB and HIV

HIV depresses the immune system and supports the acceleration of latent TB becoming active. TB remains the number one killer among people living with HIV.

Recommendations for HIV Co-infection:

There should be an immediate start to TB treatment

A start to retroviral therapy (ART)

Immediate medical oversight due to medication interactions

HIV/TB integrated programs are crucial to ensure the future of people with HIV and TB co-infection, and can be the paradigm for co-morbidity care in both the developing world and the developed nations.

12. National and Global Responses: The USA, UK, and Canada

Despite TB being most prevalent in lower income countries, some higher income countries such as the USA, UK, and Canada are reporting thousands of new cases of TB every year.

United States:

The CDC collects data on reports of TB and considers implementing routine screening for...

United Kingdom: 

Public Health England alerts high-risk groups of individuals for early detection and fights tuberculosis with BCG vaccination.

TB Alert is a charity that helps educate people about pulmonary tuberculosis and guide treatment adherence. 

Canada: 

Indigenous people also have a distorted picture of tuberculosis as it affects them at a higher rate than many other people. 

The Canadian government has partnered with healthcare agencies to address the health inequities it creates with its different populations. 

13. Living with Tuberculosis: What Patients Want to Know

Receiving a diagnosis of tuberculosis can be stressful and worrying. However, receiving the right care and preventative management can make a complete recovery possible! 

Here are a few recommendations for tuberculosis patients: 

Take all medications according to your treatment plan 

Attend all follow-up appointments 

Remain isolated in the transmission phase to reduce the risk of exposing others to your active disease 

Maintain a healthy diet to support your immune system and overall well-being 

Reach out for emotional and psychological support

Your family members should also be screened, and treated if necessary, for latent tuberculosis.

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14. In conclusion, Inaction is Injustice to Treat Tuberculosis 

Though tuberculosis is a preventable disease and a curable one, we ironically continue to cause great suffering and enduring impact across the world. We must raise the alarm whether you're from the USA, United Kingdom, Canada or wherever; Outreach and Awareness are where it all begins with prevention. 

Early detection, thorough treatment, and public health vigilance and attention must persist in order to lessen tuberculosis's impact on people and society as a whole. We can improve ourselves in acceptance; we can support health initiatives and accountabilities that we can take control of in a world without tuberculosis.