Tuberculosis

Have you ever thought of the possibility of contracting tuberculosis?

Do you even know what tuberculosis is?

Tuberculosis (TB) is one of the leading infectious cause of death worldwide, with 2 billion infected people and causing 3 million deaths a year.


Worldwide cases per 100k; red >300, orange 200-300, yellow 100-200, green 50-100, gray <50.

With that figure in mind, shouldn't you be concerned about this disease?

Getting infected:
It is very easy to contract TB. Simply by sharing the same environment with a person who suffers from TB is a risk factor, and talking to that person almost guarantees that you will contract it. This is because TB is an airborne disease.


The Sneeze of Death: sprinkle pepper at face for instant effect.

So, what causes TB?

Aetiology:
TB is primarily caused by the organism of Mycobacterium tuberculosis, and less commonly by Mycobacterium bovis by drinking unpasteurised milk.


Mycobacterium tuberculosis under the electron microscope.

Up to 80% of cases of tuberculosis are confined to the lungs, or pulmonary TB, and the rest of the cases being extra-pulmonary TB. Pulmonary TB is further divided into primary TB and post-primary TB (ie, reactivation of TB).


Chest X-ray showing TB of lungs.

How would you know if you have TB? If you have fulfilled some of the criteria below, you are at risk.

Risk factors:
You had unprotected contact or interaction with a TB patient.
You suffer from a serious disease like AIDS.
You require chemotherapy which suppresses your immune system.


Wearing protective face masks can prevent infection and spreading of TB.

When you're infected, you might exhibit symptoms characteristic of TB.

Symptoms:
Fever, general weakness, sweats, anorexia (poor appetite), cough, sputum, erythema nodusum (painful nodes on legs), or phlyctenular conjunctivitis (red nodes on cunjunctiva).

What should you do?


Always trust your doctor.

Consult a physician immediately. Not only are you sick, you could be a health hazard to others.

Your physician would then perform several hi-tech diagnostic tests on you.

Diagnostics:
Sample taking, which includes blood, urine, sputum, pus and pleural fluid.
Chest X-ray, to search of visual signs in your lungs.
Bronchoscopy, to look into your lungs with an endoscope.
Biopsy, to confirm TB lesions in your lungs.
Immunologic tests, specifically the Mantoux-Tuberculin test, which requires patients to be injected with TB antigen under the skin, in which a diagnostic skin induration would form a few days later.


The Mantoux-Tuberculin test.

Malaysians usually get their first Bacillus Calmette-Guérin (BCG) vaccine shot at 12 years old. However, this form of immunisation lasts about 5 years. Further immunisation would be required.


Skin induration of less that 4 mm is considered a negative reaction. New BCG shot is required.

Luckily, due to the advent of modern science, survival from this disease is possible with proper treatment, which is in the form of medical therapy. Depending on the severity of the disease, patients are prescribed drugs in different regimes and doses, and treatment for the most common form is as below.

Treatment:
Rifampicin - 600 mg PO, thrice a week.
Isoniazid - 900 mg PO, thrice a week.
Pyrazinamide - 2.5 g PO, thrice a week.
Ethambutol - 30 mg/kg PO, thrice a week.
Streptomycin - 1 g IM, once a day.

Treatment of tuberculosis is of long duration up to 9 months. Any breach of compliance of treatment may result in reactivation of the disease, or post-primary TB.

However, taking drugs of any kind are almost never without adverse effects, just as these ones.

Drugs and its adverse effects:
Rifampicin - Hepatitis, orange discolouration of urine and tears
Isoniazid - Hepatitis, neuropathy
Pyrazinamide - Hepatitis, arthralgia
Ethambutol - Optic neuritis
Streptomycin - Ototoxicity


Anti-TB chemotherapy drugs.

Therefore, to counter the negative effects of these drugs, it is advisable to take adequate vitamin B, particularly B6 (pyridoxine) throughout the entire treatment.


Take adequate vitamin B6 during treatment.

At the end of this post, I hope you're enlightened! Stay healthy!