Risk Factors For Tuberculosis
Approximately 2 billion people suffer from active or latent TB worldwide. Tuberculosis is a contagious, chronic and harmful infection of the lungs. Still, t may affect other parts of the body. Some risk factors for TB are:
- In the first place, individuals leading a sedentary lifestyle often contract TB. The bacterium is an aerobe meaning that it prefers an atmosphere rich in oxygen. So it infects the lungs mostly.
- Secondly, individuals living in unhygienic environments are more prone to infection than those surrounded by a cleaner atmosphere.
- Women are more likely to catch Tuberculosis than men. Most women with TB get the disease while pregnant.
- In addition to women, the elderly are at a higher risk of infection than the young. This because as we age, our immune systems debilitate.
- The doctors and health care providers who have frequent contact with TB patients should get tested regularly.
- Last but not the least, the people who have serious illnesses that compromise the immune system like HIV AIDS or Lupus are also prone to TB infection.
Symptoms Of Tuberculosis
Usually, most people infected by TB don’t have symptoms. However, when symptoms do occur, they are:
- Night sweating
- Breathing difficulty
- Chest pain
- Cough (usually with mucus)
- Coughing up blood
- Weight loss
- Swollen or tender lymph nodes (in the neck or other areas)
- Pleural effusion (fluid in the lungs)
- Unusual breath sounds (crackling)
Testing For Tuberculosis
People who have lived or supported a TB patient should have themselves tested for TB. Also, doctors, nurses and healthcare providers may need the test if they had direct contact with a patient. There are many tests employed in a clinical setting for the accurate diagnosis of TB. Some important tests are:
- Mantoux test(named after the French physician who popularized it)
- TB Blood Test
- Chest X-ray
Initial testing for TB often starts with a PPD (purified protein derivative). A PPD is an intradermal skin test also called a Mantoux test, Tuberculin skin test or simply TB test. With this test, Tuberculin is injected between layers of the dermis. Interestingly enough, tuberculin is a component of the bacteria and if a person has previously been exposed to TB, the immune system reacts to tuberculin. The Memory T cells help produce a small localized reaction within 48-72 hours of administration. If a large area of the skin shows induration rather than just redness, the test comes out positive. A positive Tuberculin test simply means that the patient has been exposed at some point to TB. Children less than five years old have a TB skin test rather than a TB blood test.
Drawback Of Mantoux Test
This test fails to distinguish between the type of TB infection. Thus, the physician can’t tell whether it is a latent or active stage of the disease.
Tuberculosis Blood Test (IGRA)
The Tuberculosis Blood Test is also called an Interferon Gamma Release Assay (IGRA). It is a TB blood test that reveals whether TB germs are present inside the body or not. Hence, there are two kinds of TB blood tests:
A positive TB blood test means that you are suffering from TB. Correspondingly, the microbes are present in your system. These germs may be dormant or active.
Advantages Of Tuberculosis Blood Test
There are multiple advantages of the TB blood test.
- First off, a TB blood test provides substantial evidence in favor of presence or absence (whatever the case may be) of germs.
- Secondly, it requires a single visit to the doctor as you don’t have to go again to have the test read(unlike the Mantoux test).
- Lastly, it doesn’t give false positive results i.e. it is not positive for BCG vaccine. A BCG vaccine protects young children against TB. The defensive effects of this vaccines diminish with age. This is a very useful feature of IGRA as many children around the globe receive BCG vaccine for protection against disseminated TB.
If you have had a positive result for any of the screening tests (i.e. IGRA or Mauntex), a doctor will then suggest a chest X-ray.
The chest X-ray helps to look for signs of Active TB. In patients with symptoms like fever, night sweats, anorexia and weight loss, it is important to collect sputum directly from a cough or from a bronchoalveolar lounge. Technically, a bronchoscope is inserted into the lungs via the windpipe. Then, a sample of alveolar tissue is collected and sent to the lab. In the end, it is cultured, stained (AFB test) and genetically analyzed through PCR.
Treatment Of Tuberculosis
Treating Latent TB
The evidence of latent TB doesn’t show up on a chest Xray. Treatment for latent TB typically involves using a single drug for nine months regularly. The most common approach is prescribing Isoniazid alone.
Treating Active TB
The treatment of active TB infection involves a combination of antibiotics. So these drugs fight the bacteria rigorously and make the patient less infectious to others around him. Fortunately, he becomes non-infectious to others usually within weeks.
Patients typically take multiple drugs for at least six months to ensure complete destruction of the bacteria.
- If the patient has active TB and weighs 53 kg or above, then he follows a course of four drugs easily remembered by the mnemonic RIPE.
Rifampin, Isoniazid, Pyrazinamide, Ethambutol
- If the patient weighs less than 53 kg, then he takes only three of these drugs.
Side-effects of Tuberculosis drugs
There are many side-effects of TB medications:
- Firstly, these medicines have a high potency that may further weaken the patient. A balanced diet is necessary to produce the required effect. Some common after effects are thrombocytopenia, vomiting, red urine, red tears, peripheral neuropathy, gout, and optic neuritis.
- A worrying side-effect is that Tuberculosis bacteria are developing resistance against these drugs day by day. Now we have MDR-TB (Multidrug resisting TB) and XDR-TB (Extremely drug resisting TB)
Direct Observation Therapy
A direct observation therapy (DOT) is a form of treatment in which the patient stays in an enclosed room and has minimal contact with others. A healthcare specialist monitors his progress and compliance. He ensures that he takes his medicine at the designated time. He encourages the patient by giving him incentives and rewards whenever he shows improvement. Also, the patient’s weight requires close monitoring.
Patients reside in negative pressure rooms that restrict contact with the outside world. All visitors wear N-95 masks. By N-95, we mean that is not resistant to oil but can filter out at least 95 other aerosols including TB.
The goal of treating Tuberculosis is to protect the patient from possible disability and death. Another objective is to reduce the spread of Tuberculosis infection to others. TB may be a stubborn infection but with the right measures at the right time, it can be cured.
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