Tuberculosis is a lung infection spread among people through the air. It’s caused by Mycobacterium tuberculosis. Tuberculosis can also be caused by Mycobacterium bovis, bacteria found in unpasteurised milk from infected cows, though this predominantly affects children. While TB mainly attacks the lungs, it can affect other organs, such as the brain, kidneys, or spine. About 1.8 billion people worldwide are infected with TB, but most have latent tuberculosis. There are about 18 million active cases globally. Active TB can lead to death when left untreated.
How does tuberculosis affect the body?
TB spreads when an infected person sneezes or coughs, spreading infected droplets in the air where others breathe it. The germs can stay in the air for a long time, especially in a cold environment without freshly circulated air. Prolonged exposure increases the risk of infection. As a result, you’re more likely to get infected by an infected person who works or lives near you.
Many healthy people can get latent tuberculosis which becomes active when the immune system weakens. This can occur because of HIV, an autoimmune disorder, cancer, dialysis, or any immunocompromising condition.
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When a healthy person contracts latent tuberculosis, it settles in the lungs growing stronger. For people who already have a compromised immune system, it becomes active TB almost immediately. It can develop within days or weeks. After infection and activation, the bacteria move through the blood and lymph nodes to other body parts.
Symptoms
When infected, symptoms don’t appear immediately. They appear in stages.
1. Primary infection
This is when tuberculosis bacteria initially enter the body. For many, this stage has no symptoms. However, some people can experience fever, shortness of breath, exhaustion, dizziness, or other pulmonary symptoms.
Healthy people won’t experience symptoms or developments, but others get latent tuberculosis.
2. Latent infection
At this stage, tuberculosis tests positive when checked but is inactive. There are no symptoms, and the disease can’t be spread.
3. Active disease
At this stage, patients feel sick and can spread infection. Having the infection beforehand increases the risk of developing active tuberculosis.
Because most people won’t show symptoms when they have latent TB, this is why when you’ve been exposed to people with TB, get a screening as soon as possible.
The first symptom in active cases is a severe cough. You will also get lingering chest pain. These are common symptoms for other ailments. You can easily think it’s another ailment, but if you have been exposed to people with TB, it’s best to get a screening.
Other symptoms include:
- Malaise
- Coughing up phlegm and, later, blood
- Difficulty breathing
- Loss of appetite
- Weight loss
- Night sweats
- Fever
- Body pain
- Fatigue
What increases the risk of infection?
People with active infection can spread tuberculosis by not covering their mouths when coughing and sneezing. Tuberculosis doesn’t last on surfaces. You can’t get TB by shaking hands with an infected person, sharing utensils, touching other surfaces, or sharing a toilet seat.
The biggest risk factor is HIV/AIDS. People who are poor, unhoused, imprisoned, smokers, addicted to narcotics, have kidney disease and diabetes, have recently gotten organ transplants, are pregnant, or are really young or really old are at higher risk of developing active TB.
Kenya’s Latent TB Infection policy also states health care workers are at high risk. People on immunosuppression medication or treatment such as chemotherapy also have a higher chance of contracting active TB.
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Treatment
Latent tuberculosis can be treated to prevent the development of active TB. Current treatment options available for TB as recommended by the World Health Organisation include:
- 6-month isoniazid daily (6H) is the preferred treatment for HIV-negative people.
- 3-month rifapentine plus isoniazid weekly (3HP) treats people above 15 years who are HIV+ and are on Nevirapine and PI-based ARVs.
- 3-month isoniazid plus rifampicin daily (3RH) treats children under 15 years who are HIV+ and are on Nevirapine and PI-based ARVs.
Dosages can last 6-12 months.
In Kenya, TB is the fifth largest cause of death. There are about 120,000 positive cases of TB each year. 40% of those cases are HIV+. Most TB cases respond to medical treatment, but a small percentage are drug-resistant.
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A skin test or a blood test tests for TB. The skin test is conducted by injecting a little tuberculin fluid into the lower part of the arm. The result will be checked in two to three days. The blood test checks for the body’s response to TB infection.
In many countries in Asia and Africa, the BCG vaccine is administered to babies shortly after birth. The Bacille Calmette–Guèrin vaccine is administered in countries with a high tuberculosis prevalence. Pregnant mothers in Kenya must get the BCG vaccines for their babies before they leave the hospital. The vaccine is free in the country.
Drug-resistant TB
Drug-resistant tuberculosis, or super TB, is a severe form of the disease that resists the medication designed to treat it. This happens because the bacteria become immune to the medication. It is similarly spread through the air. People are at higher risk of developing drug-resistant TB if they don’t complete a full dose of TB treatment, medical practitioners prescribe the wrong dosage, lack treatment, or have poor quality of medication.
It is also more frequent among patients who don’t take their TB drugs regularly, don’t complete their dosage, develop TB even after treatment, get infected in areas where super TB is prevalent, or get infected by someone with drug-resistant TB.
There are three main types of super TB. The first type is known as Multidrug-resistant TB. It is resistant to most first-line TB drugs.
Pre-Extensively Drug-resistant TB is resistant to the main TB drugs and a second-line injection.
Extensively drug-resistant TB is a rare multidrug-resistant TB resistant to first-line TB drugs and one of three second-line injections. It’s more common among HIV+ patients.
Treatment for super TB is done by experts who remain in close contact with the patient to manage the disease. Any mismanagement can lead to the patient’s death.
The easiest way to prevent super TB is for patients to take their medication exactly as the doctors dictate. Faster diagnoses of TB, constantly monitoring a patient’s response to treatment, and ensuring it’s completed is an easy way for healthcare workers to reduce the risk of super TB.
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