TUBERCULOSIS

BY:Vusumzi Mzimvubu
Contents:

Tuberculosis
Causes
Symptoms
Treatment
Prevention
Statistics
References
Tuberculosis:
Tuberculosis (TB) is an infectious diseasecaused by the
bacterium Mycobacterium tuberculosis (MTB).[1] Tuberculosis generally
affects the lungs, but can also affect other parts of the body. Most
infections do not have symptoms, in which case it is known as latent
tuberculosis. About 10% of latent infections progress to active disease
which, if left untreated, kills about half of those infected.

Causes:
Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) that
most often affect the lungs. TB is spread from person to person through
the air. When people with lung TB cough, sneeze or spit, they propel the
TB germs into the air. A person needs to inhale only a few of these germs
to become infected.
About one-third of the world's population has latent TB, which means
people have been infected by TB bacteria but are not (yet) ill with the
disease and cannot transmit the disease.
People infected with TB bacteria have a 10% lifetime risk of falling ill with
TB. However, persons with compromised immune systems, such as
people living with HIV, malnutrition or diabetes, or people who use
tobacco, have a much higher risk of falling ill.

Symptoms:
When a person develops active TB disease, the symptoms (such as
cough, fever, night sweats, or weight loss) may be mild for many months.
This can lead to delays in seeking care, and results in transmission of the
bacteria to others. People with active TB can infect 1015 other people
through close contact over the course of a year. Without proper
treatment, 45% of HIV-negative people with TB on average and nearly all
HIV-positive people with TB will die.
Treatment:
TB treatment can cure most people who have TB, using a combination of
the different drugs available for TB treatment. Surgery is sometimes used
as treatment for TB.

There are more than twenty drugs available for TB treatment. They are
used in differing combinations in different circumstances. So for example,
some TB drugs are only used for the treatment of new patients when
there is no suggestion of any drug resistance. Others are only used for
the treatment of drug resistant TB.The new TB
drugs bedaquiline and delamanid are also now available to be used for the
treatment of MDR-TB when there arent any other drugs available. More
than 90% of people with drug susceptible TB (that is TB which is not drug
resistant) can be cured in six months using a combination of first line TB
drugs.

The TB drugs that are taken for the treatment of TB, have the aim of
killing all the TB bacteria in the persons body.

All the drugs must be taken for the entire period of TB treatment. If only
one or two TB drugs are taken then the bacteria may not all be killed.
They may then become resistant to the TB drugs which then dont work.
If the person becomes sick again then different TB drugs may be needed.

Patients with active TB disease normally receive at least three drugs as

their initial TB drug treatment. Fewer than three drugs can result in the
development of resistance;

Never add a single TB drug to a failing regimen, a regimen simply means

the course of treatment, in this instance the combination of TB drugs;

Compliance with TB treatment is the responsibility of the treating

physician as well as the patient.

TB drug treatment is sometimes referred to as antitubercular treatment

or ATT.
TB treatment for new patients

This consists of a two month intensive TB treatment phase followed by a

four month continuation phase.

For the two month intensive TB treatment phase they should receive:

1. Isoniazid

2. plus rifampicin

3. plus pyrazinamide

4. plus ethambutol

followed by

1. Isoniazid

2. plus rifampicin

for the continuation TB treatment phase.

It is recommended that patients take the TB drugs every day for the six
months. Although taking the drugs three times a week is possible in some
circumstances, it is essential that all the recommended TB drugs are
taken. If only one or two drugs are taken, then the TB treatment probably
wont work, because the TB bacteria that the patient has develops
resistance to the drugs. Not only is the patient then still ill, but to be
cured they then have to take drugs for the treatment of drug resistant TB.
These drugs are more expensive and have more side effects.

TB treatment for other patients

A patient may not qualify for treatment as a new patient, for example
because they have had TB treatment before. Then they probably need to
take a different and longer course of drug treatment. .

TB treatment failure

It is often suggested that TB treatment fails because a patient doesnt

take their TB drugs correctly. However there can be a number of different
reasons for TB treatment failure. It is certainly true that if a patient
doesnt take their TB drug treatment properly that this can lead to the
development of drug resistant TB. However the patient may already have
drug resistant TB. If they already have drug resistant TB, then treatment
that someone is provided with may result in treatment failure even if the
treatment is taken correctly.

In some situations it must be considered a real possibility that the person

has drug resistant TB

Prevention :

TB education

TB education is necessary for people with TB. People with TB need to

know how to take their TB drugs properly. They also need to know how to
make sure that they do not pass TB on to other people. But TB education
is also necessary for the general public. The public needs to know basic
information about TB for a number of reasons including reducing the
stigma still associated with TB.

BCG vaccine

The vaccine called Bacillus Calmette-Guerin (BCG) was first developed in

the 1920s. It is one of the most widely used of all current vaccines, and it
reaches more than 80% of all new born children and infants in countries
where it is part of the national childhood immunization programme..

TB Treatment as TB prevention

TB drug treatment for the prevention of TB, also known as

chemoprophylaxis, can reduce the risk of a first episode of active TB
occurring in people with latent TB. There is more about the provision of
treatment for people with latent TB.

Isoniazid is one of the drugs used to prevent latent TB from progressing

to active TB or TB disease. Isoniazid is a cheap drug, but in a similar way
to the use of the BCG vaccine, it is mainly used to protect individuals
rather than to interrupt transmission between adults. This is because
children rarely have infectious TB, and it is hard to administer isoniazid on
a large scale to adults who do not have any symptoms. Taking isoniazid
daily for six months is difficult in respect of adherence, and as a result
many individuals who could benefit from the treatment, stop taking the
drug before the end of the six month period.

In households where someone has infectious TB, the following actions

should be taken whenever possible:

Houses should be adequately ventilated;

Anyone who coughs should be educated on cough etiquette and
respiratory hygiene, and should follow such practice at all times;
While smear positive, TB patients should:
Spend as much time as possible outdoors;
If possible, sleep alone in a separate, adequately ventilated room;
Spend as little time as possible on public transport;
Spend as little time as possible in places where large numbers of
people gather together.

Cough etiquette and respiratory hygiene means covering your nose and
mouth when coughing or sneezing. This can be done with a tissue, or if
the person doesnt have a tissue they can cough or sneeze into their
upper sleeve or elbow, but they should not cough or sneeze into their
hands. The tissue should then be safely disposed of.3Educating people
about TB is also an important part of TB prevention, as well as ensuring
that people who need TB treatment receive it as soon as possible.

Households where someone has culture positive MDR TB

It is not fully known how differences between drug susceptible, and drug
resistant TB, as well as HIV status, affect the risk of TB transmission.
However it is thought that people with drug resistant TB remain infectious
for much longer, even if treatment has been started, and this may
prolong the risk of transmission in the household.

Face masks are different from respirators and can be made from either
cloth or paper. A face mask worn by someone with infectious TB can help
to prevent the spread of M. tuberculosis from the patient to other people.
The face mask can capture large wet particles near the mouth and nose of
the patient, preventing the bacteria from being released into the
environment. Cloth masks can be sterilized and reused.

Respirators can protect health care workers from inhaling M. tuberculosis

in certain circumstances, but they are expensive to purchase and they
require specialized equipment to ensure that they fit properly. The use of
a face mask does not protect health care workers against TB, and so a
health care worker or other staff should not wear a face mask in a
household (or indeed in a health care) setting.

Statistics:
References :
1. www.who.int
2. www.tbfacts.org
3. The BCG vaccine
4. Implementing the WHO Stop TB Strategy: a handbook for national
tuberculosis control programmes, Geneva, World Health
Organization, 2008 The History of the BCG vaccine.
5. www.nhs.uk
6. www.who.int/tb/publications/2009/
7. Treatment of Tuberculosis guidelines, WHO, Geneva, 2011,
8. Guidelines for treatment of Tuberculosis, WHO, Geneva, 2010,
9. The Global Plan to Stop TB, WHO, Geneva, 2011, vi
www.stoptb.org/global/plan/
10. Based on Lambregts-van Weezenbeck, C. S. Control of drug-
resistant tuberculosis Tubercle and Lung Disease,
11. Monitoring of relapse, treatment failure and drug resistance,
British HIV Association www.bhiva.org/