Tuberculosis (TB)

Symptoms Of Tuberculosis

Pulmonary tuberculosis or TB of the lungs is the most common type of TB. Other types such as TB of the bones, lymph nodes, brain, kidneys, intestine, and genitals are also seen. Symptoms of Pulmonary TB include:

• Cough that lasts for more than 2 weeks with or without fever 
• Fever, especially an evening rise in body temperature
• Presence of blood in the sputum
• Chest pain
• Loss of appetite
• Loss of weight
• Tiredness
• Night sweats and chills
  
  

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Symptoms of TB other than pulmonary TB 

Occasionally, tuberculosis may also affect other organs, such as bones, stomach, etc., and presents with common symptoms like fever, weight and appetite loss and some specific symptoms related to the organ system involved like:

• Bone TB involving the spine can cause back pain and neurological complications like paraplegia where the lower limbs become paralyzed.

• Gastrointestinal system disease can cause nausea, vomiting, diarrhea, malabsorption, etc.

• Tuberculosis of the kidneys can cause blood in the urine.

• Infection involving the brain and its covering membrane can cause seizures, headaches, neurological abnormalities, etc.

Types Of Tuberculosis

There are 5 different types of tuberculosis based on the type of infection. These include:

1. Latent tuberculosis

• In latent tuberculosis, the person carries the bacteria but does not develop any symptoms. 

• However, there is a possibility that the latent infection may reactivate at a later stage in life when the body’s immune defenses go down and may lead to active disease.
  
  

2. Active tuberculosis

• Active tuberculosis refers to a condition where the bacteria are in an active stage and cause symptoms. 

• Active tuberculosis can be further classified into pulmonary and systemic tuberculosis. 

• Although tuberculosis is primarily a disease of the lungs (pulmonary TB), it may affect other organs in the body, such as bones, lymph nodes, brain, kidneys, intestine, and reproductive system. 

• When active tuberculosis is present in other body parts, it is known as systemic tuberculosis.
  
  

3. Disseminated tuberculosis

• Also known as miliary tuberculosis, this is a severe type of infection where the tuberculosis bacteria spread to the entire body through the bloodstream. 
  
  

4. Multidrug resistant tuberculosis (MDR TB)

• This type of tuberculosis is caused by a bacteria that is resistant to at least two most common and potent drugs used to treat TB namely isoniazid and rifampin.
  
  

5. Extensively drug-resistant tuberculosis (XDR TB)

• This is a rare type of tuberculosis in which the bacteria is resistant to more than two drugs used to treat TB. 

• In addition to isoniazid and rifampin, people suffering from XDR TB are resistant to fluoroquinolones (an antibacterial medicine) and at least one of three injectable second-line drugs used to treat bacteria. 

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Causes Of Tuberculosis

• Tuberculosis is caused by a bacterium called Mycobacterium tuberculosis. 

• TB usually spreads from one person to the other through the air. 

• When a person suffering from TB sneezes, coughs, or spits, the bacteria gets into the air. Hence, when a person inhales even a few of these bacteria from the air, he/she becomes infected. 

• Although it is contagious, the bacteria grows at a slow rate and requires you to spend considerable time around the person who is sick. 

• This means it requires close and prolonged contact with a person who has active tuberculosis.

Note: Tuberculosis cannot spread through a simple handshake or sharing utensils as the bacteria cannot survive for long outside of the human body. 

Risk Factors Of Tuberculosis

Although all age groups are at risk of TB, the risk is higher in people who:

1. Environmental and exposure factors

• Living in or travelling to countries with high TB prevalence (e.g., tropical and developing countries).

• Working in crowded places with high exposure risk (hospitals, community centres, prisons, etc.).
  
  

2. Nutritional and lifestyle factors

• Malnourishment, as undernourished individuals are more at risk.

• Excessive alcohol consumption and smoking weaken lung health and immunity.
  
  

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3. Medical and immunity-related factors

• Diabetes or long-term use of steroids and anti-cancer drugs.

• Weakened immunity due to illness or recovery from a severe condition.

• HIV infection, which significantly increases TB susceptibility.

Diagnosis Of Tuberculosis

Along with a detailed history and physical examination, the following tests are used to confirm a diagnosis of tuberculosis:

1. Blood Tests

• Cartridge-based nucleic acid amplification test (CB-NAAT): It is a rapid molecular test that helps to detect TB. It not only identifies the bacteria responsible for TB but also helps to find rifampicin-resistant bacteria.

• TB platinum interferon-gamma release assay: It is used to check for the body’s immune response to the tuberculosis bacteria.

• Other tests: Such as Complete blood count, and Erythrocyte sedimentation rate are performed to evaluate the body’s response to infection.

• HIV 1 And 2 antibody: As tuberculosis is highly associated with HIV, doctors usually check for the likelihood of HIV exposure when tuberculosis is suspected. 
  
  

2. Sputum analysis

• Sputum samples are analyzed using tests like AFB (ZN Stain), sputum, and Mycobacterium tuberculosis DNA PCR - Qualitative -Sputum. 

• These tests help to check for the presence of tuberculosis bacteria in the sputum. 

• A positive test confirms the diagnosis.
  
  

3. Skin prick test

• This is also known as the Mantoux test. 

• This screening test helps assess your risk of TB infection or the likelihood of disease progression if already infected.

• A small amount of tuberculin is injected into your skin, and if swelling or a reaction appears within 48-72 hours, it indicates possible TB exposure. 

• However, recent TB vaccination may sometimes cause false-positive results.
  
  

4. Imaging studies

• Chest X-ray and HRCT scan (High-resolution computed tomography): Help assess lung damage and detect signs of pulmonary tuberculosis.

• X-ray dorsal spine and MRI brain: Aid in diagnosing extrapulmonary TB by identifying infections in the spine, brain, or other organs.

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Prevention Of Tuberculosis

Here are key strategies to prevent tuberculosis and stop its spread:

Get vaccinated

The BCG vaccine helps protect against severe forms of TB, especially in children.

Maintain good ventilation

Ensure proper airflow in living spaces to reduce the spread of airborne TB bacteria.

Wear a mask

People without TB can benefit by wearing a mask in high-risk areas to reduce exposure. While individuals with TB should wear a mask to prevent transmitting the infection to others.

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Practice good hygiene

Cover your mouth while coughing or sneezing and dispose of tissues properly.

Limit close contact

Avoid prolonged exposure to individuals with active TB, especially in enclosed spaces.

Strengthen immunity

Maintain a healthy diet, avoid smoking and excessive alcohol, and manage chronic conditions like diabetes.

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Note: Timely testing and treatment can help prevent TB from spreading.

Specialist To Visit

If you have symptoms, such as prolonged cough, bloody sputum, fever, or unexplained weight loss, you must seek prompt medical care. The specialist doctors who can diagnose and treat tuberculosis are:

• General physician
• Chest physician
• Infectious disease specialist
• Pulmonologist
  
  

A general physician identifies TB symptoms early and refers for specialized diagnosis and treatment.

A chest physician diagnoses and manages lung-related TB complications, ensuring proper respiratory care.

An infectious disease specialist provides expert treatment for TB, especially drug-resistant and complex cases.

A pulmonologist focuses on lung health, helping manage and treat pulmonary TB effectively.

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Treatment Of Tuberculosis

The treatment for tuberculosis depends on the type of infection. It includes:

For latent tuberculosis

• In India, if you have tested positive for tuberculosis in a screening test, treatment may be recommended only if you belong to the high-risk category. 

• The medicines for latent tuberculosis must be taken for a duration of 6 to 9 months as prescribed by a doctor.

For active tuberculosis

Antibiotics are the main treatment options for people suffering from TB. These medicines are usually given in combination as part of a regimen to effectively treat tuberculosis. These medicines kill the bacteria causing tuberculosis or prevent its growth.

The first line of treatment for active tuberculosis consists of combination therapy with five antitubercular drugs. These include: 

• Streptomycin 
• Isoniazid
• Rifampicin
• Pyrazinamide
• Ethambutol

Easy-to-use combination kits, containing a combination of the first-line antitubercular drugs are also readily available. 

The treatment continues for 6-8 months even if the symptoms get better, as it ensures complete recovery and prevents the development of drug resistance.

Note: The DOTS regimen (Directly Observed Therapy - Short Term) is followed in India, where the patient has to take the medicine in front of a DOTS agent. This is to ensure adherence to the treatment.

For MDR TB and XDR TB

The tuberculosis bacteria are prone to develop drug resistance. 

Treatment options for MDR and XDR tuberculosis consist of higher dosing of the first line of drugs and a combination of other oral medicines and injections. The course of the treatment is usually 18 months for MDR-TB and 24 months for XDR-TB.

Some of the common examples include:

• Amikacin injections
• Streptomycin injections
• Levofloxacin preparations
• Moxifloxacin preparations
• Para-amino salicylic acid 
• Clofazimine preparations
• Imipenem injections
• Clarithromycin preparations
• Bedaquiline

Supportive care

• Anti-fever and analgesics like paracetamol medicines to provide relief from fever and pain.

• Antitussive medications like dextromethorphan hydrobromide to help reduce cough.

• Vitamin B supplements are given along with tuberculosis medication to help combat neurological side effects like nerve pain and neuropathies 

• Antacids like omeprazole to prevent gastrointestinal symptoms

• Medicines to reduce uric acid levels (hyperuricemia is known to be a side-effect of TB medicines) such as allopurinol and febuxostat are recommended.

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Home Care For Tuberculosis

Herbal remedies can relieve cough, a common TB symptom. However, they do not cure TB. It is important to stick to your prescribed treatment for proper care. Effective home remedies include:

Ginger (Adrak): It contains anti-inflammatory and antioxidant properties that can help soothe the throat, reduce irritation, and relieve cough.

Turmeric (Haldi): It has curcumin, which acts as an anti-inflammatory and antibacterial agent, helping to calm cough and respiratory irritation.
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Cinnamon (Dalchini): It contains compounds that can help relax the airways, reduce inflammation, and ease coughing.

Other things to consider to care for yourself or others at home with active tuberculosis:

• Always use a handkerchief to cover your mouth and nose while sneezing or coughing.

• Wash your hands frequently with soap and water or use hand sanitizers.

• Take a balanced diet rich in vitamins and minerals.

• Drink plenty of fluids throughout the day.

• Take plenty of rest. Do not engage in any strenuous activities.

• Take the entire course of medicines prescribed by the doctor, even if your symptoms reduce or you start feeling better.

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Complications Of Tuberculosis

Most patients recover completely from tuberculosis. However, it may cause serious complications, especially in HIV patients and those who suffer from immunocompromised states. Leaving tuberculosis untreated may further lead to:

• Miliary tuberculosis or disseminated tuberculosis where the infection spreads widely throughout the body, affecting multiple organs

• Pleural effusion, pneumothorax, and empyema which is an accumulation of fluids, air, or pus, respectively, in the lungs

• Acute respiratory distress syndrome or fluid build-up in the lungs

• Paraplegia or paralysis of the lower body due to tuberculosis of the spine

• Tuberculous arthritis of hips or knees

• Male infertility and female infertility, in TB of reproductive organs

• Seizures and growth retardation, in TB of the brain

• MDR TB and XDR TB

Alternative Therapies For Tuberculosis

There is a limited role of alternative therapies in the management of tuberculosis. One of the alternate therapy that can help manage the symptoms of TB is:

Chest physiotherapy 

• It may help with the removal of secretions from the lung and improve lung function. 

• It uses different types of breathing exercises. 

• It also includes postural drainage, advising patients to sleep in different positions such as sleeping on the back with their head down. 

• These positions are believed to help in the removal of secretions in the lung with the help of gravity.

Note: It is important to understand this is an adjunct to the conventional treatment and more research is required to understand its efficacy.

Living With Tuberculosis

Tuberculosis is a disease that is often associated with a stigma as there are many misconceptions surrounding it. However, with recent improvements in available treatments and public awareness campaigns, the stigma of the disease is declining, and more and more people are recovering completely from the disease.

Here are a few tips you need to keep in mind if you are on medications for tuberculosis:

Maintain a routine 

If you are taking medications by yourself, take them at the same time every day, marking off the date on a calendar or using a weekly pill dispenser.

Be aware of new symptoms

Inform your doctor if you experience any unusual symptoms or side effects of the medications. Your doctor might consider changing the drugs.

Complete your course of medications

Not finishing the course or stopping the medications mid-way can not only increase the risk of getting sick and spreading the infection again but can also make the bacteria resistant to the drugs.

Get all the support

• Medicines free of cost are available for all TB patients at Government hospitals.

• The latest guidelines, information, and programs about TB can be easily accessed through Nikshay Patrika, a quarterly newsletter by the Central Tuberculosis Division.

• DOTS treatment is free of cost which helps prevent failure of the treatment and lowers the risk of MDR-TB by ensuring strict adherence and uninterrupted treatment for TB.

• Other forms of TB don’t spread through close contact. Support individuals with TB instead of isolating them.

• Reach out to NGOs and community support groups related to TB which can help you support both physically, emotionally, and financially.