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Tuberculosis (TB)

Tuberculosis (TB)

It starts with a cough. At first, it is easy to ignore, but soon the coughing becomes more violent and alarming. Your clothes begin to feel loose on your body as your weight begins to drop. You are too tired to function during the day, but your nights are interrupted as you wake up in pools of sweat. These are the most common signs of Tuberculosis.[1]

An infection that most often attacks the lungs, active TB can be very scary and disruptive, but through modern medicine, it can also be cured. The contagiousness of this infection can cause people with this disease to feel, or physically be, isolated from their peers, friends and loved ones, but it is important to remember that people with TB can be treated effectively and move forward with their lives.


What is Tuberculosis?

Tuberculosis is a bacterial infection caused by a type of bacteria called Mycobacterium Tuberculosis and is spread through the air when a person with TB of the lungs or throat coughs, sneezes, or talks. [1] Though TB enters through the lungs, the bacteria can travel to different parts of the body, such as the kidneys, brain or spine, causing symptoms specific to where the bacteria end up.[2] For example, someone with spinal TB may start having frequent back pain which, if left untreated, can spread, destroying more and more essential organs until eventually, the body shuts down completely.[3]

There are two types of TB: Active TB, which causes visible symptoms, and Latent TB, which has no symptoms.[3]


What are the symptoms of Tuberculosis?

Active TB actively causes visible symptoms, making it much easier to spot. Symptoms of active TB include weeks of ongoing coughing ­which may include blood, chest pains, profuse sweating at night, fatigue, weight loss, fever, chills, and a loss of appetite.[3] Active TB is contagious and is spread when bacteria are sent through the air through a cough or sneeze, or even by laughing or singing.[4]

Latent TB has no symptoms, nor is it contagious, but the bacteria are still in your body and can become active at any moment. Imagine Latent TB as a dormant volcano. When it is lying in wait, it is completely harmless, but as soon as the first rumblings and spits of smoke begin, it can quickly become a dangerous situation.[4]

Testing for Tuberculosis may depend on your symptoms. These are some of the most common tests depending on what kind of Tuberculosis your doctor may think you have.[5]

  • Active Tuberculosis in the lungs:
    • Chest X-ray: Pictures of the chest are used to check for deterioration caused by TB.
    • Phlegm test: A sample of spit will be tested for any TB bacteria.
  • Active Tuberculosis outside of the lungs
    • CT scan, MRI scan, or ultrasound: Using radio waves, doctors will take pictures of the inside of your body to see if any of your organs look like they are infected.
    • Endoscopy: A long, thin tube with a camera at the end will be inserted through your mouth or natural opening, depending on where the TB may be, to see if there are signs of TB.
    • Lumbar Puncture: A small amount of spinal fluid will be taken and sampled to search for any signs of the bacteria in your system.
  • Latent Tuberculosis:
    • The Mantoux Test: A small amount of liquid, called PPD tuberculin, will be injected just underneath the skin. If you have latent TB, you will have a skin reaction, like a small, hard, red bump.
    • IGRA: Also known by its long name, Interferon Gamma Release Assay, IGRA is a blood test that can help supplement the Mantoux test or can be given on its own.

How common is Tuberculosis?

Across the world, about 10 million people are newly infected with TB each year,[6] around 280,000 of whom live in Europe.[7] In recent years, the global rate of TB has declined by about 2% every year, whereas, in Europe, the average annual decline in the TB incidence rate was 4.7% from 2008 to 2017.[8] While the number of cases is decreasing and the infection is curable, TB is still the leading cause of death from a single infection.[9] Additionally, the mycobacterium can easily become drug-resistant.

Anyone can get TB, although certain factors can make someone more vulnerable. Those who are malnourished, have another infection that affects their immune system, heavily consume alcohol or smoke cigarettes are at higher risk of developing Active TB.[6]


Treatment and Care

While the symptoms of TB can be extremely frightening, the infection, for the most part, can be cured completely. The treatment plan, which is the same when treating Latent TB (which does not always need treatment) and Active TB inside or outside the lungs, is a combination of antibiotics. The process is long; generally, people with TB will need to take medicine for 6-12 months10 but the good news is the infection will typically only be contagious for the first few weeks.

Between 2000 and 2019, nearly 60 million lives were saved by TB treatment plans.[6] The most important part of TB treatment is consistency and discipline. You will begin to feel better within a few weeks of starting treatment, but do not be fooled into thinking you have been cured. If you stop the treatment plan early you run the risk of developing drug-resistant TB. This strain of infection cannot be cured with the same antibiotics you have used previously and could require years of additional treatment.11 In some serious cases, there may be no treatment available at all.


Caring for someone with Tuberculosis

Finding out you have TB can be an extremely unnerving and isolating experience. Imagine coughing up blood, being unable to sleep, and feeling nauseous, only to find out that you are carrying an infectious disease and will not be able to interact with your loved ones for weeks.[3]

Even with the promise of a cure, the initial stages of TB can be physically and emotionally difficult. Those with TB will need their loved ones to support them. As a caretaker, your very first priority must be your own safety. After all, you cannot take care of someone if you are unwell yourself. It’s important to take the necessary precautions, such as using a face mask and keeping spaces ventilated to make sure you can stay healthy enough to be a helpful support system.12

When it comes to TB, treatment adherence is incredibly important. If your loved one has TB, sit down with them and come up with a schedule to track their treatments. This is a long-term process, a loved one with TB may be disheartened about the length of their treatment plan or be lulled into a false sense of confidence. To support them in the best way, it is important to try and help them work through these feelings and remind them of the long, happy and TB-free life they will have after their treatment is complete.


Questions to ask your doctor

The list below includes example questions to help start a conversation with your health care provider. There may be other relevant questions based on your symptoms, stage, and medical history that are not listed here.

  • How do I know if I have TB?
  • What can I do to make sure I do not spread this infection?
  • How will I know when I am no longer contagious?
  • When will I know if my TB is drug-resistant or not, and what are my options if it is?
  • If I get TB and am cured, can I get it again?
  • Are there any lifestyle changes I can make to help speed up my treatment process?
  • Is there a difference in treatment time if I have TB in my lungs vs. outside of it?
  • How regularly should I be tested if I have latent TB?
  • Which test do you recommend for latent TB? Why?
  • What are the side effects of TB treatment?

Glossary

  • Mycobacterium tuberculosis: The type of bacteria that causes Tuberculosis.
  • Latent: Present but not showing symptoms and not contagious.
  • (Multi)-drug resistant: A type of TB that does not respond to common treatments.
  • Sputum: Phlegm coughed up from deep inside the lungs.
  • Extrapulmonary: A word to indicate anywhere other than the lungs.
  • Incidence: the proportion or rate of persons in a population who develop a condition during a particular time period.
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