Tuberculosis- A Silent Killer

Tuberculosis- A Silent killer

I was just reading an article recently on how there is an increase in a drug resistant form of TB across the land and thought a good idea to have a look at it. More often especially in Southern Africa, TB is associated with HIV/AIDS so people do not want to come out in the open. The stigma though in some cases has led to deaths that could have been stopped and in some cases spreading of the disease. The most important thing is to talk to your doctor and ignore what people, neighbours, friends might say. Avoiding treatment can only make it worse.

What is Tuberculosis?

TB is caused by the bacterium Mycobacterium tuberculosis. TB in the lungs or throat can be infectious i.e. the bacteria can be spread to other people. TB in other parts of the body is usually not infectious. TB is spread mainly through the air. When infectious people cough, sneeze, talk, laugh or spit, droplets containing bacteria are sprayed into the air. People nearby may inhale these bacteria and become infected. Bacteria can stay air-borne for a long time, and can remain active in house dust for weeks. However, transmission usually occurs only after substantial exposure to someone with active TB. People with TB disease are most likely to spread it to those they spend time with daily, such as family members and co-workers. You are unlikely to get TB from someone coughing in a public place. You cannot get TB from handshakes, toilet seats, or sharing eating utensils, bedclothes or clothing with people who have TB.

Infection can also be acquired from contact with an infected cow or through drinking contaminated milk. However, this is an extremely rare way of getting TB. Most milk is pasteurized, and dairy herds are usually kept under veterinary control.

Symptoms

Symptoms of TB may include the following:

• A cough that starts out dry but later produces sputum (thick liquid from deep inside the lungs) or blood
• Coughing for longer than a month
• Chest pain
• Breathing difficulty e.g. shortness of breath
• Weakness or fatigue
• Loss of weight and appetite
• Chills and fevers (the fever may be low, and may be intermittent)
• Joint pain
• Wheezing
• Rales (additional sounds made to those of normal breathing)
• Excessive sweating, including sweating at night
• Hearing loss
• Diarrhoea
• A persistent lump or lesion
• Clubbing of fingers or toes - the nails become swollen and feel slightly "pulpy".

Some people have mild symptoms or none at all. People may therefore spread bacteria without knowing they have TB.

Once you are infected by the TB bacteria, there are essentially two things that can happen: you may develop active disease; or your body may control the bacteria - you will be infected, but will not have active TB.

TB Infection (Latency)

It is very important to realise that most people who are infected with the TB bacteria do not develop active TB. These people therefore have no symptoms and are not infectious. The immune system controls the infection by forming walls around the bacteria. This inactivates the bacteria, but does not kill them. They can lie dormant inside these walls for years. In many people, TB bacteria remain inactive for a lifetime, but in others, especially those with weak immune systems, the bacteria may become active and cause active TB disease.

People with latent TB infection

• Have no symptoms
• Do not feel sick
• Cannot spread TB to others
• Usually have a positive skin test reaction (see later)
• Can develop TB disease later if they receive no preventive therapy

TB Disease

TB disease is a serious illness caused by active TB bacteria. It can either develop when you are first exposed to the TB bacteria, especially if you have a weak immune system, or it can develop as reactivation disease in people who have been previously infected. Some people develop TB disease within weeks of becoming infected: their immune systems are too weak to stop bacterial growth. Other people may get sick later, when their immune systems become weak for some reason such as drug abuse, poor nutrition, immune suppression, old age or ill health. Babies and children often have weak immune systems. TB bacteria become active if the immune system can't stop their growth; they multiply and cause disease.

People with TB disease can be cured if they have proper medical treatment. Without the correct treatment, however, they may become seriously ill and even die.

Risk factors

At high risk for developing active TB include:

• People with HIV infection.
• Because HIV weakens the immune system, people with both TB and HIV infection are at high risk of developing TB disease.
• If you are HIV-positive, you are 30 times more likely to get active TB once infected than someone infected with TB who is HIV-negative.
• People with HIV should be TB tested and those with a positive skin test should get HIV tested. This way someone with both infections can take medicine to reduce the chance of developing TB disease.
• Treatment is more difficult and the infecting bacteria are often resistant to therapy. However, of diseases associated with HIV, TB is relatively preventable and curable.
• Patients receiving certain medical treatments, such as corticosteroid treatment, anti-cancer chemotherapy, or transplant anti-rejection medication.
• People who have been in close contact with someone who has infectious TB.
• People who became infected with TB in the last two years.
• Babies and young children.
• People who inject drugs.
• People with other conditions that weaken the immune system, especially
• Diabetes mellitus
• Silicosis
• Cancer of the head or neck
• Leukaemia or Hodgkin's disease
• Severe kidney disease
• Low body weight
• Substance abuse
• Elderly people
• People born where TB is common, such as Africa, Asia or Latin America.
• Low-income groups with poor health care access.
• People in residential facilities such as nursing homes and correctional facilities.
• People exposed to TB through their work, such as health care workers.

When to see a doctor

Call a health professional if,

• You have been exposed to TB, or if symptoms develop.
• Symptoms persist despite treatment.
• New symptoms develop.

See your doctor and do not let the stigma and labelling stop you from getting help. The sooner you see the doctor the better and if you get medication by all means finish the course even when you feel better. Hope this helps.