INFORMATION CAMPAIGN:

TUBERCULOSIS

LINKS:

http://www.tbfacts.org/tb-treatment/
http://www.emedicinehealth.com/tuberculosis/page2_em.htm
http://www.livestrong.com/article/176319-what-are-the-effects-of-tb/

CAUSE AND EFFECT:

CAUSE:
All cases of TB are passed from person to person via droplets. When someone
with TB infection coughs, sneezes, or talks, tiny droplets of saliva or mucus are
expelled into the air, which can be inhaled by another person.

Once infectious particles reach the alveoli (small saclike structures in the air
spaces in the lungs), another cell, called the macrophage, engulfs the TB
bacteria.
o Then the bacteria are transmitted to the lymphatic system and bloodstream
and spread to other organs occurs.
o The bacteria further multiply in organs that have high oxygen pressures, such
as the upper lobes of the lungs, the kidneys, bone marrow, and meninges --
themembrane-like coverings of the brain and spinal cord.
When the bacteria cause clinically detectable disease, you have TB.
People who have inhaled the TB bacteria, but in whom the disease is
controlled, are referred to as infected. Their immune system has walled off the
organism in an inflammatory focus known as a granuloma. They have no
symptoms, frequently have a positive skin test for TB, yet cannot transmit the
disease to others. This is referred to as latent tuberculosis infection or LTBI.
Risk factors for TB include the following:
o HIV infection,
o low socioeconomic status,
o alcoholism,
o homelessness,
o crowded living conditions,
o diseases that weaken the immune system,
o migration from a country with a high number of cases,
 o and health-care workers.

EFFECT:
These can include:

feeling sick or dizzy

skin rashes
pins and needles
flu like symptoms
In very few cases people may experience jaundice, which is the yellowing of skin
or eyes. If this happens, stop taking your medication and tell your doctor straight
away.
Patients should always discuss any side effects with their doctor, as it may be
possible to change TB medication. People with TB should be tested for liver and
kidney problems before starting treatment. If there are concerns over their liver
or kidney function, careful monitoring throughout treatment will be needed.
People with HIV who are taking antiretroviral therapy in addition to TB drugs may
have more problems with side effects from certain TB drugs. They will need to be
monitored throughout treatment, and may need dose adjustments.

OTHER EFFECTS:

Lung Damage and Death

If a TB infection is not diagnosed and treated, the infection can be fatal, explains
the Mayo Clinic. The bacteria severely damages the lungs, which causes severe
coughing that may produce blood, wheezing, chest pain and difficulty breathing.
The infection may also cause fever, fatigue and unintentional weight loss. If the
infection is not treated, if the bacteria is drug-resistant or if the infected person
has a weakened immune system from another disease or condition, the damage
to the lungs can become so severe that the person cannot breath properly, which
can lead to death.

Meningitis
If the TB infection spreads to the brain, it can cause meningitis. The infection in
the brain can have several serious effects, including fever, loss of appetite,
listlessness and periods of lost consciousness. In addition, a patient with TB
meningitis may suffer from severe nausea and vomiting, severe headache, neck
stiffness and light sensitivity. Left untreated, TB meningitis can lead to frequent
seizures, muscle paralysis, impaired mental function and abnormal behavior.

Arthirtis

In rare cases, a TB infection may spread to the joints, causing TB arthritis. The
most commonly infected joints include the wrists, ankles, knees, hips and spine.
When the bacteria does spread to a joint, typically only one joint is infected. The
affected joint often suffers from stiffness, swelling, tenderness and a decreased
range of motion. TB arthritis may also cause a fever and excessive sweating,
particularly during the night. The muscles around the joint may experience
spasms and may atrophy over time. If the infection is in the spine, the parts of
body below the infection may feel tingling, numbness or weakness.

Miliary TB

Another rare type of TB is miliary TB, in which the infection spreads throughout
the body. The name miliary arose because the millions of infected spots
throughout the body are roughly the same size as millet--small, round seeds often
found in bird food. This type of infection usually only occurs in people with an
already weakened immune system, such as HIV patients. The bacteria spreads
through the bloodstream and lymph system to infect all parts of the body, causing
symptoms of general ill feeling, fever, chills, weight loss, weakness, difficulty
breathing and anemia.

SYMPTOMS:

Although your body may harbor the bacteria that cause tuberculosis, your
immune system usually can prevent you from becoming sick. For this reason,
doctors make a distinction between:

Latent TB. In this condition, you have a TB infection, but the bacteria remain
in your body in an inactive state and cause no symptoms. Latent TB, also
 called inactive TB or TB infection, isn't contagious. It can turn into active TB,
so treatment is important for the person with latent TB and to help control
the spread of TB. An estimated 2 billion people have latent TB.
Active TB. This condition makes you sick and can spread to others. It can
occur in the first few weeks after infection with the TB bacteria, or it might
occur years later.
Signs and symptoms of active TB include:

Coughing that lasts three or more weeks

Coughing up blood
Chest pain, or pain with breathing or coughing
Unintentional weight loss
Fatigue
Fever
Night sweats
Chills
Loss of appetite
Tuberculosis can also affect other parts of your body, including your kidneys,
spine or brain. When TB occurs outside your lungs, signs and symptoms vary
according to the organs involved. For example, tuberculosis of the spine may give
you back pain, and tuberculosis in your kidneys might cause blood in your urine.

When to see a doctor

See your doctor if you have a fever, unexplained weight loss, drenching night
sweats or a persistent cough. These are often signs of TB, but they can also result
from other medical problems. Your doctor can perform tests to help determine
the cause.

The Centers for Disease Control and Prevention recommends that people who
have an increased risk of tuberculosis be screened for latent TB infection. This
recommendation includes:
 People with HIV/AIDS
IV drug users
Those in contact with infected individuals
Health care workers who treat people with a high risk of TB

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.

TB treatment, the drugs

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.2 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.3
Killing the TB bacteria
The TB drugs that are taken for the treatment of TB, have the aim of killing all the
TB bacteria in the persons body. This means that the person is cured of TB.
However, TB bacteria die very slowly, and so the drugs have to be taken for quite
a few months. Even when a patient starts to feel better they can still have
bacteria alive in their body. So the person needs to keep taking the TB
treatment until all the bacteria are dead.
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.
General principles of drug treatment of pulmonary TB
Some general principles of pulmonary TB drug treatment (sometimes referred to
as TB chemotherapy) are:

Drug treatment is the only effective treatment for TB;

Single drug treatment for active TB is associated with a substantial relapse
rate. A patient is said to have a relapse if they improve whilst taking TB
treatment but become ill again after they have finished their treatment.
Single drug treatment is also associated with the development of bacteria
that are resistant to the drug;
Patients with active TB disease should 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.

First line drugs for TB treatment

The first line drugs:

Isoniazid
Rifampicin
Pyrazinamide
Ethambutol
and Streptomycin
are those TB drugs that generally have the greatest bactericidal activity when
used for TB treatment. The amount of drug that a TB patient needs to take
depends on the patients weight.
TB treatment for new patients
New patients are those who have not had TB treatment before, or they have
received less than one month of anti TB drugs. New patients are presumed to
have drug susceptible TB (i.e. TB which is not drug resistant) unless:

1. There is a high level of isoniazid resistance locally in new TB patients, or

2. the patient has developed active TB disease after known contact with a
patient who is documented as having drug resistant TB.
For new patients with presumed drug susceptible pulmonary TB, the World
Health Organisation (WHO) recommends that they should have six months of TB
treatment. 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:

Isoniazid
plus rifampicin
plus pyrazinamide
plus ethambutol
followed by

Isoniazid
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. If they just have the same course of TB drug
treatment again, they will probably not be cured. The drug regimen or plan will
need to be worked out in the same way as a TB treatment regimen or plan is
worked out for a patient who needs treatment for drug resistant TB.
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.
The three main causes of TB treatment failing, relate to the actions of doctors in
prescribing incorrect regimes, the fact that there may be problems with the drugs
being delivered (either when they are delivered or the quality), and that patients
for a number of reasons may not have a sufficient intake of the drugs.4
Doctors as a cause of TB drug treatment failure:
Inappropriate guidelines,
Non compliance with guidelines,
Absence of guidelines.
Drugs as a cause of inadequate TB treatment:
Poor quality,
Irregular supply,
Wrong delivery (dose/combination),
Drugs are unsuitable due to drug resistance.
Patients as a cause of TB drug treatment failure:
Lack of information,
Lack of money for treatment and/or transport,
Actual or presumed side effects,
Lack of commitment to a long course of drugs,
Malabsorption,
 Social barriers.
Patients who experience only a short improvement whilst on TB treatment, or
who never respond to treatment, are said to have failed their TB treatment.
Treatment failure is also sometimes defined as the continued presence of positive
sputum or culture (positive result to a culture test) or positive sputum or culture
appears again, during the course of a patients anti tuberculosis drug treatment
(att).5
After three months of multi drug treatment for pulmonary TB caused by drug
susceptible bacteria, 90-95% of patients will have negative sputum or culture and
show clinical improvement. Normally it is considered that if a patient still has a
positive culture after three months of treatment, the patient must be carefully
evaluated to identify why their positive culture hasnt changed to negative.
Patients whose sputum culture remain positive after four months of drug
treatment should be classified as treatment failures. If drug
treatment failure occurs then a sample should be sent to a reference laboratory
for drug susceptibility testing for both first and second line drugs.
TB treatment relapse & recurrence
A patient is said to relapse if they become and remain culture negative (or they
become well) whilst on TB treatment, but become culture positive (or become ill)
again after finishing their TB treatment.
Recurrence of active TB is usually used to refer to the situation when a persons
first TB treatment appears to have been successful. There has then been a
significant time interval before active TB develops again. This may either be
because of reactivation of the persons previously latent TB or because they have
been reinfected. In any of these situations occur it must be considered a real
possibility that the person has drug resistant TB. Their new TB
treatment programme must be decided taking this into account.
TB treatment monitoring

All patients receiving TB treatment should be monitored during their treatment to

assess their response to the drug treatment. Regular monitoring also helps to
ensure that patients complete their treatment. It can also help to identify and
manage adverse drug reactions. Patients need to have their weight checked every
month, and if the patients weight changes the drug dosages may need to be
adjusted.6
When patients have pulmonary TB the patients response to TB treatment should
be monitored using sputum smear microscopy. The recommendation from the
World Health Organisation (WHO) is that for smear positive TB patients treated
with first line drugs, the patients should have smear microscopy performed at the
end of the two month intensive phase of treatment. Sputum should be collected
when the patient is given the last dose of the intensive phase of treatment.
If the patient has a positive sputum smear at the end of the intensive phase, then
there should be a patient assessment carried out. This is because the positive
smear could indicate a number of different situations. An example is that the
patient might have drug resistant TB, and a change in the TB drugs they are taking
might be needed. Alternatively, patient adherence might have been poor, and
they might not have been taking their drugs correctly. So the assessment might
result in changes needing to be made to the patients treatment, or to their
support and supervision. Different action may need to be taken in a variety of
other circumstances, such as the patient having received treatment before.
HEALTHY LIFESTYLE:

1. Minimize risk of exposure

If one is suspected of having active TB or have received less than two weeks of the
appropriate treatment, then others should take caution and abstain from being in
close quarters with the infected individual. A few germs inhaled by a healthy
person can make one infected as well. Wearing face masks and gloves can
minimize the risk of getting TB.
2. Take extra care if you are at high-risk
As mentioned above, some people have a higher risk of getting TB than others. If
a person belongs to the high-risk category, he or she should take extra measures
to make sure he or she does not contract TB. Aside from the high-risk groups
mentioned above, people who live in close confinement with others like in
prisons, small houses, shelters etc., should pay extra attention as well as those
who abuse drugs and have limited access to suitable healthcare facilities.
3. Take extra care when travelling to high-risk areas
People travelling to countries most affected by TB, particularly Afghanistan,
Angola, Bangladesh and other less developed countries in Latin Americaand
Africa, must get themselves tested and take extra precautions to reduce exposure
to an active TB infection.
4. Develop healthy lifestyle
One of the most efficient ways to protect oneself from TB is to maintain a healthy
lifestyle by eating healthy and balanced food, exercising regularly, sleeping
adequately, developing good personal hygiene, and restraining from consuming
dangerous substances like alcohol, drugs and cigarettes.
5. Take the BCG vaccine
If the chance of contracting TB is very high then one could get the TB vaccine
called BacilliCalmette-Guerin (BCG). This vaccine is mainly used in high TB risk
countries. However, the BCG vaccine is not as effective in adults as it is in babies.
It should be used when travelling to a country where TB is widely prevalent.