Tuberculosis
Summary/Definition
Tuberculosis is an infectious disease caused by tuberculosis bacteria (bacilli) affecting the lungs and transmitted by airborne droplets through talking, coughing and sneezing. The bacilli can affect human tissues and organs – lungs, kidneys, organs of the central nervous system, bones and joints. There are types of tuberculosis, the names of which depend on where the disease is localised, pulmonary tuberculosis affects the lungs. In addition to the lungs, there is extrapulmonary tuberculosis, which occurs in various organs, can affect lymph nodes, gastrointestinal tract, joints, brain membranes, genitourinary organs, and others.
Mycobacterium tuberculosis is a type of acid-fast bacterium that infects mainly human organs and is transmitted from person to person by airborne droplets. People become infected with tuberculosis mainly by inhaling tuberculosis bacteria mixed with small particles of saliva spread by a person with pulmonary tuberculosis during coughing, sneezing and talking. The likelihood of infection depends on the amount of bacteria excreted by the pulmonary tuberculosis patient, the degree of illness and the frequency of coughing. In closed rooms, the concentration of bacteria is high, which increases the risk of infection. At the same time, in the open air, when tuberculosis bacteria are exposed to sunlight, their activity decreases, and they can practically not be infected. In patients with active pulmonary tuberculosis who receive appropriate treatment, the infectiousness of the disease is significantly reduced after about two weeks. About 30 percent of people who come into close contact with a tuberculosis patient become infected, but not everyone infected with tuberculosis bacteria develops tuberculosis. About 10% of infected people develop the disease, and half of these (5%) may not develop the disease until 1-2 years after infection, after which the incidence declines rapidly, but in some cases, the disease develops throughout life.
Symptoms
Patients do not have any specific complaints when they are first infected with tuberculosis. There may be mild systemic symptoms such as fever and malaise. Common symptoms of pulmonary tuberculosis reinfection include prolonged cough, weight loss, night sweats, fever, generalised weakness and loss of appetite. As the disease progresses, lung cells collapse and fill with fluid, breathing difficulties may occur, as well as haemoptysis in bronchial tuberculosis or pulmonary tuberculosis with cavernous tuberculosis.
Depending on the organ affected, tuberculosis presents with different symptoms. Tuberculosis of the kidneys may cause symptoms of cystitis – haematuria, difficulty or frequent urination. Tuberculosis of the spine may cause back pain. TB meningitis can cause headaches and vomiting.
Diagnostics
Early detection and treatment of tuberculosis patients are important because the infectiousness of tuberculosis patients is highest immediately before treatment, and the infectiousness decreases rapidly over a short period with antituberculosis drugs. By questioning people suspected of having pulmonary tuberculosis because of respiratory symptoms, such as a cough lasting more than two weeks without a clear cause, it is first necessary to ask the patient whether there has been recent contact with patients with active pulmonary tuberculosis and whether there are any comorbidities that can easily cause pulmonary tuberculosis and what medications he or she is taking. If tuberculosis is suspected, immunological tests such as tuberculosis skin test and interferon-gamma test, imaging diagnostic tests such as chest X-ray or computed tomography (CT), acid-fast bacterial smear, acid-fast bacterial culture test and others are performed.
Treatment and course of the disease
The important factors in the comprehensive treatment of the disease are not only the basic treatment and the elimination of relapse and complications from tuberculosis but also the prevention of the spread of tuberculosis bacteria in the community and the assessment of drug resistance of the bacteria. It is important to prescribe a comprehensive therapy of effective antituberculosis drugs, the regular administration of which in the required amount for a sufficient period will give a favourable result. Antituberculosis drugs are mainly divided into first-line and second-line drugs. The most common side effect of tuberculosis treatment is gastrointestinal disorders, which occur when some drugs are taken concomitantly. The majority of gastrointestinal disorders gradually disappear after taking the drugs for 2-3 weeks, but if there is no change, it is necessary to adjust the method of taking the drugs, such as reducing the dose or taking the drug before bedtime, to control the symptoms. Treatment for tuberculosis lasts about 6 months on average, with 4 types of drugs being taken at the same time for the first 2 months and 2 to 3 types of drugs for the next 4 months.
Complications
A variety of complications can occur in the lungs: haemoptysis, pleurisy, pulmonary pneumothorax, bronchiectatic disease, chronic obstructive pulmonary disease, pulmonary mycosis, malignant tumours arising from pulmonary tuberculosis scars, tuberculosis and extrapulmonary tuberculosis.
