Tuberculosis – causes, symptoms, treatment, prevention

Proven content

Tuberculosis is an infectious and contagious disease known for a long time. Infectious, because the stimulus that triggers the tuberculosis process is an infectious agent discovered in 1882 by Robert Koch, the so-called the acid-fast mycobacterium of human tuberculosis, also known as Koch’s mycobacterium after its discoverer, contagious – because the germ causing tuberculosis can be transmitted directly from person to person.

Tuberculosis – description of the disease

Tuberculosis, once referred to as “consumption”, is one of the most dangerous epidemiological diseases in the world. Its pathogenesis was first described by the French physician Theophile Laenneca – much of this information is still used today. 45 years later, the French surgeon Jean-Antoine Villemin described the infectious nature of tuberculosis. Another breakthrough event in tuberculosis research was a lecture by Robert Koch in 1882, during which he pointed to bacteria being the etiological factor of tuberculosis.

Tuberculosis is caused by mycobacteria from the Mycobacterium tuberculosis complex group. Tuberculosis bacilli are gram-positive, aerobic or micro-aerobic bacilli – they are structurally very different from other bacteria. Mycobacterium tuberculosis is extremely resistant to antibiotics, which is why treating the disease is so difficult. The high drug resistance of mycobacteria also results from many mutations occurring inside the genome.

Tuberculosis is a disease that can affect virtually anyone, but most often it develops in the elderly, malnourished or abusing alcohol. Mycobacteria tuberculosis are bacteria that are extremely resistant to dehydration and can survive for months in dust particles. However, they show high sensitivity to UV radiation and high temperature.

The causes of tuberculosis

The source of the infection is the most common a man sick with tuberculosisin whose excreta – especially sputum or urine – there are tuberculosis bacilli. The most common route of infection with Mycobacterium tuberculosis is inhalation route, and the main source of infection are mycobacterial patients, i.e. actively expelling mycobacteria along with the secretion from the respiratory tract.

A patient with tuberculosis expels mycobacteria not only when coughing, but also when expectoring, sneezing or talking. One patient with active mycobacteria can infect about 15 people a year. Mycobacteria, together with air, enter the body through the respiratory tract during breathing, and their carriers are sputum or saliva droplets or dust particles remaining in the air in the form of aerosols.

Another possible route of infection is alimentary wayalthough in areas with a proper sanitary-veterinary regime it does not always play a role in the transmission of mycobacterium tuberculosis. The main source of infection through the ingestion is dairy products derived from cattle suffering from tuberculosis or unpasteurized milk. In Poland, this route of infection is practically non-existent.

Tuberculosis is often called a social disease because it is closely related to living conditions:

1. malnutrition,
2. poor housing conditions,
3. poor sanitary conditions,
4. poverty.

Exactly that poverty it is the most common external factor that weakens the human body. It is related to poor housing conditions, lack of proper hygiene of life and poor sanitary conditions. The combination of all these factors creates perfect conditions for the development of a mycobacterial infection. In a dark and unventilated apartment, more mycobacteria will remain in the air than in a ventilated and well-sunny room.

In turn, the internal factor that favors the transformation of mycobacteria into a disease are ailments that weaken the body, e.g. HIV / AIDS. In people infected with HIV, the risk of developing tuberculosis is even several dozen times higher. Other ailments that increase the transformation of mycobacteria into tuberculosis include: blood diseases, cancer, diabetes, people after transplantation, and silicosis.

In any case, tuberculosis does not only affect people living in poverty, but is also observed in young people who devote themselves intensively to their professional work, and therefore often live under a lot of stress, eat in a hurry, eat unbalanced food or use all kinds of stimulants in excess. Another, very important group of people with a high increase in tuberculosis incidence are people infected with HIV.

Tuberculosis symptoms

In some patients tuberculosis may be asymptomatic and it is detected completely by chance. Symptoms may be general, resulting from our body’s reaction to infections, and may be specific to the affected organ. Due to the fact that the lungs are most often attacked, the symptoms of the lower respiratory tract are dominant.

Characteristic for tuberculosis are:

1. night sweats
2. recurrent low-grade fever,
3. a cough that lasts for at least 3 weeks, initially dry and then moist, producing mucus or purulent discharge,
4. blood plucking,
5. dyspnoea,
6. pain in the chest,
7. weight loss
8. weakness and easy fatigue with little effort.

Breakdown of tuberculosis

The typical breakdown of tuberculosis includes:

primary tuberculosis – it arises after the first contact with the bacteria that causes tuberculosis. Its symptoms are: coughing, low-grade fever, general weakness, pale skin and sweating. The body then begins to defend itself and may, as a result, become resistant to the disease in some way. Primary tuberculosis usually develops in the lungs or in the parotracheal or paravernal lymph nodes.

tuberculosis – it is the result of reactivation of primary tuberculosis after several months or years and may affect the lungs as well as other organs; it is the most common form of tuberculosis. Infection usually occurs via droplets.

However, taking into account the place of the disease development, we distinguish pulmonary tuberculosis (which is the most common form of tuberculosis, the characteristic symptom of which is persistent cough for a long time – initially dry and then with the production of sputum) and extrapulmonary tuberculosis, including:

1. tuberculosis of the lymph nodes – mainly in children and young adults – in people with reduced immunity, tuberculosis mycobacteria enter the lymph nodes and lead to a cycle of changes in them. Tuberculous changes cause the lymph nodes (neck, nape) to begin to enlarge, become soft, and then they break and exit the necrotic (serous-purulent) content, which contains invisible mycobacteria. Only after the purulent content has come out, the nodes return to their original form – they become smaller. A star scar forms at the site of the puncture.
2. pleural tuberculosis – most often occurs in adolescents and young adults as an immune reaction after primary infection. It can affect any part of the body and is one of the most common extrapulmonary forms of tuberculosis. The disease usually begins acutely and rapidly develops symptoms such as fever, dry cough, pleural pain, and shortness of breath.
3. miliary tuberculosis – is caused by the spreading of tuberculosis mycobacteria through the blood; may indicate an acute or subacute infection. Thus, miliary tuberculosis arises when primary or post-primary tuberculosis mycobacteria enter the bloodstream and are seeded in the meninges of the brain, lungs, bones, or other organs; The symptoms of miliary tuberculosis located in the lungs include: cyanosis, cough, shortness of breath, shallow and rapid breathing.
4. tuberculosis of the genitourinary system – is secretive and may lead to renal failure; usually it does not give any characteristic symptoms and its development is discreet. The underlying cause of infection is usually the hematogenous sowing of tuberculous bacilli, which gives rise to pathological changes first in one kidney, and then in both,
5. central nervous system tuberculosis – is a severe form of tuberculosis, which can occur in the form of meningitis, tuberculosis of the brain or spinal cord. We talk about it when the mycobacteria that cause tuberculosis enter the brain and spinal cord. The initial symptoms of the disease include elevated temperature, sleepiness, lethargy or over-excitement, headache, nausea and vomiting.
6. tuberculosis of the reproductive organs – localized in the vulva, vagina, fallopian tubes and uterine mucosa; this form of tuberculosis may be asymptomatic and is therefore diagnosed completely by chance. Symptoms include: vaginal discharge, pelvic pain, menstrual disorders, and even postmenopausal bleeding.
7. tuberculosis of bones and joints – mainly in the elderly; the first symptom may be a spontaneous fracture of, for example, the spine; it arises as a result of infection with tuberculosis bacilli, which cause serous-necrotic changes in the skeleton. Most often, tuberculosis bacilli are located in the vertebrae of the spine and the articular long bones.
8. gastrointestinal tuberculosis – rare; it usually occurs as a result of an infection through the digestive tract (ingestion of the patient’s own sputum). The lesions are usually located in the ileocecal area in most cases
9. skin tuberculosis – may occur as an independent disease or accompany pulmonary tuberculosis or tuberculosis of other internal organs. It is a chronic skin disease that comes in many forms that produce symptoms depending on the type of disease. Treatment of tuberculosis sometimes requires several months of antibiotics, but depends on whether the disease is associated with organ tuberculosis, nodal tuberculosis or tuberculosis of the skeletal system.

Tuberculosis – diagnosis

In the diagnosis of tuberculosis, a microbiological test is used, consisting in the cultivation of mycobacteria from material collected from the patient or a smear. The test material is usually taken from:

1. sputum;
2. bronchial secretions;
3. urine (suspected genitourinary tuberculosis);
4. gastric lavage on an empty stomach.

The cultured mycobacteria are identified, and then their sensitivity to anti-mycobacterial preparations is determined. The disadvantage of this method is the long-term growth of the bacteria, and the test result is obtained only after about six weeks. Mycobacteria are grown using special media. For this purpose, a solid substrate is used – the Löwenstein-Jensen method, or a liquid substrate (in Poland, the Bactec method is most often used).

Other tests used in the diagnosis of tuberculosis are:

1. chest X-ray – allowing to detect characteristic changes in the lungs,
2. tuberculin reaction – consists in intradermal injection of tuberculin into the forearm; the reading of the diameter of the infiltration is made after 48-72 hours; a positive result is an infiltrate with a diameter of more than 10 mm; The disadvantage of the tuberculin test is that it does not differentiate a previous infection from the currently active disease. This test is safe and there are no obstacles to its performance. Even the most intense reaction leaves no traces.

Early detection of tuberculosis and its treatment prevents the spread of Mycobacterium infection in the environment (family).

Do you have symptoms that might be TB? Schedule an e-consultation today. The doctor will be able to see you within 10 minutes.

Treatment of tuberculosis

Treatment of tuberculosis should be long enough as the tuberculosis bacilli may go into a “dormant” state. Some bacteria are resistant to treatment, so several medications are used. You should not stop the treatment yourself, because the bacteria most resistant to drugs can survive despite the disappearance of the disease symptoms. If you stop treatment yourself or stop taking your medications too early, your tuberculosis may come back.

The therapy is divided into:

1. the intensive phase (a very large amount of drugs is used, but for a shorter time; its aim is to kill as many tuberculosis bacilli as possible);
2. continuation phase (involves the use of fewer drugs despite its longer duration; this phase is aimed at getting rid of the remaining mycobacteria that survived the intensive phase).

The most commonly used antituberculosis preparations are:

1. ethambutol (taking it may result in: deterioration of visual acuity, impaired green and red perception, retrobulbar inflammation of the optic nerve),
2. rifampicin (side effects are: thrombocytopenia, rash, chills, low blood pressure, nausea, muscle aches, vomiting, abdominal pain),
3. streptomycin (may cause dizziness, fever, rash, tingling around the mouth),
4. pyrazinamide (nausea, vomiting, liver damage or flushing may occur)
5. isoniazid (side effects are jaundice, peripheral nerve dysfunction, joint pain, chest pain).

Vaccinations

In our country, infants are required to be vaccinated once with the BCG vaccine. Thanks to it, the risk of severe forms of tuberculosis, e.g. miliary tuberculosis, is minimized. The vaccine can have side effects, but these are rarely seen – in about 1 in 1000 children vaccinated. These can include enlarged lymph nodes under the arms or visible sores at the site of the vaccination.

Tuberculosis – prevention

The most important methods of preventing tuberculosis include:

1. early detection of the disease and implementation of immediate treatment,
2. examining family members of people diagnosed with tuberculosis (in order to exclude it),
3. improving the living and working conditions of people (better sanitary conditions, sunny apartments, good working conditions),
4. avoiding alcohol and drug abuse (including smoking),
5. culture of the sick – covering the mouth with the hand when coughing and expectoration (the same applies to sneezing),
6. BCG vaccinations (compulsory in Poland).

Tuberculosis in children

Infection can occur at any time after birth. Sometimes it may take several years from the moment of infection to the appearance of symptoms of the disease. When a child is infected with Mycobacterium tuberculosis, but this is not noticeable, then we are talking about latent tuberculosis. In children, the infection enters the body primarily through droplets.

In a sick child, primary changes appear first in the lymph nodes. When the body is unable to defend itself, the mycobacteria are spread through the bloodstream or through the bronchi. The incidence of tuberculosis in children is not high. It is more common in younger children than in adolescents.

Symptoms of childhood tuberculosis in the early stages are not characteristic. The child is low-grade, sweating, losing weight and coughing. When pleural involvement occurs as a result of the disease, exudate appears in the pleural cavity. Dyspnoea also occurs when the lymph nodes near the trachea enlarge, which can lead to a narrowing of their lumen and cause atelectasis.

Aseptic pyuria is another symptom. A child with renal tuberculosis will experience pain while urinating and pain in the loins. The symptoms of gastrointestinal tuberculosis include abdominal pain, vomiting, loss of appetite and weight loss. Diagnosis of the disease can be difficult due to the lack of general symptoms. Diagnostics includes invasive, radiological and bacteriological tests.

Tuberculosis in children – treatment

The main method of treating childhood tuberculosis is antibiotic therapy – the treatment lasts for many months. Patients are then administered anti-mycobacterial drugs. Initially, children are treated in hospital, but further treatment depends on the form of the disease. In addition to antituberculosis drugs, children are also given glucocorticosteroids and pyridoxine.

While childhood tuberculosis can be fully cured, the greatest problems are caused by the complete removal of tuberculosis from the body. After treatment, the child usually has to remain under the supervision of a pulmonologist. When a child is diagnosed with pleurisy, then physiotherapeutic measures will be necessary to avoid curvature of the spine.

Strengthen your immunity using special dietary supplements containing colostrum – a substance present in cattle’s milk up to a few days after giving birth.