DefeatTB

It is estimated that one-third of the world’s population is infected with latent TB. Up to 1 in 10 of people with a latent TB infection (but who do not have HIV) will develop active TB at some point.

Parts of the world that have high rates of TB include:

• Africa – particularly sub-Saharan Africa (all the African countries that are south of the Sahara desert) and West Africa, including Nigeria and South Africa
• Southeast Asia – including India, Pakistan, Indonesia and Bangladesh
• Russia
• China
• South America

FOR MORE INFO: http://www.stoptb.org/countries/tbdata.asp

In spite of the availability of chemotherapy for TB, there are 14 million Tuberculosis cases in India and a staggering 5,00,000 deaths every year due to this disease. Most TB cases occur in the 15-59 year age group (economically the most productive years).

World TB Day Every year March 24th is observed as the ‘World TB Day’ because TB was discovered by Robert Koch on March 24th 1880. Despite the availability of good chemotherapy and effective treatment regimens TB kills more adults each year than any other infectious disease – more than malaria, diarrhea, AIDS and other tropical diseases put together. Awareness about the symptoms of the disease and removal of the stigma about the disease are crucial factors in TB control.

Tuberculosis (TB) is a serious disease caused by the germ Mycobacterium tuberculosis. Mycobacterium bovis is part of the tuberculosis family, primarily a disease of cattle but may affect other animals as well as humans. TB can hurt a person’s lungs or other parts of the body. However, TB can be prevented with treatment and it can be cured.

TB is spread when a person who has active, untreated TB germs in their lungs or throat coughs, sneezes, laughs, or speaks, spreading their germs into the air. A person who breathes in TB germs usually has had very close, day-to-day contact with someone who has active TB disease. That’s why a person usually gets TB germs from someone he/she spends a lot of time with, like a family member, friend, or close co-worker who has the disease.
A person is not likely to get TB from someone coughing in the subway or at a restaurant. TB is not spread by sitting on a toilet seat or by sharing dishes, utensils, sheets, clothing or other inanimate objects.

When you first breathe in TB germs into your lungs, your body protects you by building a wall around the germs the way a scab forms over a cut. This makes the germs go to “sleep” and stops them from hurting your body. Sleeping TB germs are called “latent TB”. A person with latent TB are said to have latent TB infection (LTBI). Latent TB germs can stay asleep for a long time, sometimes for life. However, sometimes TB germs “wake up” when body defenses are weakened. When this happens, you have active TB disease.

Some people develop TB disease soon after becoming infected when TB bacteria begin to multiply rapidly, before their immune system can fight back. Other people may get sick later, when their immune system becomes weak for some reason.
Babies and young children often have weak immune systems. People infected with HIV have very weak immune systems. Other people who have weak immune systems, are those who have the following conditions:

• diabetes mellitus
• cancer of the head or neck
• hematological malignancies
• severe kidney disease
• low body weight
• certain medical treatments (such as corticosteroid treatment or organ transplants)

• A person who has symptoms of active TB disease
• A person who has been exposed to someone (a family member, friend, or co-worker) who has active TB disease
• A person who has HIV infection or certain medical illnesses such as diabetes or chronic kidney failure
• A person who is taking steroid or other immune suppressing drugs for chronic medical conditions
• A person who lives or works in a homeless shelter, prison, hospital, nursing home or other similar group setting

The most common symptoms of TB involving primalrily the lungs are:

• cough
• fever, especially rising in the evening
• night sweats
• chest pain
• weight loss
• loss of appetite
• coughing up of blood.

In some cases, a TB infection can spread from the lungs to other parts of the body. TB infections that occur outside the lungs are known as extrapulmonary TB.
Extrapulmonary TB is more common in people with weakened immune systems (the body’s natural defence against infection and illness).
These types of extrapulmonary TB can cause additional symptoms, which are described below.

Lymph nodes are small, oval glands that are part of the immune system. They remove unwanted bacteria and particles from the body. Symptoms of lymph node TB include:

• persistent, painless swelling of the lymph nodes, which usually affects nodes in the neck, but swelling can occur in nodes throughout your body
• over time, the swollen nodes can begin to release a discharge of fluid through the skin

• bone pain
• curving of the affected bone or joint
• loss of movement or feeling in the affected bone or joint
• weakened bone that may fracture easily

• abdominal pain
• diarrhoea
• bleeding from your anus

• a burning sensation when you urinate
• blood in your urine
• a frequent urge to pass urine during the night
• groin pain

Your central nervous system consists of your brain and spinal cord. Symptoms of central nervous system TB include:

• headaches
• stiff neck
• changes in your mental state, such as confusion
• blurred vision
• fits

FOR MORE INFO: http://www.tbalertindia.org/about-tb.html
http://www.tbalert.org/tuberculosis/symptoms.php

If you have been exposed to someone with active TB disease or meet any of the criteria for testing listed in the previous question, you should get a TB skin test. The TB skin test is an easy way to tell if the TB germs are in your body. A trained health care worker will examine your arm 2 or 3 days after the test has been placed. If the test is “positive,” you probably have LTBI. You will need a chest x-ray and a medical examination to make sure that you don’t have TB disease and to see if you should receive treatment for latent TB infection.

To fight this global epidemic, India initiated the Revised National Tuberculosis Control Programme (RNTCP). Which uses the WHO recommended DOTS strategy in fighting the disease. In March 2006 India officially announced 100% coverage of the DOTS strategy; this means everyone has a health facility in their area that provides free diagnosis and treatment for TB.

• Blood tests
• Chest X-ray

If you’ve had a positive skin test, your doctor is likely to order a chest X-ray. This may show white spots in your lungs where your immune system has walled off TB bacteria, or it may reveal changes in your lungs caused by active tuberculosis.

Sputum tests

If your chest X-ray shows signs of tuberculosis, your doctor may take a sample of your sputum — the mucus that comes up when you cough. The samples are tested for TB bacteria. These bacteria can also be tested to see if they are resistant to the effects of medications commonly used to treat tuberculosis. This helps your doctor choose the medications that are most likely to work.
Tuberculin skin test: The TB skin test (also called the Mantoux tuberculin skin test) is performed by injecting a small amount of fluid (called tuberculin) into the skin in the lower part of the arm. A person given the tuberculin skin test must return within 48 to 72 hours to have a trained health care worker look for a reaction on the arm. The health care worker will look for a raised, hard area or swelling, and if present, measure its size using a ruler. Redness by itself is not considered part of the reaction.
The skin test result depends on the size of the raised, hard area or swelling. It also depends on the person’s risk of being infected with TB bacteria and the progression to TB disease if infected.

• Positive skin test: This means the person’s body was infected with TB bacteria. Additional tests are needed to determine if the person has latent TB infection or TB disease. A health care worker will then provide treatment as needed.
• Negative skin test: This means the person’s body did not react to the test, and that latent TB infection or TB disease is not likely.

FOR MORE INFO: http://www.cdc.gov/tb/topic/testing/default.htm

It is a strategy being practiced in more than 180 countries, including India. Revised National Tuberculosis Control Programme (RNTCP) applying the principles of DOTS to the Indian context.
FOR MORE INFO: http://tbassnindia.org/DOTSClinicsinIndia.html

If you have been exposed to someone who has active TB, and the result of your skin test is “negative,” you most likely do not have TB germs in your body. You probably do not need to take medicine. However, in some instances your doctor may recommend treatment, even if the result of your skin test is negative. Also, someone whose immune system is weakened by chronic medical conditions may also be recommended to take medicine even though the TB skin test may not be positive.

Yes. The BCG vaccine usually does not protect people against TB. Even if you had the vaccine, you can still become infected with the TB germ and develop active TB disease. Therefore, you may still need a TB skin test. Talk to your health care worker for more information.

Latent TB infection means that TB germs are in a person’s body but are not active. Many healthy people have LTBI. Most of them never get sick. The germs are in their bodies, but are not active and cannot be spread to others.

Yes. If you have latent TB, you cannot spread TB to other people. You can work and go to school and do your normal routine. You cannot spread TB to others.

best for you. Treatment for LTBI generally lasts for 9 months. It is important that you finish the treatment.
The most common drug used for the treatment of LTBI is a medicine called isoniazid, or INH. Most people can take INH without problems. Make sure that you tell your health care worker about any health problems that you have or any medicines that you are taking. Children and adults who can’t swallow pills can get INH in liquid form.
FOR MORE INFO: http://www.cdc.gov/tb/topic/treatment/default.htm

Yes. Active TB disease can be cured with medicine. If you have active TB, you must take your medicine for at least 6 months.

Usually, after a week or more of taking effective medication, most patients with active TB disease will stop spreading germs. A doctor will test the patient and then decide when the patient is no longer contagious. Most TB patients live at home and can continue their normal activities as long as they are taking the TB medicine.

The only way to cure active TB is take all of your medicine for at least six months. TB germs take a long time to die. Even if you feel better after a few weeks, continue taking your medicine. If you do not, you will stop feeling better.

The first-line anti-TB agents that form the core of treatment regimens include:

• isoniazid (INH)
• rifampin (RIF)
• ethambutol (EMB)
• pyrazinamide (PZA)

Regimens for treating TB disease have an initial phase of 2 months, followed by a choice of several options for the continuation phase of either 4 or 7 months (total of 6 to 9 months for treatment).
It is very important that people who have TB disease finish the medicine, taking the drugs exactly as prescribed. If they stop taking the drugs too soon, they can become sick again; if they do not take the drugs correctly, the TB bacteria that are still alive may become resistant to those drugs. TB that is resistant to drugs is harder and more expensive to treat.

Treatment completion is determined by the number of doses ingested over a given period of time. Although basic TB regimens are broadly applicable, there are modifications that should be made under special circumstances (such as people with HIV infection, drug resistance, pregnancy, or treatment of children).
FOR MORE INFO: http://www.cdc.gov/tb/topic/treatment/default.htm
http://www.mayoclinic.com/health/tuberculosis/DS00372/DSECTION=treatments-and-drugs

Very few people develop side-effects to TB drugs. Minor side-effects include vomiting, nausea, loss of appetite, joint pain, orange/red urine, or skin rash, which can be managed using simple medicines or adjusting the dosages of the drugs.
Major side-effects include deafness and dizziness (streptomycin); jaundice, vomiting (mainly rifampicin and isoniazid); visual impairment (ethambutol), shock, purpura, or acute renal failure (rifampicin).

These side-effects need to be managed by a trained physician and may require hospitalization.

TB bacteria die very slowly. It takes at least six months to kill all the TB bacteria. People start feeling well after only a few weeks of treatment. But TB bacteria are still alive in the body. You must continue to take your medicine until all the TB bacteria are dead, even though you may feel better and have no more symptoms of TB disease.

If you do not continue taking your medicine after you feel better or are not regular, TB bacteria will grow again and you will become sick again because the bacteria may become resistant to the drugs you are taking. When this happens you may need different drugs to kill the TB bacteria if the old drugs no longer work. These new drugs must be taken for a longer time and usually have more serious side-effects.
If you become infectious again, you could spread TB bacteria to your family, friends, or anyone else who spends time with you. It is very important to take your medicine the way your doctor or nurse tells you.

The most important way to stop spreading TB is to take all your medicines correctly. You need to do a sputum test at various time points of your treatment. This test will show whether the treatment is effective.
You can further lessen the risk of spreading the infection by:

• covering your mouth when you cough. Use of a simple mask by the patient can reduce transmission of the germs.
• staying in a room with good ventilation. TB spreads in closed spaces where air doesn’t move.

Remember, TB is spread through the air. People cannot get infected with TB bacteria through handshakes, sitting on toilet seats, or sharing plates and utensils with someone who has TB.

• You can return to school or work if
• You have started anti-TB medicines and are not having any bad side effects from them
• You are feeling better
• You are not likely to transmit TB to others in the work or school environment
• Your doctor has decided it is safe for you to go back because you are no longer infectious or work in a place where you are not exposing people who are sick

If people with active TB disease do no take their medication, they can become seriously ill, they can develop germs that are resistant to the TB medications and may even die. But people with active TB disease can be cured, if they have proper medical treatment and take their medication as prescribed.

There are times when TB germs are “resistant” to one or more of the TB medicines most often prescribed by doctors. This means that the medicines are not able to kill the TB germs. Drug-resistant TB can develop if people with active TB take their medicine incorrectly, or if they have not been given the right dosages of TB medicines. When this happens, combinations of other (second line) TB medicines have to be given to the patient. These medicines are not as effective and have to be taken much longer.
A person with untreated drug-resistant TB of the lungs or throat can spread drug-resistant germs to other people. Drug-resistant TB can take much longer to cure than regular TB.
FOR MORE INFO: http://www.searo.who.int/en/Section10/Section2097/Section2106_10677.htm#TB_disease_treated

Yes. Even Multi Drug resistant TB can be cured. However, the patient will have to take treatment for a longer duration which can extend up to two years or even more, (depending on the resistance pattern found in the germ according to various test results).

Yes. There are even worse forms, like Extensively Drug resistant (XDR) TB and TDR-TB, in which there is resistance to second line TB drugs as well.

MDR-TB treatment depends on the lesser effective drugs (as compared to the first line anti TB medications). Thus, the treatment duration is much longer (≥2 years) as compared to that with the first line antiTB agents. These medications are costlier and are less well tolerated in view of there side effect profile.

For Drug Sensitive TB treatment for a duration of 6 months, the total cost ranges from Rs.4,000- 8,000 (including medications and investigations).
Whereas for a drug resistant TB treatment, the costRs.10.000 per month for approx. 6 months (intensive phase) followed by Rs.5000 per month for around 1-1.5 years (continuation phase).

The MDR-TB prevalence is estimated to be 2.3 per cent among new cases and 12-17 per cent among re-treatment cases according to WHO estimates. However, we have to keep in mind that, this does not include patients treated by the private practitioners.
FOR MORE INFO: http://www.who.int/tb/challenges/mdr/TDRFAQs160112final.pdf

damienfoundation.in
tbassnindia.org
medindia.net
mayoclinic.com
angelfire.com/indie/tbindia