Tuberculosis (TB)

Pulmonary tuberculosis or TB of the lungs is the most common type of TB. Other types, such as TB of the bones, lymph nodes, brain, kidneys, intestine, and genitals, are also observed.

Symptoms of Pulmonary TB

Tuberculosis most commonly affects the lungs and can cause the following symptoms:

• Coughing that lasts for more than 2 weeks with or without fever
• Fever, especially an evening rise in body temperature
• Presence of blood in the sputum
• Chest pain
• Loss of appetite
• Loss of weight
• Chronic fatigue
• Night sweats and chills

Symptoms of TB Other Than Pulmonary TB

Occasionally, tuberculosis may also affect other organs, such as bones and the gastrointestinal system, presenting with common symptoms like fever, weight loss, and appetite loss, along with specific symptoms related to the affected organ system:

• Bone TB involving the spine can cause back pain and neurological complications, such as paraplegia, where the lower limbs become paralyzed.
• Gastrointestinal system involvement can cause nausea, vomiting, diarrhea, and malabsorption.
• Tuberculosis of the kidneys can cause blood in the urine.
• Infection involving the brain and its covering membranes can lead to seizures, headaches, and neurological abnormalities.

Here’s everything about TB causes, symptoms, and treatment (in Hindi). Watch the video to know more.

Tuberculosis is caused by a bacterium called Mycobacterium tuberculosis. TB usually spreads from one person to another through the air. When a person suffering from TB sneezes, coughs, or spits, the bacteria are released into the air. If another person inhales even a few of these bacteria, they can become infected. Although it is contagious, the bacteria grow at a slow rate and require considerable time spent around the infected individual. This means close and prolonged contact with a person who has active tuberculosis is necessary for transmission.

Important points to remember:

• Tuberculosis cannot spread through a simple handshake.
• Sharing utensils does not transmit the bacteria.
• The bacteria cannot survive for long outside of the human body.

Although all age groups are at risk of TB, the risk is higher in people who:

• Live in or travel to countries with a higher prevalence of tuberculosis, such as tropical and developing nations.
• Work in environments with constant exposure to crowds, such as hospitals, community centers, and prisons.
• Suffer from malnourishment; undernourished individuals are three times more at risk of TB compared to healthy individuals.
• Have diabetes or are on medications such as steroids or anti-cancer therapies.
• Have weakened immunity or are recovering from an illness.
• Are infected with HIV/AIDS, as the risk of developing tuberculosis is 18 times higher for patients with HIV.
• Consume excessive alcohol and smoke tobacco products.

Along with a detailed history and physical examination, the doctor also orders laboratory tests and imaging studies to confirm a suspected case of tuberculosis. The following tests are used to confirm a diagnosis:

Laboratory Tests

• Blood Tests
  • Cartridge-based nucleic acid amplification test (CB-NAAT): A rapid molecular test that detects TB, identifies the bacteria responsible, and finds rifampicin-resistant bacteria within two hours. It is recommended by WHO as an initial diagnostic test for suspected pulmonary and other forms of TB, especially in children.
  • TB Platinum Interferon Gamma Release Assay: Used to assess the body’s immune response to tuberculosis bacteria.
  • Complete Blood Count and Erythrocyte Sedimentation Rate: Performed to evaluate the body’s response to infection.
  • HIV 1 and 2 Antibody: Given the association between tuberculosis and HIV, doctors typically check for the likelihood of HIV exposure when tuberculosis is suspected.
• Sputum Analysis
  • Sputum samples are analyzed using tests such as stain AFB (ZN Stain) and Mycobacterium tuberculosis DNA PCR - Qualitative - Sputum. These tests help check for the presence of tuberculosis bacteria in the sputum. A positive test confirms the diagnosis of tuberculosis.
• Skin Prick Test
  • Also known as the Mantoux test, this screening test determines a person’s risk of TB infection or the progression of the disease if infected. A small amount of tuberculin is injected into the skin. If swelling or a reaction occurs at the injection site within 48-72 hours, it is considered a positive test, indicating exposure to the tuberculosis bacteria. False-positive results are possible if the person has been recently vaccinated for tuberculosis.

Imaging Studies

In cases of pulmonary tuberculosis, imaging studies such as X-Ray chest PA View and HRCT chest - plain are required to evaluate the extent of the disease in the lungs. In extrapulmonary tuberculosis cases, other imaging studies such as X-Ray dorsal spine AP & lateral view and MRI brain may be performed as appropriate.

There are two types of preventive measures:

1. Prevent the Spread of Tuberculosis

As tuberculosis spreads through infected droplets, it is important for a patient with active tuberculosis to follow certain hygiene measures to prevent the transmission of the infection.

• Always cover your mouth with a handkerchief when coughing or sneezing to prevent the spread of droplets.
• Patients with active tuberculosis must wear a surgical mask in the presence of others to prevent the transmission of droplets.
• Wash your hands with soap and water or use hand sanitizers frequently to keep your hands clean.
• The room where a patient with active tuberculosis lives must be well ventilated and should be cleaned with a disinfectant every day.
• The pasteurization of milk also helps to prevent humans from getting bovine TB.
• Completing your course of TB treatment is crucial as it lowers the risk of recurrence and prevents community transmission of the disease.

2. Vaccines for Tuberculosis

In countries where tuberculosis infections are prevalent, babies are given the BCG (Bacillus Calmette Guerin) vaccine at birth to provide immunity against the disease. TB is not a genetic disease. To learn about other common myths, click here!

The treatment for tuberculosis depends on the type of infection.

Latent Tuberculosis

In India, if you have tested positive for tuberculosis in a screening test, treatment may be recommended only if you belong to the high-risk category. The medicines for latent tuberculosis must be taken for a duration of 6 to 9 months as prescribed by a doctor.

Active Tuberculosis

Antibiotics are the main treatment options for people suffering from TB. The treatment approach usually involves taking these drugs for several months. These medicines are typically given in combination as part of a regimen to effectively treat tuberculosis. They kill the bacteria causing tuberculosis or prevent its growth.

The first line of treatment for active tuberculosis consists of combination therapy with five antitubercular drugs:

• Streptomycin (given as an injection)
• Isoniazid
• Rifampicin
• Pyrazinamide
• Ethambutol

A single tablet containing the four oral medicines is available, and the dose of this combination medicine is based on the patient's weight.

Easy-to-use combination kits, containing the first-line antitubercular drugs, are also readily available. The treatment continues for 6-8 months even if the symptoms improve, as this ensures complete recovery and prevents the development of drug resistance.

The DOTS regimen (Directly Observed Therapy - Short Term) is followed in India, where the patient must take the medicine in front of a DOTS agent to ensure adherence to the treatment.

MDR TB and XDR TB

The tuberculosis bacteria are prone to develop drug resistance. Some patients do not respond to the first line of treatment and develop multi-drug resistant tuberculosis (MDR-TB). There are strains of bacteria resistant to most available drugs, causing a severe form of the disease known as extensively drug-resistant tuberculosis (XDR-TB).

Treatment options for MDR and XDR tuberculosis consist of higher dosing of the first line of drugs and a combination of other oral medicines and injections. The course of treatment is usually 18 months for MDR-TB and 24 months for XDR-TB.

Some common examples of medications include:

• Amikacin injections
• Streptomycin injections
• Levofloxacin preparations
• Moxifloxacin preparations
• Para-amino salicylic acid
• Clofazimine preparations
• Imipenem injections
• Clarithromycin preparations
• Bedaquiline

Supportive Care

This involves the use of medications aimed at improving symptoms such as fever, cough, and pain. Some common classes of drugs used for supportive care of TB include:

• Anti-fever and analgesic medicines to provide relief from fever and pain.
• Antitussive medications to help reduce cough.
• Vitamin B supplements given along with antitubercular medicines to help combat neurological side effects like nerve pain and neuropathies caused by antitubercular medicines.
• Antacids to prevent gastrointestinal symptoms.
• Medicines to reduce uric acid levels (hyperuricemia is known to be a side effect of TB medicines), such as allopurinol and febuxostat.
• In some cases, a herbal medicine/tonic for the liver is recommended, as antitubercular medicines can impact the liver.

With active tuberculosis, you can do the following things to care for yourself at home:

• Always use a handkerchief to cover your mouth and nose while sneezing or coughing.
• Wash your hands frequently with soap and water or use hand sanitizers.
• Take a balanced diet rich in vitamins and minerals.
• Drink plenty of fluids throughout the day.
• Take plenty of rest. Do not engage in any strenuous activities.
• Take the entire course of medicines prescribed by the doctor, even if your symptoms reduce or you start feeling better.

Most patients recover completely from tuberculosis. However, it may cause serious complications, especially in HIV patients and those who suffer from immunocompromised states. Leaving tuberculosis untreated may further lead to:

• Miliary tuberculosis or disseminated tuberculosis
• Pleural effusion, pneumothorax, empyema - an accumulation of fluids, air, or pus, respectively, in the lungs
• Acute respiratory distress syndrome or fluid build-up in the lungs
• Paraplegia or paralysis of the lower body due to tuberculosis of the spine
• Tuberculous arthritis of hips or knees
• Infertility in men and women due to tuberculosis of reproductive organs
• Seizures and growth retardation due to tuberculosis of the brain
• MDR TB and XDR TB

There is a limited role of alternative therapies in the treatment of tuberculosis.

Chest physiotherapy may assist in the removal of secretions from the lungs and improve lung function. It includes:

• Different types of breathing exercises.
• Postural drainage, which advises patients to sleep in various positions, such as on their back with their head down. These positions are believed to facilitate the removal of lung secretions through gravity.

Herbal preparations from medicinal plants, such as ginger, turmeric, and cinnamon, may provide symptomatic relief from cough.

Check out our Ayurveda page for detailed information about medicinal herbs.

Tuberculosis is a disease often associated with stigma due to various misconceptions surrounding it. However, with recent improvements in available treatments and public awareness campaigns, the stigma is declining, and more individuals are recovering completely from the disease. During the active phase of the disease, it is advisable to refrain from interacting with many people and to avoid crowded places to prevent transmission. Here are a few tips to keep in mind if you are on medications for tuberculosis:

• Maintain a routine by taking medications at the same time every day, marking off the date on a calendar, or using a weekly pill dispenser.
• Inform your doctor if you experience any unusual symptoms or side effects from the medications. Your doctor may consider changing the drugs.
• Complete your course of medications. Not finishing the course or stopping mid-way can increase the risk of getting sick and spreading the infection again, and can also make the bacteria resistant to the drugs.
• Follow cough etiquette by covering your mouth when sneezing or coughing and disposing of used tissues properly.
• Ask your doctor about improvements in your condition, changes in medications, necessary lab tests, and any questions you have related to your condition. This will help you understand your health better.
• Caregivers should avoid close contact with the patient. If possible, let the patient share a single room with proper ventilation.
• Eat a diet rich in nutrients such as vitamins, minerals, and antioxidants. Avoid oily, salty, and spicy foods. Opt for home-cooked meals to boost your immunity and stay healthy.

Psychosocial impact of TB

Although TB is common in India, many myths and stigma are still associated with the condition. Lack of support from family and community, as well as insufficient knowledge about the disease and its treatment, adversely affects the physical and mental state of the patient. The long duration of TB treatment and economic hardships can be exhausting, and a negative emotional state can increase the risk of mental health issues such as anxiety and depression, further impacting treatment.

This situation can be addressed through proper awareness about the disease among both the patient and the community. For example:

• Medicines free of cost are available for all TB patients at government hospitals.
• Latest guidelines, information, and programs about TB can be accessed through Nikshay Patrika, a quarterly newsletter by the Central Tuberculosis Division.
• DOTS treatment is free and helps prevent treatment failure and lowers the risk of MDR-TB by ensuring strict adherence and uninterrupted treatment.
• Unlike pulmonary TB, other forms of TB do not spread through close contact. Therefore, avoid excluding the patient from your social circle; instead, support them in fighting the disease.
• Reach out to NGOs and community support groups related to TB, which can provide physical, emotional, and financial support.