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Tuberculosis: Treatment, symptoms, advice and help

About tuberculosis

Tuberculosis is an important chronic infectious disease in the world caused usually by Mycobacterium tuberculosis in humans. It usually affects the lungs but may also affect the other parts of the body.

Tuberculosis: Incidence, age, and sex

An estimated 1 to 2 billion people worldwide, are infected with the tubercle bacillus and 1 to 3 million deaths from tuberculosis occur annually mostly in the developing countries. About 80% of the population in many Asian and African countries test positive on tuberculin tests, while only 5-10% of the US population test positive.

Signs & symptoms of tuberculosis: Diagnosis

Most infections in humans result in an asymptomatic, latent infection, and about one in ten latent infections eventually progresses to active disease. When the disease becomes active, 75% of the cases are TB in the lungs which cause chest pain, blood in the sputum and a productive, prolonged cough for more than three weeks. Constitutional symptoms include fever, chills, night sweats, appetite loss, weight loss, pallor, and often a tendency to tire very easily.

In the other 25% of active cases, the infection moves from the lungs, causing other kinds of TB, collectively denoted extrapulmonary tuberculosis described further under complications.

The diagnosis of tuberculosis disease is confirmed if M. tuberculosis is isolated from any body site or if the clinical, radiographic, or histological findings are consistent with tuberculosis and at least two of the following criteria are met: (a) a 5-TU Mantoux test yields more than 5mm of induration, (b) other disease entities are ruled out and the subsequent clinical course and response to therapy are consistent with tuberculosis, and (c) an adult source case with contagious tuberculosis is discovered.

Causes and prevention of tuberculosis

The major agents of human tuberculosis are Mycobacterium tuberculosis and Mycobacterium bovis. M. tuberculosis is transmitted from persons to person, usually by droplets of mucus that become airborne when an infected person coughs, sneezes, laughs or sings. Primary prevention, such as vaccination, is designed to prevent the establishment of tuberculosis infection. Secondary prevention, such as isoniazid therapy, aims at preventing the development of active disease after infection has occurred.

Tuberculosis: Complications

Central Nervous System - Tuberculosis involvement of the central nervous system (CNS) is the most serious complication of tuberculosis in children. Tuberculosis meningitis, fever, headache, irritability, drowsiness, and malaise. Coma, irregular pulse or respirations, hypertension, hemiplegic or paraplegia, decerebrate posturing, and eventually death.

Skeletal tuberculosis - The most commonly affected bones are the vertebrae causing destruction and collapse. Paraspinal abscess, psoas abscess, or retriopharyngeal abscess may develop from the bone lesion.

Abdominal and gastrointestinal tuberculosis - The most commonly affected regions are the jejunum and ileum. Shallow ulcers are the most common lesions. Symptoms include pain, diarrhea or constipation, and weight loss. Generalized peritonitis may occur as a result of hematogenous dissemination.

Renal tuberculosis causes haematuria, dysuria, or vague flank pain and hydronephrosis if ureteral stricture is present.

Tuberculosis: Treatment

A variety of chemotherapeutic agents are available for treating patients with tuberculosis. The first-line drugs, which include isoniazid, rifampin, pyrazinamide, ethambutol, and streptomycin are most often used for initial treatment. The second-line drugs, including paraaminosalicylic acid, ethionamide, capreomycin, kanamycin, fluoroquinolones (ciprofloxacin and ofloxacin), and cycloserine, are used when drug resistance or intolerance is encountered.

Corticosteroids aid patients with tuberculosis meningitis endobronchial disease military disease with alveolar-capillary block, pericarditis, peritonitis, and pleural effusion.