Tuberculosis (TB): symptoms, vaccination, contagious, test

Tuberculosis symptoms include persistent cough (with blood), shortness of breath and fever. Tuberculosis (TB) is a bacterial infectious disease that is often caused by Mycobacterium tuberculosis, which in many cases affects the lungs. TB is an ancient disease, researchers have already discovered traces of it in Egyptian mummies. Tuberculosis can be cured. The treatment takes place with a mix of antibiotics and takes a long time. It is becoming increasingly common for the TB bacteria to be resistant (insensitive) to one or more anti-tuberculosis drugs. There is a vaccine against TB, which is given to people who regularly or for a long period of time go to a country where TB is common.

  • What is tuberculosis (TB)?
  • TB: killer number 2
  • Very fatal infectious disease
  • Multidrug-resistant TB
  • TB mortality rate is decreasing
  • Cause of TB
  • Risk factors
  • Weakened immune system
  • Traveling to or living in certain areas
  • Lack of medical care
  • Drug use and smoking
  • Working in healthcare
  • Living or working in a residential (care) institution
  • Stay in a refugee camp
  • TB contagious
  • Two forms of TB
  • Infection does not always lead to symptoms
  • Latent and open TB
  • What are the signs and symptoms of TB?
  • Symptoms are very diverse
  • Incubation period and contamination
  • Complications
  • Diagnosis and test
  • Treatment of TB
  • Prevention
  • Is there a vaccine against tuberculosis?

 

Occurrence of TB worldwide / Source: OMS-WHO, Wikimedia Commons (CC BY-SA-3.0)

What is tuberculosis (TB)?

Tuberculosis (TB) is caused by the bacterium mycobacterium tuberculosis and is a potentially serious infectious disease that mainly affects the lungs. The bacteria that cause tuberculosis are spread from one person to another by tiny droplets of mucus released into the air through coughing and sneezing. The bacteria can move through the body through the blood and lymphatic vessels, affecting various organs. TB usually occurs in the lungs.

TB: killer number 2

Very fatal infectious disease

Tuberculosis (TB) is the most fatal infectious disease worldwide after HIV/AIDS. Every year, just under nine million people contract TB and this disease claims more than 1.7 million lives every year. More than 95% of TB deaths occur in low-income and middle-income countries and it is among the top three causes of death among women aged 15 to 44.
In 2009, there were approximately 10 million orphans due to TB deaths among parents.
TB is the biggest cause of death for people with HIV. TB and HIV is a deadly combination and can be the death blow to AIDS patients. Without treatment, the TB-HIV combination is fatal within a few months.

Multidrug-resistant TB

Multidrug-resistant tuberculosis (MDR-TB) is present in almost all countries surveyed and is a serious threat to public health. According to the latest data, almost half a million people worldwide develop multidrug-resistant tuberculosis every year. In MDR-TB, the pathogen Mycobacterium tuberculosis is resistant to the two most powerful anti-TB drugs.

TB mortality rate is decreasing

The number of people with tuberculosis is steadily decreasing every year. The TB mortality rate fell by 40% between 1990 and 2010. Yet, aided by the AIDS epidemic, TB is increasing in several regions of the world. In regions where HIV is widespread, the number of people with TB has tripled over the past 15 years. TB is no longer very common in the Netherlands. Approximately 1,100 people are diagnosed here every year in the country.

Cause of TB

Tuberculosis is a bacterial infectious disease that is often caused by Mycobacterium tuberculosis , which in many cases affects the lungs. This tuberculosis bacterium moves in the body via the blood and lymphatic vessels and an infection with this culprit can cause serious inflammation. The most common form of TB is pulmonary tuberculosis, but kidney, joint and gland tuberculosis or tuberculosis in other organs also occur.

Risk factors

Anyone can get tuberculosis, but certain factors can increase your risk of developing the disease. These factors are:

Weakened immune system

A healthy immune system often fights the bacterium mycobacterium tuberculosis, but your body fails if your resistance is low. A number of diseases and medications can weaken your immune system, including:

  • HIV/AIDS;
  • diabetes;
  • severe kidney disease;
  • certain cancers;
  • cancer treatment, such as chemotherapy;
  • medicines to prevent rejection of transplanted organs;
  • some medications used to treat rheumatoid arthritis, Crohn’s disease and psoriasis;
  • malnutrition;
  • very young age or advanced age.

 

Traveling to or living in certain areas

The risk of contracting tuberculosis is greater for people who live in or travel to countries with high rates of (multidrug-resistant tuberculosis) TB, including Africa, Eastern Europe, Asia, Russia, Latin America and the Caribbean Islands.

Lack of medical care

Lack of adequate medical care is a risk factor.

Drug use and smoking

Excessive drug or alcohol consumption weakens your immune system and makes you more vulnerable to tuberculosis. Smoking also increases the risk of developing TB.

Working in healthcare

Regular contact with sick people increases the risk of exposure to bacteria that cause TB. Wearing a mask and washing your hands often significantly reduces the risk of this.

Living or working in a residential (care) institution

People who live or work in overcrowded prisons, refugee shelters, or nursing homes all have a higher risk of tuberculosis. This is because the risk of TB is higher when there is overcrowding and poor ventilation.

Stay in a refugee camp

Refugees who stay in a (makeshift) refugee camp are more likely to develop TB due to poor nutrition and poor health and from living in overcrowded, unsanitary conditions.

TB contagious

Two forms of TB

Two forms of TB are distinguished: ‘closed’ and ‘open’ pulmonary tuberculosis. The closed form is not contagious, but open tuberculosis certainly is. TB is spread from person to person through the air. When people with open TB cough or sneeze, bacteria can be released and inhaled through the air by someone else.

Infection does not always lead to symptoms

About 1 in 3 people become infected with TB, but only 1 in 10 develop the disease. People who are healthy in body and mind have an immune system that is usually strong enough to keep the pathogen at bay. But in the case of a weakened immune system, TB can still manifest itself years later. The chance of this is about 10%. Especially if someone has the HIV virus, the chance is twenty times greater that he or she will develop TB. People who structurally do not consume enough nutrients, have diabetes or smoke, also have a much higher risk of becoming ill.

Latent and open TB

The TB bacteria can remain latent in the body after infection for a very long time, sometimes for a lifetime. Under conditions that are favorable to them, these ‘dormant’ TB bacteria can divide again and cause disease. For this reason, two types of TB are distinguished:

  • Latent TB. In this condition, you have a TB infection, but the bacteria remain in your body in an inactive state and do not cause any symptoms. Latent TB, also called inactive TB, is not contagious. It can turn into active TB, so treatment is important for the person with latent TB to contain further spread of TB.
  • Active TB. This condition makes you sick and can spread to others. It can occur in the first few weeks after infection with the bacteria, or it can occur years later.

These forms are also known as ‘closed’ and ‘open’ pulmonary tuberculosis.

Fatigue / Source: Istock.com/BartekSzewczyk

What are the signs and symptoms of TB?

Symptoms are very diverse

The symptoms of TB are very diverse and can include:

  • persistent cough (sometimes with blood);
  • shortness of breath;
  • fever;
  • chestpain;
  • sweating during sleep (night sweats);
  • decreased appetite and weight loss;
  • non-painful, swollen lymph nodes in the neck;
  • fatigue;
  • drumstick fingers in lung tuberculosis.

 

Incubation period and contamination

All these symptoms may indicate TB. The incubation period can be months or even years, depending on resistance. Someone with these complaints should report to their GP as soon as possible. Because a person can suffer from mild symptoms for months, this can lead to a delay in a patient seeking medical help, resulting in the bacteria being passed on to others in the meantime. People with open TB can infect about 10-15 other people through close contact over the course of a year. After three to four weeks of taking the medication, a patient can no longer infect others.

Complications

Without treatment, tuberculosis can be fatal. Untreated open TB often affects the lungs, but can also spread to other parts of your body through your bloodstream. Examples of complications of TB include:

  • Backache. Back pain and stiffness are often complications of tuberculosis.
  • Damage to the joints. Tuberculosis arthritis most often affects the hips and knees.
  • Swelling of the membranes covering your brain (meningitis). This can lead to a persistent or intermittent headache that lasts for weeks. Mental changes are also possible.
  • Liver or kidney problems. Your liver and kidneys filter waste and impurities from your bloodstream. These functions are affected when the liver or kidneys are affected by tuberculosis.
  • Cardiac tamponade. This is a rare life-threatening complication involving accumulation of fluid, blood, clots or gas in the pericardial space. This condition can be fatal.

 

CT scan / Source: IStock.com/Pavel Losevsky

Diagnosis and test

If TB is suspected, the diagnosis can be made on the basis of a Mantoux test and an X-ray and a CT scan to assess the damage to the lungs. If the Mantoux test shows that the body has produced antibodies against the bacteria (as can be seen by a reaction in the form of a bump at the injection site), it must still be tested whether the person actually has TB. The disadvantage of the Mantoux test is that the result can be influenced by several factors and that it can only be performed once (a second time the test is unreliable). In a
patient who coughs up phlegm, a sample of the coughed up sputum is taken in the laboratory examined for bacteria and tested for sensitivity to certain medications. If it turns out that someone has open tuberculosis, the people with whom he has regular contact will also have to be examined. After all, he may have infected them.

Treatment of TB

The treatment of tuberculosis consists of a combination of medications (antibiotics) to prevent the bacteria from becoming resistant. The drug course is long and intensive. The patient must also observe good ‘cough hygiene’, especially in the case of open tuberculosis. This means that he must sneeze or cough into a handkerchief or with his elbow in front of his mouth. This is to prevent the bacteria from spreading.
Most people are completely cured of TB with the right medication. If the bacteria are resistant to two or more medications (which is rare in the Netherlands), the disease can be fatal. TB can also have a bad outcome if the patient’s immune system is seriously weakened or if tuberculosis has spread widely.

Prevention

Infection with the TB bacteria occurs through coughing and sneezing. You can therefore possibly prevent infection by avoiding people who cough heavily. Also avoid poorly ventilated, dark and small spaces where there are many people.

Vaccination / Source: Production Perig/Shutterstock.com

Is there a vaccine against tuberculosis?

There is a vaccine against TB, but it is only given to people who regularly or for long periods of time go to a country where TB is common. A possible side effect is lymph node swelling. The vaccine leaves a scar. Normally someone is protected for life after vaccination. The vaccine does not protect against all forms of TB.

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