Tuberculosis, how is it spread? Symptoms and treatment


What is tuberculosis? It is mortal?

Tuberculosis is an infectious disease produced by an organism that shares the characteristics of a fungus and a bacterium, called Mycobacterium tuberculosis or Koch’s bacillus.

It is a micro-organism that passes very easily from one person to another through coughing, expectoration and even speech because, in these processes, small microcapsules called Pflügge drops are formed, in which said infectious agent.

Although the most common and historically relevant form is lung involvement, tuberculosis can affect other organs and systems, as well as spread throughout the body in rarer cases.

Who can it affect?

Contact with the microorganism Mycobacterium tuberculosis is very frequent in the first years of life. Usually, this contact does not mean disease, since our immune system immediately controls this agent, which, however, remains in the body, as a possible seed that will grow in the future if our immune defenses are lowered. This occurs in only 10% of people exposed to this bacillus.

Are there risk factors for tuberculosis? How is it spread?

As explained above, all the factors that affect a decrease in immunity are risk factors for tuberculosis. Specifically, we can mention the following:

  • HIV infection: at the present time, the development of the immunodeficiency associated with this pathology (AIDS) is the most important risk factor for suffering from tuberculosis.
  • Immunosuppressive treatments: the drugs used in pathologies such as hematic cancer (leukemias, lymphomas, among others), immunological diseases (corticosteroids) or rheumatology, create the basic situation for the “nests” of the Mycobacterium microorganism to hatch and produce the initial lung dissemination and, with it, tuberculosis disease.
  • Age: aging usually involves problems such as the decrease in the performance of our immunity, so advanced age can be considered a risk factor. At the opposite age extreme, children are also at higher risk.
  • Suffering from alcoholism, malnutrition or drug addiction: patients suffering from this type of problem are a population that can develop it more easily.
  • Conditions of overcrowding, poverty and malnutrition : they cause exposed people to suffer more exposure and a decrease in their immune function, with the consequent greater risk. This is still a very common situation in refugee camps or regions at war.

What are the symptoms of tuberculosis?

The most frequent expression of tuberculosis is pulmonary, although bone, genito-urinary or meningeal tuberculosis may also occur. Likewise, there is a form that is disseminated throughout the body.

Here we will focus on the symptoms of pulmonary tuberculosis, which develops in phases:

  1. Primary infection or first contact with Koch’s bacillus : it usually occurs without symptoms or produces a mild cold.
  2. Reactivation or post-primary tuberculosis : it can manifest itself more abruptly.

In both cases, the most common symptoms of pulmonary tuberculosis are:

  • Elevation of body temperature.
  • Productive cough that lasts more than 3 weeks.
  • Gradual weight loss : it can be independent or associated with a lack of appetite.
  • Increasing tiredness.

These last three signs can increase in intensity and generate cachectic symptoms (extreme malnutrition, fatigue, weakness) if the disease is not detected and treated properly.

It can also manifest:

  • High fever.
  • Chest pain: caused by pleural involvement (more common in young people).
  • Expulsion of blood with expectoration: this phenomenon is called hemoptysis, and from there comes the synonym or expression tísis, historically used to refer to tuberculosis.
  • On certain occasions, it can go practically unnoticed, with a fever or low-grade fever at night, or a feeling of chills and fatigue.

Therefore, tuberculosis is a diagnosis to consider in cases of unexplained fever or of unknown origin.

Diagnosis of tuberculosis

The diagnosis of pulmonary tuberculosis disease is based on demonstrating the presence of Mycobacterium or Koch’s bacilli in sputum, the secretion that is spit out of the mouth after expectoration, and a chest X-ray is also performed.

On the other hand, there is also a different skin test, called Mantoux, which tries to determine if the patient has been in contact with Mycobacterium tuberculosis.

It is also called PPD because it is practiced on the skin of the person, inoculating it with an inactive portion of the microorganism. If the patient has been in contact and has not lost immunity, the skin will show a significant reaction in the form of a red circle that must be measured.

If the size of this redness is greater than 5 mm, the test is considered positive and that the person has not only come into contact with the infectious agent but is still present in their lungs.

Treatment for tuberculosis? Does tuberculosis leave sequelae?

Both people with risk factors who present a positive Mantoux and those who have had their first contact with Mycobacterium tuberculosis less than 2 years ago, should follow a treatment that “eradicates” the infectious agent from their lungs, in order to avoid the future risk that it will wake up and develop the disease.

In the treatment to prevent tuberculosis, a single drug is usually used and in the antituberculous treatment the association of at least 3 drugs is necessary.

In both cases, these are therapies that are prolonged in time (more than 6 months) and that must be carried out rigorously and with maximum adherence, given the “elusive” nature of Mycobacterium.

In this sense, and as occurs with antibiotics, not adequately complying with the treatment or the premature abandonment of the medication contributes to the appearance of resistance.

Keys points to preventing tuberculosis

If you have risk factors for immunosuppression, consult your doctor to establish if you are at risk of suffering from tuberculosis and you should follow preventive therapy for the disease (prophylaxis).

  • Check if you have a fever regularly.

If you have a continuous fever or night sweats that cannot be explained by another cause, it is recommended that you undergo diagnostic tests that rule out possible tuberculosis, especially if you have risk factors.

  • See your doctor quickly if you cough up blood.

Cough with bloody expectoration should always and immediately be consulted with a doctor.

  • Take precautions to avoid catching it.

If you are going to travel to an area in conflict, to places where there are overcrowded conditions, to areas where there are many sick people or you are going to have to share closed spaces, previously establish your immune status with respect to tuberculosis.

In addition, you must follow the recommendations very well in terms of the use of masks and global protection. Upon returning to your country of origin, it is advisable to repeat the skin test (Mantoux) if the one you did before traveling was negative.

  • Protect the people around you.

If you suspect that you may have tuberculosis, your doctor will tell you to use a mask to avoid contagion from your relatives, people with whom you live or your environment in general.

Treatment of the disease can be done on an outpatient basis, but for 2 weeks or as long as the specialist indicates, you must respect isolation.

  • Faithfully follow medical treatment.

If the diagnosis has been confirmed and you have already started treatment for tuberculosis, it is essential that you follow the medical recommendations to the letter and do not forget or delay the established doses in the day.

Dr. Ashwani Kumar is highly skilled and experienced in treating major and minor general medicine diseases.