Often simply called TB, tuberculosis also used to be called “consumption” and you are probably familiar with the symptoms from movies and books. These symptoms include a long-lasting cough, chest pain, coughing up blood, and weakness.
In 1926, health reports cited tuberculosis as the cause of one out of every 13 deaths. Historically, it was a common disease affecting both famous and regular people equally. Robert Browning, John Keats, King Henry VII of England, and Florence Nightingale were reputed to have had tuberculosis. More recently, individuals like Vivian Leigh, Tom Jones, and Ringo Starr were affected in their youth.
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Today, the risk of contracting tuberculosis is small, thanks to various medications and less congested living conditions with improved sanitation. However, about 1,600 new cases are reported in Canada each year, with the highest incidence of tuberculosis among 25- to 44-year-old people, and First Nations and Inuit having the greatest risk.
Women seem to account for most cases until the older ages are reached when men seem to have an increased incidence. Perhaps these trends arise from women being in the home more often and potentially in contact with others with tuberculosis. Then, as men age, they have more medical conditions that impact their health.
Tuberculosis is an infection caused by a bacteria known as Mycobacterium tuberculosis. It affects the lungs most commonly since this is the site where the bacteria are usually first breathed in. However, the bacteria can spread to the kidney, spine, and brain. If not treated, the infection can result in death, so early diagnosis and treatment is key.
The disease is transmitted by droplets spread by an infected person when they exhale. An uninfected person breathes these droplets into their lungs, and when the bacteria from the droplets begin multiplying in their lungs, the new person becomes infected. Some people, when they are exposed to the bacteria, do not become infected, a phenomenon termed “latent tuberculosis.” Their body is able to stop the bacteria from multiplying so the bacteria become inactive, although they are still alive and may be active later. It is for this reason, that anyone who comes into contact with an infected person needs to be treated.
About 10 per cent of people who are infected will develop tuberculosis some time during their lives, and the chances are the greatest during the first two years after exposure. Thus, after exposure, you don’t know if or when you might develop the disease, but a healthy immune system seems to be key.
If you already have an immune system that is not healthy, then exposure to tuberculosis increases the risk for the disease. Babies and young children may not have fully developed immune systems. Diseases that affect the immune system such as HIV infections or cancer, and even diseases like diabetes can increase your risk.
Any drugs that impair the immune system can add to the risk, for example anti-rejection drugs for organ transplants, rheumatoid arthritis drugs, and drugs of abuse. Heavy cigarette smoking, low birth weight, and malnutrition may also weaken the immune system and thus raise the risk.
Tuberculosis is not spread as easily as the common cold or flu, but it is the same type of spread, i.e. droplet spread. While the common cold or flu can be spread through contaminated surfaces such as doorknobs or handshaking, tuberculosis is not. However, if you spend several hours with an infected person, you are likely to breathe in contaminated droplets, and if you are sharing a crowded home, your chances increase. Families sharing cramped living spaces, nursing home residents, prison inmates, and health-care professionals working with people with tuberculosis are at greatest risk. People with a low socio-economic status also seem to have a greater risk, perhaps because of crowded living quarters, homelessness, or maybe even inadequate treatment.
Today, antibiotics are the cornerstone of tuberculosis treatment and are used both for anyone who has come into contact with the disease or actually has the disease. A six- to nine-month course of treatment is needed, and if it is not completed, the infection may remain, with the bacteria becoming resistant to the antibiotics.
Tuberculosis treatment is one prescription where you want to follow the instructions carefully and finish all your antibiotics.
Marie Berry is a lawyer/pharmacist interested in health and education.
