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Guide Health: Tuberculosis — not just an old disease!

There are two categories of tuberculosis, latent and active

Tuberculosis has been infecting people for thousands of years. Peruvian remains that are 6,000 years old have shown evidence of this illness, and it has even been found in Egyptian mummies.

The prevalence of the infection peaked during the 18th and 19th centuries, but recently we have seen a resurgence.

Tuberculosis is caused by an infection known as mycobacterium tuberculosis which infects the lungs. It is spread through coughing, i.e. droplet spray, but it does not spread as easily as the common cold or influenza, and it does not spread via contaminated surfaces or objects.

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You need to inhale the droplets that an infected person has coughed out, and you need a lengthy exposure, for instance living in the same home with repeated exposure.

There are two categories of tuberculosis, latent and active. With latent tuberculosis you do have the bacteria in your body, but your chest X-ray will be normal and you will feel fine. At this point you won’t have any signs of tuberculosis in your sputum and you are not contagious.

About 10 per cent of people with latent tuberculosis will go on to develop active tuberculosis, and because there is no way to know who these people are, everyone who tests positive for the tuberculosis bacteria is treated.

With active tuberculosis, the infection is active and all diagnostic tests will be positive, including chest X-ray and sputum. You are certainly contagious and will have symptoms such as coughing, chest pain, unexplained weight loss, and fatigue.

At one time, tuberculosis was not curable, but now there are effective drugs. The one drawback is that treatment takes months, not days, and you need to remember to take all of the doses. If left untreated, tuberculosis can spread to other areas of the body such as kidneys, spine, or even the brain.

Some people are more at risk for tuberculosis, for example younger children and babies who do not have a fully developed immune system, and people who have compromised immune systems or who take drugs that can adversely affect their immune systems. If you have other diseases like diabetes, kidney disease, lung disease or cancer, or if you are an organ transplant patient, you also have a greater risk.

A risk factor that can be modified is living in the crowded spaces that make the spread much easier. Nursing homes are examples, and people who live in crowded shelters can be at higher risk, along with caregivers and staff at these institutions.

At one time, tuberculosis was known as consumption and it was treated by admitting the patient to a sanatorium where the emphasis was on fresh air, which certainly worked to reduce the spread of the infection.

Tuberculosis is a tough infection to treat. A combination of drugs is needed in order to prevent the development of resistance and to enable using lower doses with fewer adverse effects.

Treatment usually requires six months and doses shouldn’t be missed. Usually, health departments monitor treatment and follow up with patient contacts. The idea is that an infected person needs to be treated, but so do any contacts they may have had in order to curtail the infection’s spread.

In 1943, the first drug for tuberculosis, streptomycin, was discovered. Today, there are many more effective drugs. The most common include isoniazid, rifampin or one of its related drugs, pyrazinamide, ethambutol, moxifloxacin and other fluroquinolones.

Vitamin B6 is often given along with isoniazid in order to prevent nervous system adverse effects. Dosing can be daily, five times a week, three times a week, twice a week, or even once a week depending upon whether the infection is latent or active and the recommended drug regime.

It is estimated that a third of the world’s population have the tuberculosis bacteria in their body, and while some show symptoms, others do not. You may have thought it was an old disease, but it is still around. And with world travel, it’s sure to be for some time!

About the author

Contributor

Marie Berry is a lawyer/pharmacist interested in health and education.

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