Tuberculosis is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacteria tuberculosis. One third of the world’s population is thought to have been infected with M. tuberculosis with new infections occurring at a rate of about one per second. In 2007, there were an estimated 13.7 million chronic active cases globally, while in 2010, there were an estimated 8.8 million new cases and 1.5 million associated deaths, mostly occurring in developing countries. The distribution of tuberculosis is not uniform across the globe; about 80% of the population in many Asian and African countries test positive in tuberculin tests, while only 5–10% of the United States population tests positive. The main symptoms of variants and stages of tuberculosis are given, with many symptoms overlapping with other variants, while others are more (but not entirely) specific for certain variants. Multiple variants may be present simultaneously.
About 5–10% of those without HIV, infected with tuberculosis, develop active disease during their lifetimes. In contrast, 30% of those coinfected with HIV develop active disease. Tuberculosis may infect any part of the body, but most commonly occurs in the lungs (known as pulmonary tuberculosis). Who can develop Tuberculosis disease? Persons most likely to develop TB disease are those who have recently become infected with TB through someone with whom they live or have close contact. TB disease usually develops within the first two years after getting infected with TB. After the two years is over, the risk of developing TB disease decreases.
However, it may still be possible to develop TB disease if the immune system is weakened by another medical condition, drug abuse, malnutrition or old age. Persons with TB disease who have taken the correct TB medications for a specified period of time do not continue spreading TB to others. TB bacteria do not spread by kissing or sharing drinking glasses, dishes, or other objects. TB bacteria must be inhaled in order for infection to occur. TB spreads through the air. When a person with contagious TB coughs, laughs, sings, etc., the TB bacteria are released into the air. These TB bacteria can remain in the air for many hours. Anyone who breathes this air that contains TB bacteria may become infected.
What are the symptoms of contagious TB disease? The most common symptom of contagious TB disease is a cough that lasts for more than a three weeks, sometimes producing mucous and/or blood. Other symptoms may include fatigue, loss of appetite, weight loss, fever, and night sweats. Chest pain may also occur. For TB disease outside the lungs, the symptoms vary by where in the body the disease occurs. People can have TB disease without having any symptoms. Most people infected with the germ that causes TB never develop active TB. If active TB does develop, it can occur two to three months after infection or years later. The risk of active disease lessens as time passes. When and for how long is a person able to spread tuberculosis? A person with TB disease may remain contagious until he/she has been on appropriate treatment for several weeks. However, a person with latent TB infection, but not disease, cannot spread the infection to others, since there are no TB germs in the sputum.
What is the treatment for tuberculosis? People with latent TB infection should be evaluated for a course of preventive therapy, which usually includes taking antituberculosis medication for several months. People with active TB disease must complete a course of treatment for six months or more. Initial treatment includes at least four anti-TB drugs, and medications may be altered based on laboratory test results. The exact medication plan must be determined by a physician. Directly observed therapy (DOT) programs recommend all TB patients to help them complete their therapy. For patients with disease due to drug resistant organisms, expert consultation from a specialist in treating drug resistant TB should be obtained.
Patients with drug resistant disease should be treated with drugs to which their organisms are susceptible. The effectiveness of treatment for latent infection with MDR-TB is uncertain. What can be done to prevent the spread of MDR-TB? Ensuring people with MDR-TB take all their medication and teaching patients to cover their mouth and nose when coughing and sneezing can reduce the risk of spread of MDR-TB. The usual regimen for TLTBI is isoniazid given daily for 9 months for all patients. Patients should be clinically evaluated every month for signs of hepatitis and other adverse reactions to isoniazid. They should also be educated about the symptoms caused by adverse reactions to isoniazid and instructed to seek medical attention immediately if these symptoms occur. In addition, people at greatest risk for hepatitis should have liver function tests before starting isoniazid. Four months of rifampin is an acceptable alternative regimen for TLTBI.
All patients being treated for TB disease should be educated about the symptoms caused by adverse reactions to the drugs they are taking and instructed to seek medical attention immediately if they have symptoms of a serious side effect. Patients should be seen by a clinician at least monthly during treatment and evaluated for possible adverse reactions. In addition, before starting treatment, patients may have baseline tests to help clinicians detect any abnormalities that may complicate treatment. Symptoms do not improve during the first 2 months of treatment, Symptoms worsen after improving initially, Culture results have not become negative after 2 months of treatment, Culture results become positive after being negative.
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Topic: Tuberculosis: Infectious Disease and Tb Patients
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