Tuberculosis (TB)

Certain factors raise the likelihood of contracting TB:

1. Environmental Exposure

• Living in or traveling to high-TB areas
• Spending time in crowded environments like hospitals, prisons, or shelters

2. Nutrition and Lifestyle

• Poor nutrition or undernourishment
• Smoking and heavy alcohol use weaken the immune response

3. Medical Conditions

• Chronic illnesses like diabetes
• Immunosuppressive medications or cancer treatments
• HIV infection significantly increases the risk of TB infection

To confirm a tuberculosis diagnosis, doctors rely on a combination of clinical evaluation and several diagnostic tests:

1. Blood Tests

• Cartridge-Based Nucleic Acid Amplification Test (CB-NAAT): This is a fast molecular test that detects the TB-causing bacteria and also checks for resistance to rifampicin, a key anti-TB drug.
• Interferon-Gamma Release Assay (IGRA): This test measures the immune system’s response to the TB bacteria and helps in identifying latent infection.
• Other Blood Work: Tests like complete blood count (CBC) and erythrocyte sedimentation rate (ESR) help gauge the body's overall response to infection.
• HIV 1 and 2 Antibody Test: Since TB and HIV often occur together, testing for HIV is standard practice when TB is suspected.

2. Sputum Examination

Samples of sputum are analyzed through tests such as the Acid-Fast Bacillus (AFB) stain, TB PCR (polymerase chain reaction), and Mycobacterium tuberculosis DNA testing. A positive result confirms the presence of TB bacteria in the sputum.

3. Mantoux (Skin Prick) Test

This test involves injecting a small amount of tuberculin under the skin. If a raised bump or swelling appears within 48–72 hours, it indicates exposure to TB. However, recent BCG vaccination can sometimes yield a false-positive result.

4. Imaging Tests

• Chest X-ray and HRCT (High-Resolution CT) Scan: These are used to identify lung damage or abnormalities typical of pulmonary TB.
• Spine X-ray and Brain MRI: Useful in detecting TB in other parts of the body such as the spine and brain.

To reduce the risk of TB infection and transmission, consider these preventive strategies:

• Vaccination: The BCG vaccine offers protection, particularly against severe TB forms in children.
• Good Ventilation: Proper airflow in homes and shared spaces helps dilute airborne TB bacteria.
• Mask Use: Wearing masks in high-risk settings protects both healthy individuals and prevents those with TB from spreading the bacteria.
• Hygiene Practices: Cover your mouth when coughing or sneezing, and dispose of used tissues properly.
• Avoid Close Contact: Steer clear of extended time in enclosed areas with someone who has active TB.
• Boost Immunity: Maintain a nutritious diet, avoid tobacco and alcohol, and manage chronic conditions like diabetes.

Timely diagnosis and complete treatment are crucial to stopping the spread of tuberculosis.

Specialists to Consult

If symptoms such as a long-lasting cough, blood in sputum, fever, or unexplained weight loss are present, immediate medical attention is needed. Doctors who specialize in diagnosing and managing TB include:

• General Physician: First point of contact for identifying TB symptoms and referring for advanced care.
• Chest Physician: Manages complications related to lung involvement.
• Infectious Disease Specialist: Experienced in handling complex and drug-resistant TB cases.
• Pulmonologist: Specializes in respiratory system disorders and is key to treating pulmonary TB.

Treatment protocols vary depending on the form of TB infection:

For Latent TB

In India, preventive treatment is usually advised only for individuals at higher risk. The medication course generally spans 6 to 9 months and should be taken strictly under a doctor’s guidance.

For Active TB

Active TB is treated using a combination of antibiotics that kill or inhibit the growth of the bacteria. The initial treatment phase usually includes five drugs:

• Streptomycin
• Isoniazid
• Rifampicin
• Pyrazinamide
• Ethambutol

These medications are often combined into user-friendly kits for ease of adherence.

The treatment duration is typically 6–8 months, even if symptoms improve early, to ensure complete cure and prevent resistance.

India follows the DOTS (Directly Observed Treatment, Short Course) program, where a health worker supervises medicine intake to ensure adherence.

For MDR and XDR TB

Drug-resistant TB requires a longer and more intensive treatment.

• MDR-TB: Treated over 18 months
• XDR-TB: May need 24 months or more

Drugs used include:

• Amikacin and Streptomycin (injectables)
• Levofloxacin and Moxifloxacin
• Para-aminosalicylic acid
• Clofazimine
• Imipenem
• Clarithromycin
• Bedaquiline

Supportive Treatment

• Pain and Fever Management: Paracetamol is commonly used.
• Cough Relief: Dextromethorphan hydrobromide helps suppress persistent cough.
• Nerve Protection: Vitamin B supplements help prevent nerve-related side effects of TB drugs.
• Digestive Support: Omeprazole is used to manage gastric irritation from medications.
• Uric Acid Control: Allopurinol and Febuxostat may be prescribed if TB medications cause elevated uric acid levels.

Complete adherence to treatment and regular follow-ups are key to successful recovery and preventing relapse or resistance.

While most individuals recover fully with proper treatment, tuberculosis can cause serious complications, particularly in those with HIV or weakened immune systems. If untreated, TB can result in:

• Miliary or disseminated TB: Where the infection spreads throughout the body, impacting multiple organs.
• Lung complications: Such as pleural effusion, pneumothorax (air accumulation), or empyema (pus buildup).
• Acute respiratory distress syndrome (ARDS): Severe fluid accumulation in the lungs.
• Spinal TB: May lead to paraplegia or loss of function in the lower limbs.
• Joint involvement: TB can cause arthritis in large joints like the hips or knees.
• Reproductive complications: TB of reproductive organs may lead to infertility in both men and women.
• Neurological issues: Such as seizures or developmental delays in cases of TB affecting the brain.
• Drug-resistant TB: Including MDR-TB and XDR-TB, which are more difficult to treat.

Alternative treatments have limited roles in managing TB and should not replace standard medical therapy. One supportive approach is:

Chest physiotherapy:

This technique aims to clear lung secretions and enhance respiratory efficiency. It includes breathing exercises and postural drainage—patients may be advised to lie in specific positions (such as with the head lowered) to help facilitate mucus drainage with gravity.

Important: These therapies are only complementary to conventional TB treatment. More scientific evidence is needed to establish their effectiveness.

While herbal remedies may help ease coughing—a frequent symptom of TB—they are not a substitute for prescribed medication. It's vital to adhere to your treatment plan. Some supportive home remedies include:

• Ginger (Adrak): Known for its anti-inflammatory and antioxidant effects, ginger can help calm the throat and reduce coughing.
• Turmeric (Haldi): Contains curcumin, a compound with antibacterial and anti-inflammatory properties that can help soothe respiratory discomfort.
• Cinnamon (Dalchini): Contains compounds that may relax airways, reduce inflammation, and alleviate cough symptoms.

Additional self-care tips for managing TB at home:

• Always cover your mouth and nose with a cloth or tissue when coughing or sneezing.
• Frequently wash your hands with soap and water or use hand sanitizer.
• Follow a nutritious diet that provides essential vitamins and minerals.
• Stay well hydrated throughout the day.
• Get adequate rest and avoid physically demanding activities.
• Complete the entire medication course as prescribed, even if you begin to feel better.

TB continues to carry social stigma due to misinformation. However, increasing awareness and improved treatments have helped reduce stigma and support recovery. If you’re undergoing treatment for TB, consider the following tips:

• Stick to a routine: Take your medications at the same time daily. Use a calendar or pill organizer to help you stay consistent.
• Monitor for side effects: If new symptoms arise, inform your doctor. Adjustments to the treatment plan might be needed.
• Finish your medication course: Discontinuing medicines prematurely can lead to relapse or drug-resistant TB.
• Seek support: Government hospitals provide TB medications free of charge.