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'''For the WikiDoc page for this topic, click [[Tuberculosis|here]]''' | '''For the WikiDoc page for this topic, click [[Tuberculosis|here]]''' | ||
{{Tuberculosis (patient information)}} | {{Tuberculosis (patient information)}} | ||
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==Overview== | ==Overview== | ||
[[Tuberculosis]] ([[TB]]) is a [[bacterial infection]] that kills 1.8 million people worldwide. Approximately 10.4 million people in the world are infected with TB. Active [[tuberculosis]] kills 60% of the time if not treated, but treatment cures 90% of patients. In year 2015, the total no of cases reported with Tb in USA were approximately 9,421. Most people who are [[infected]] with [[TB]] have latent [[TB]]. This means that the [[bacteria]] is controlled by the body's [[immune system]]. People with latent [[TB]] do not have [[symptoms]] and cannot transmit [[TB]] to other people. According to WHO, about 3 million lives are saved globally in the year 2015 by treating Tb. | [[Tuberculosis]] ([[TB]]) is a [[bacterial infection]] that kills 1.8 million people worldwide. Approximately 10.4 million people in the world are infected with TB. Active [[tuberculosis]] kills 60% of the time if not treated, but treatment cures 90% of patients. In year 2015, the total no of cases reported with Tb in USA were approximately 9,421. Most people who are [[infected]] with [[TB]] have latent [[TB]]. This means that the [[bacteria]] is controlled by the body's [[immune system]]. Also, most of these TB cases skew strongly toward men, but when looking at impact of disease on women, it also remains among among a top killer for them in the world as well{{Cite web|Tuberculosis=https://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-asia-pacific-2020_f494a701-en}}. People with latent [[TB]] do not have [[symptoms]] and cannot transmit [[TB]] to other people. According to WHO, about 3 million lives are saved globally in the year 2015 by treating Tb. | ||
==What are the Symptoms of Tuberculosis?== | ==What are the Symptoms of Tuberculosis?== | ||
Latent [[TB]] is held in the [[alveoli]] of the [[lungs]]. As active [[TB]] develops, the [[bacteria]] spread out from the [[alveoli]] to the [[lungs]] and then to other [[organ systems]]. As a result, depending on which [[organ system]] is affected, the [[symptoms]] may be different. The primary stage of [[TB]] usually doesn't cause [[symptoms]]. When [[symptoms]] of [[pulmonary]] [[TB]] occur, they may include:<ref name=CDC>{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm }}</ref> | Latent [[TB]] is held in the [[alveoli]] of the [[lungs]]. As active [[TB]] develops, the [[bacteria]] spread out from the [[alveoli]] to the [[lungs]] and then to other [[organ systems]]. As a result, depending on which [[organ system]] is affected, the [[symptoms]] may be different. The primary stage of [[TB]] usually doesn't cause [[symptoms]]. When [[symptoms]] of [[pulmonary]] [[TB]] occur, they may include:<ref name="CDC">{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm }}</ref> | ||
* [[Cough]] | |||
* [[Night sweats]] | *[[Cough]] | ||
* [[Coughing]] up blood | *[[Night sweats]] | ||
* Excessive [[sweating]], especially at night | *[[Coughing]] up blood | ||
* [[Fatigue]] | *Excessive [[sweating]], especially at night | ||
* [[Fever]] | *[[Fatigue]] | ||
* Unintentional [[weight loss]] | *[[Fever]] | ||
* [[Shortness of breath]] | *Unintentional [[weight loss]] | ||
* [[Chest pain]] | *[[Shortness of breath]] | ||
* [[Wheezing]] | *[[Chest pain]] | ||
*[[Wheezing]] | |||
[[Symptoms]] of [[TB]] disease in other parts of the body will depend on the affected area. | [[Symptoms]] of [[TB]] disease in other parts of the body will depend on the affected area. | ||
==What Causes Tuberculosis?== | ==What Causes Tuberculosis?== | ||
[[Pulmonary tuberculosis]] ([[TB]]) is caused by the [[bacterium]] [[Mycobacterium tuberculosis]]. The [[bacteria]] usually damages the [[lungs]] but [[TB]] bacteria can damage any part of the body such as the [[kidney]], [[spine]], and [[brain]]. If not treated properly, TB disease can be fatal.<ref name=CDC>{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/topic/basics/default.htm }}</ref> | [[Pulmonary tuberculosis]] ([[TB]]) is caused by the [[bacterium]] [[Mycobacterium tuberculosis]]. The [[bacteria]] usually damages the [[lungs]] but [[TB]] bacteria can damage any part of the body such as the [[kidney]], [[spine]], and [[brain]]. If not treated properly, TB disease can be fatal.<ref name="CDC">{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/topic/basics/default.htm }}</ref> | ||
===Multidrug-Resistant Tuberculosis=== | ===Multidrug-Resistant Tuberculosis=== | ||
[[Multi-drug-resistant tuberculosis]] is caused by the [[bacterium]] [[Mycobacterium tuberculosis]] resistant to anti-[[TB]] drugs. This [[drug resistance|resistance]] can occur when drugs are misused or mismanaged:<ref name=CDC>{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm }}</ref> | [[Multi-drug-resistant tuberculosis]] is caused by the [[bacterium]] [[Mycobacterium tuberculosis]] resistant to anti-[[TB]] drugs. This [[drug resistance|resistance]] can occur when drugs are misused or mismanaged:<ref name="CDC">{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm }}</ref> | ||
* When patients do not complete their full course of treatment | |||
* When health-care providers prescribe the wrong treatment, the wrong [[dose]], or length of time for taking the [[drugs]] | *When patients do not complete their full course of treatment | ||
* When the supply of [[drugs]] is not always available | *When health-care providers prescribe the wrong treatment, the wrong [[dose]], or length of time for taking the [[drugs]] | ||
* When the [[drugs]] are of poor quality | *When the supply of [[drugs]] is not always available | ||
*When the [[drugs]] are of poor quality | |||
==Who is at Highest Risk?== | ==Who is at Highest Risk?== | ||
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The following people are at higher risk for active [[TB]]: | The following people are at higher risk for active [[TB]]: | ||
* Elderly | |||
* Infants | *Elderly | ||
* People with weakened [[immune system]]s ([[AIDS]], [[chemotherapy]], [[diabetes]], or certain medications) | *Infants | ||
*People with weakened [[immune system]]s ([[AIDS]], [[chemotherapy]], [[diabetes]], or certain medications) | |||
Your risk of contracting [[TB]] increases if you: | Your risk of contracting [[TB]] increases if you: | ||
* Are in frequent contact with people who have [[TB]] | |||
* Have poor [[nutrition]] | *Are in frequent contact with people who have [[TB]] | ||
* Live in crowded place or with poor hygiene | *Have poor [[nutrition]] | ||
*Live in crowded place or with poor hygiene | |||
The following factors may increase the rate of [[TB]] [[infection]] in a population: | The following factors may increase the rate of [[TB]] [[infection]] in a population: | ||
* Increase in [[HIV]] infections | |||
* Increase in number of homeless people | *Increase in [[HIV]] infections | ||
* The appearance of [[drug-resistant]] strains of [[TB]] | *Increase in number of homeless people | ||
*The appearance of [[drug-resistant]] strains of [[TB]] | |||
===Multidrug-Resistant Tuberculosis=== | ===Multidrug-Resistant Tuberculosis=== | ||
[[Drug resistance]] is more common in people who:<ref name=WHO>{{cite web | title = Multidrug-resistant tuberculosis | url = http://www.who.int/tb/challenges/mdr/en/ }}</ref> | [[Drug resistance]] is more common in people who:<ref name="WHO">{{cite web | title = Multidrug-resistant tuberculosis | url = http://www.who.int/tb/challenges/mdr/en/ }}</ref> | ||
* Do not take their [[TB]] medicine regularly | |||
* Do not take all of their [[TB]] medicine as told by their doctor or nurse | *Do not take their [[TB]] medicine regularly | ||
* Develop [[TB]] disease again, after having taken [[TB]] medicine in the past | *Do not take all of their [[TB]] medicine as told by their doctor or nurse | ||
* Come from areas of the world where [[drug-resistant]] [[TB]] is common | *Develop [[TB]] disease again, after having taken [[TB]] medicine in the past | ||
* Have spent time with someone known to have [[drug-resistant]] [[TB]] disease | *Come from areas of the world where [[drug-resistant]] [[TB]] is common | ||
*Have spent time with someone known to have [[drug-resistant]] [[TB]] disease | |||
==When to Seek Urgent Medical Care?== | ==When to Seek Urgent Medical Care?== | ||
Call your health care provider if: | Call your health care provider if: | ||
* You have been exposed to TB or traveled to areas having [[endemic]] disease | |||
* You develop symptoms of TB | *You have been exposed to TB or traveled to areas having [[endemic]] disease | ||
* Your symptoms continue despite treatment | *You develop symptoms of TB | ||
* New symptoms develop | *Your symptoms continue despite treatment | ||
*New symptoms develop | |||
==Diagnosis== | ==Diagnosis== | ||
Diagnosing active TB can be done with a combination of symptoms, patient history (any known exposure to TB), TB tests, and x-rays. | Diagnosing active TB can be done with a combination of symptoms, patient history (any known exposure to TB), TB tests, and x-rays. | ||
Latent [[tuberculosis]] can be detected about 6-8 weeks after exposure. There are two tests that can be used to help detect [[TB]] [[infection]]:<ref name=CDC>{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm }}</ref> | Latent [[tuberculosis]] can be detected about 6-8 weeks after exposure. There are two tests that can be used to help detect [[TB]] [[infection]]:<ref name="CDC">{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm }}</ref> | ||
* [[TB skin test]] | |||
:* The [[TB skin test|skin test]] is used most often | *[[TB skin test]] | ||
:* A small needle is used to put some testing material, called [[tuberculin]], under the [[skin]] | |||
:* In 2-3 days, the patient should return to the health care worker, who will check if there is a reaction to the test | :*The [[TB skin test|skin test]] is used most often | ||
* [[TB]] [[blood test]] | :*A small needle is used to put some testing material, called [[tuberculin]], under the [[skin]] | ||
:* In some cases, a [[TB]] [[blood test]] is used to test for [[Tuberculosis|TB infection]] | :*In 2-3 days, the patient should return to the health care worker, who will check if there is a reaction to the test | ||
:* This [[blood test]] measures how a person’s [[immune system]] reacts to the germs that cause [[TB]] | |||
*[[TB]] [[blood test]] | |||
:*In some cases, a [[TB]] [[blood test]] is used to test for [[Tuberculosis|TB infection]] | |||
:*This [[blood test]] measures how a person’s [[immune system]] reacts to the germs that cause [[TB]] | |||
The [[drug resistance]] will be shown by a [[drug]] susceptibility test. | The [[drug resistance]] will be shown by a [[drug]] susceptibility test. | ||
To tell if someone has [[TB]] disease, other tests may be needed:<ref name=CDC>{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm }}</ref> | To tell if someone has [[TB]] disease, other tests may be needed:<ref name="CDC">{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm }}</ref> | ||
* [[Chest x-ray]] - [[X-ray]] of the [[lungs]] often show can show cavities or lesions that are typical of [[TB]] | |||
* Sample of [[sputum]] (phlegm that is coughed up from deep in the [[lungs]]) | *[[Chest x-ray]] - [[X-ray]] of the [[lungs]] often show can show cavities or lesions that are typical of [[TB]] | ||
*Sample of [[sputum]] (phlegm that is coughed up from deep in the [[lungs]]) | |||
It is important to tell your health care provider if you have ever had a “positive” reaction to a [[TB skin test]] or [[TB]] [[blood test]], or if you have been treated with [[TB]] drugs in the past. | It is important to tell your health care provider if you have ever had a “positive” reaction to a [[TB skin test]] or [[TB]] [[blood test]], or if you have been treated with [[TB]] drugs in the past. | ||
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===Multidrug-Resistant Tuberculosis=== | ===Multidrug-Resistant Tuberculosis=== | ||
* When the testing results are known, the treatment regimen should be adjusted according to the results, in order to avoid suboptimal treatment. Patients should be monitored closely throughout treatment. <ref name=CDC>{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm }}</ref> | *[[TB]] is a treatable and curable disease. Treatment for [[multidrug-resistant tuberculosis]] must be confirmed by drug-susceptibility testing. However, since this testing can take weeks, treatment should be started with an [[empirical]] regimen based on expert advice as soon as [[drug-resistant]] [[TB]] disease is suspected. <ref name="CDC">{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm }}</ref><ref name="WHO">{{cite web | title = Multidrug-resistant tuberculosis | url = http://www.who.int/tb/challenges/mdr/en/ }}</ref> | ||
*When the testing results are known, the treatment regimen should be adjusted according to the results, in order to avoid suboptimal treatment. Patients should be monitored closely throughout treatment. <ref name="CDC">{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm }}</ref> | |||
* A common treatment regimen includes at least 5 [[drugs]], to which the [[bacteria]] was shown to be susceptible.<ref>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref> | *A common treatment regimen includes at least 5 [[drugs]], to which the [[bacteria]] was shown to be susceptible.<ref>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref> | ||
* Treatment regimens are commonly divided into 2 phases: the initial phase and the continuation phase. | *Treatment regimens are commonly divided into 2 phases: the initial phase and the continuation phase. | ||
* A [[fluoroquinolone]] is indicated in the treatment of patients with [[MDR-TB]]. | *A [[fluoroquinolone]] is indicated in the treatment of patients with [[MDR-TB]]. | ||
* Directly observed therapy should always be used in the treatment of [[drug-resistant]] [[TB]] to ensure adherence.<ref name=CDC>{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm }}</ref> | *Directly observed therapy should always be used in the treatment of [[drug-resistant]] [[TB]] to ensure adherence.<ref name="CDC">{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm }}</ref> | ||
====Special Considerations==== | ====Special Considerations==== | ||
=====HIV-Infected Persons===== | =====HIV-Infected Persons===== | ||
* Treatment of [[drug-resistant]] [[TB]] in persons with [[HIV infection]] is the same as for patients without [[HIV]]. | |||
* Management of [[HIV]]-related [[TB]] requires expertise in the management of both [[HIV]] and [[TB]]. | *Treatment of [[drug-resistant]] [[TB]] in persons with [[HIV infection]] is the same as for patients without [[HIV]]. | ||
* Providers must monitor the interactions among many of the [[antiretroviral drugs]]. | *Management of [[HIV]]-related [[TB]] requires expertise in the management of both [[HIV]] and [[TB]]. | ||
* [[Rifampin]] should not be used with most [[antiretroviral drugs]]. [[Rifabutin]], which has fewer problematic drug interactions, may be used in place of [[Rifampin]]. | *Providers must monitor the interactions among many of the [[antiretroviral drugs]]. | ||
* These recommendations are likely to be modified, as new [[antiretroviral]] agents and [[pharmacokinetic]] data become available. | *[[Rifampin]] should not be used with most [[antiretroviral drugs]]. [[Rifabutin]], which has fewer problematic drug interactions, may be used in place of [[Rifampin]]. | ||
*These recommendations are likely to be modified, as new [[antiretroviral]] agents and [[pharmacokinetic]] data become available. | |||
=====Children===== | =====Children===== | ||
* Treatment for children who have [[TB]] disease after exposure to a [[drug-resistant]] case should be guided by the source-case susceptibility results. | |||
* When a source is unknown and circumstances suggest an increased risk of [[drug resistance]], children should be treated with a standard four-drug initial-phase regimen until their susceptibility pattern is known. | *Treatment for children who have [[TB]] disease after exposure to a [[drug-resistant]] case should be guided by the source-case susceptibility results. | ||
* [[Ethambutol]] can be used safely (15-20 mg/kg per day), in the likelihood of [[Isoniazide]] resistance. | *When a source is unknown and circumstances suggest an increased risk of [[drug resistance]], children should be treated with a standard four-drug initial-phase regimen until their susceptibility pattern is known. | ||
* [[Streptomycin]], [[kanamycin]], or [[amikacin]] also can be selected as the fourth drug. | *[[Ethambutol]] can be used safely (15-20 mg/kg per day), in the likelihood of [[Isoniazide]] resistance. | ||
* Long-term use of [[fluoroquinolones]] in children has not been approved. However, most experts agree that these drugs should be considered for children with [[MDR-TB]]. | *[[Streptomycin]], [[kanamycin]], or [[amikacin]] also can be selected as the fourth drug. | ||
* Consultation with a specialist in pediatric [[TB]] treatment is recommended. | *Long-term use of [[fluoroquinolones]] in children has not been approved. However, most experts agree that these drugs should be considered for children with [[MDR-TB]]. | ||
*Consultation with a specialist in pediatric [[TB]] treatment is recommended. | |||
=====Pregnant Women===== | =====Pregnant Women===== | ||
* Case management for pregnant women who have [[drug-resistant]] [[TB]] requires consultation with an expert because most second-line [[drugs]] can have harmful effects on the [[fetus]]. | |||
* [[Pyrazinamide]] should not be used as part of the treatment regimen for pregnant women. | *Case management for pregnant women who have [[drug-resistant]] [[TB]] requires consultation with an expert because most second-line [[drugs]] can have harmful effects on the [[fetus]]. | ||
* Counseling concerning risks to the [[fetus]] should be provided. | *[[Pyrazinamide]] should not be used as part of the treatment regimen for pregnant women. | ||
*Counseling concerning risks to the [[fetus]] should be provided. | |||
=====Close Contacts of Drug-Resistant TB Patients===== | =====Close Contacts of Drug-Resistant TB Patients===== | ||
* Contacts of [[isoniazid]]-[[drug resistance|resistant]] [[TB]]. | |||
* Persons who have been exposed to [[Isoniazid]]-[[drug-resistant|resistant]], [[Rifampin]]-susceptible [[TB]] and are known or suspected to have latent [[TB]] [[infection]], a 4-month regimen of daily [[Rifampin]] is recommended. | *Contacts of [[isoniazid]]-[[drug resistance|resistant]] [[TB]]. | ||
* When [[Rifampin]] cannot be used, [[rifabutin]] may be substituted. | *Persons who have been exposed to [[Isoniazid]]-[[drug-resistant|resistant]], [[Rifampin]]-susceptible [[TB]] and are known or suspected to have latent [[TB]] [[infection]], a 4-month regimen of daily [[Rifampin]] is recommended. | ||
*When [[Rifampin]] cannot be used, [[rifabutin]] may be substituted. | |||
=====Contacts of MDR-TB===== | =====Contacts of MDR-TB===== | ||
* For persons with known or suspected latent [[tuberculosis]] [[infection]] [[drug resistance|resistant]] to both [[Isoniazid]] and [[Rifampin]], alternative regimens should be considered. | |||
* Alternative regimens should include two [[drugs]] to which the [[TB]] strain is susceptible. | *For persons with known or suspected latent [[tuberculosis]] [[infection]] [[drug resistance|resistant]] to both [[Isoniazid]] and [[Rifampin]], alternative regimens should be considered. | ||
* A potential regimen should include a daily [[fluoroquinolone]]. | *Alternative regimens should include two [[drugs]] to which the [[TB]] strain is susceptible. | ||
* Contacts who are not [[immunosuppressed]] may be treated for 6 months or observed without treatment. | *A potential regimen should include a daily [[fluoroquinolone]]. | ||
* All persons with suspected MDR latent TB should be monitored for 2 years regardless of the treatment regimen. | *Contacts who are not [[immunosuppressed]] may be treated for 6 months or observed without treatment. | ||
*All persons with suspected MDR latent TB should be monitored for 2 years regardless of the treatment regimen. | |||
==Where to Find Medical Care for Tuberculosis?== | ==Where to Find Medical Care for Tuberculosis?== | ||
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==Possible Complications== | ==Possible Complications== | ||
Pulmonary TB can cause permanent lung damage if not treated early. Medicines used to treat TB may cause side effects, including liver problems. Other side effects include: | Pulmonary TB can cause permanent lung damage if not treated early. Medicines used to treat TB may cause side effects, including liver problems. Other side effects include: | ||
* Changes in vision | |||
* Orange- or brown-colored tears and urine | *Changes in vision | ||
* Rash | *Orange- or brown-colored tears and urine | ||
*Rash | |||
A vision test may be done before treatment so your doctor can monitor any changes in your eyes' health over time. | A vision test may be done before treatment so your doctor can monitor any changes in your eyes' health over time. | ||
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On an individual basis, covering coughs and sneezes do reduce transmission. On a larger scale, adequate ventilation and the reduction of crowded areas can also reduce transmission. As with all infectious diseases, earlier identification of the disease is necessary to prevent spreading. | On an individual basis, covering coughs and sneezes do reduce transmission. On a larger scale, adequate ventilation and the reduction of crowded areas can also reduce transmission. As with all infectious diseases, earlier identification of the disease is necessary to prevent spreading. | ||
A prophylactic antibiotic INH can cure latent TB before it progresses to active TB and should be given to people who: | A prophylactic antibiotic INH can cure latent TB before it progresses to active TB and should be given to people who: | ||
*Have latent TB | *Have latent TB | ||
*Are close contact with known infected patients | *Are close contact with known infected patients | ||
*Live in countries where TB is prevalent. | *Live in countries where TB is prevalent. | ||
*Are at risk of TB infection | *Are at risk of TB infection | ||
A [[vaccine]] called [[BCG]] prevents the spread of [[TB]] to other parts of the body but not the [[infection]]. It is recommended just for infants in countries known to have high levels of [[TB]]. [[BCG]] is known to interfere with [[TB skin test]]s, giving [[false positive]]s, and other tests are needed to test for [[TB]] in these cases. It is not recommended for overall use in the US because it has limited effectiveness for preventing [[TB]].<ref name=CDC>{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm }}</ref> | |||
TB is not spread by <ref name=CDC11>http://www.cdc.gov/tb/publications/factsheets/general/tbtravelinfo.htm Accessed on October 14, 2016</ref> | A [[vaccine]] called [[BCG]] prevents the spread of [[TB]] to other parts of the body but not the [[infection]]. It is recommended just for infants in countries known to have high levels of [[TB]]. [[BCG]] is known to interfere with [[TB skin test]]s, giving [[false positive]]s, and other tests are needed to test for [[TB]] in these cases. It is not recommended for overall use in the US because it has limited effectiveness for preventing [[TB]].<ref name="CDC">{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm }}</ref> | ||
TB is not spread by <ref name="CDC11">http://www.cdc.gov/tb/publications/factsheets/general/tbtravelinfo.htm Accessed on October 14, 2016</ref> | |||
*Shaking someone’s hand | *Shaking someone’s hand | ||
*Sharing food or drink | *Sharing food or drink | ||
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*Sharing toothbrushes | *Sharing toothbrushes | ||
*Kissing | *Kissing | ||
===Travel warning and guidelines=== | ===Travel warning and guidelines=== | ||
Travelers who anticipate possible prolonged exposure to persons with TB (for example, those who expect to come in contact routinely with clinic, hospital, prison, or homeless shelter populations) should have a tuberculin skin test (TST) or TB blood test before leaving the United States. If the reaction to the TST or TB blood test is negative, they should have a repeat test 8 to 10 weeks after returning to the United States. Additionally, annual testing may be recommended for those who anticipate repeated or prolonged exposure or an extended stay over a period of years. Because persons with HIV infection are more likely to have an impaired response to both the TST and TB blood test, travelers who are HIV positive should tell their physicians about their HIV infection status. | Travelers who anticipate possible prolonged exposure to persons with TB (for example, those who expect to come in contact routinely with clinic, hospital, prison, or homeless shelter populations) should have a tuberculin skin test (TST) or TB blood test before leaving the United States. If the reaction to the TST or TB blood test is negative, they should have a repeat test 8 to 10 weeks after returning to the United States. Additionally, annual testing may be recommended for those who anticipate repeated or prolonged exposure or an extended stay over a period of years. Because persons with HIV infection are more likely to have an impaired response to both the TST and TB blood test, travelers who are HIV positive should tell their physicians about their HIV infection status. | ||
According to WHO, the list of countries having a high burden of TB includes: | According to WHO, the list of countries having a high burden of TB includes: | ||
*India | |||
*Pakistan | *India | ||
*Bangladesh | *Pakistan | ||
*Bangladesh | |||
*South Africa | *South Africa | ||
*China | *China | ||
*Congo | *Congo | ||
*Columbia | *Columbia | ||
*Cambodia | *Cambodia | ||
*Indonesia | *Indonesia | ||
*Korea | *Korea | ||
*Brazil | *Brazil | ||
*Ethiopia | *Ethiopia | ||
*Myanmar | *Myanmar | ||
*Mozambique | *Mozambique | ||
*Thailand | *Thailand | ||
*Angola | *Angola | ||
*Vietnam | *Vietnam | ||
*Kenya | *Kenya | ||
*Central Africa | *Central Africa | ||
*Russia | *Russia | ||
*Liberia | *Liberia | ||
*Zimbabwe | *Zimbabwe | ||
*Namibia | *Namibia | ||
*Philippine | *Philippine | ||
*Nigeria | *Nigeria | ||
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===Multidrug-Resistant Tuberculosis=== | ===Multidrug-Resistant Tuberculosis=== | ||
To prevent [[multi-drug-resistant tuberculosis]], the following rules should be observed:<ref name=CDC>{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm }}</ref> | To prevent [[multi-drug-resistant tuberculosis]], the following rules should be observed:<ref name="CDC">{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm }}</ref> | ||
* Take all medications exactly as prescribed by the health care provider | |||
* No [[doses]] should be missed and treatment should not be stopped early | *Take all medications exactly as prescribed by the health care provider | ||
* Patients should tell their health care provider if they are having trouble taking the medications | *No [[doses]] should be missed and treatment should not be stopped early | ||
* If patients plan to travel, they should talk to their health care providers and make sure they have enough medicine to last while away | *Patients should tell their health care provider if they are having trouble taking the medications | ||
* Avoid exposure to known [[MDR TB]] patients in closed or crowded places such as hospitals, prisons, or homeless shelters: | *If patients plan to travel, they should talk to their health care providers and make sure they have enough medicine to last while away | ||
:* In the case of health care workers who are more likely to have contact with [[TB]] patients, [[infection]] control or occupational health experts should be consulted | *Avoid exposure to known [[MDR TB]] patients in closed or crowded places such as hospitals, prisons, or homeless shelters: | ||
:* Administrative and environmental procedures for preventing exposure to [[TB]] should be implemented. Once those procedures are implemented, additional measures could include using personal [[respiratory]] protective devices | |||
:*In the case of health care workers who are more likely to have contact with [[TB]] patients, [[infection]] control or occupational health experts should be consulted | |||
:*Administrative and environmental procedures for preventing exposure to [[TB]] should be implemented. Once those procedures are implemented, additional measures could include using personal [[respiratory]] protective devices | |||
Health care providers can help prevent [[MDR-TB]] by:<ref name="CDC">{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm }}</ref> | |||
*Quickly [[diagnosis|diagnosing]] cases | |||
* Quickly [[diagnosis|diagnosing]] cases | *Following recommended treatment guidelines | ||
* Following recommended treatment guidelines | *Monitoring patients’ response to treatment | ||
* Monitoring patients’ response to treatment | *Making sure therapy is completed | ||
* Making sure therapy is completed | |||
==Sources== | ==Sources== | ||
*[http://www.nlm.nih.gov/medlineplus/tutorials/tuberculosis/htm/index.htm NLM]<br> | *[http://www.nlm.nih.gov/medlineplus/tutorials/tuberculosis/htm/index.htm NLM]<br> | ||
[http://www.cdc.gov/ Center for Disease Control or Prevention]<br> | [http://www.cdc.gov/ Center for Disease Control or Prevention]<br> | ||
[http://www.who.int/en/ World Health Organization] | [http://www.who.int/en/ World Health Organization] | ||
Revision as of 00:47, 20 January 2021
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Tuberculosis |
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Tuberculosis On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ethan Leeman; João André Alves Silva, M.D. [2]
Overview
Tuberculosis (TB) is a bacterial infection that kills 1.8 million people worldwide. Approximately 10.4 million people in the world are infected with TB. Active tuberculosis kills 60% of the time if not treated, but treatment cures 90% of patients. In year 2015, the total no of cases reported with Tb in USA were approximately 9,421. Most people who are infected with TB have latent TB. This means that the bacteria is controlled by the body's immune system. Also, most of these TB cases skew strongly toward men, but when looking at impact of disease on women, it also remains among among a top killer for them in the world as wellEmpty citation (help). People with latent TB do not have symptoms and cannot transmit TB to other people. According to WHO, about 3 million lives are saved globally in the year 2015 by treating Tb.
What are the Symptoms of Tuberculosis?
Latent TB is held in the alveoli of the lungs. As active TB develops, the bacteria spread out from the alveoli to the lungs and then to other organ systems. As a result, depending on which organ system is affected, the symptoms may be different. The primary stage of TB usually doesn't cause symptoms. When symptoms of pulmonary TB occur, they may include:[1]
- Cough
- Night sweats
- Coughing up blood
- Excessive sweating, especially at night
- Fatigue
- Fever
- Unintentional weight loss
- Shortness of breath
- Chest pain
- Wheezing
Symptoms of TB disease in other parts of the body will depend on the affected area.
What Causes Tuberculosis?
Pulmonary tuberculosis (TB) is caused by the bacterium Mycobacterium tuberculosis. The bacteria usually damages the lungs but TB bacteria can damage any part of the body such as the kidney, spine, and brain. If not treated properly, TB disease can be fatal.[1]
Multidrug-Resistant Tuberculosis
Multi-drug-resistant tuberculosis is caused by the bacterium Mycobacterium tuberculosis resistant to anti-TB drugs. This resistance can occur when drugs are misused or mismanaged:[1]
- When patients do not complete their full course of treatment
- When health-care providers prescribe the wrong treatment, the wrong dose, or length of time for taking the drugs
- When the supply of drugs is not always available
- When the drugs are of poor quality
Who is at Highest Risk?
Tuberculosis is spread from person to person through the air (cough, sneeze) and physical contact.
The following people are at higher risk for active TB:
- Elderly
- Infants
- People with weakened immune systems (AIDS, chemotherapy, diabetes, or certain medications)
Your risk of contracting TB increases if you:
- Are in frequent contact with people who have TB
- Have poor nutrition
- Live in crowded place or with poor hygiene
The following factors may increase the rate of TB infection in a population:
- Increase in HIV infections
- Increase in number of homeless people
- The appearance of drug-resistant strains of TB
Multidrug-Resistant Tuberculosis
Drug resistance is more common in people who:[2]
- Do not take their TB medicine regularly
- Do not take all of their TB medicine as told by their doctor or nurse
- Develop TB disease again, after having taken TB medicine in the past
- Come from areas of the world where drug-resistant TB is common
- Have spent time with someone known to have drug-resistant TB disease
When to Seek Urgent Medical Care?
Call your health care provider if:
- You have been exposed to TB or traveled to areas having endemic disease
- You develop symptoms of TB
- Your symptoms continue despite treatment
- New symptoms develop
Diagnosis
Diagnosing active TB can be done with a combination of symptoms, patient history (any known exposure to TB), TB tests, and x-rays.
Latent tuberculosis can be detected about 6-8 weeks after exposure. There are two tests that can be used to help detect TB infection:[1]
- The skin test is used most often
- A small needle is used to put some testing material, called tuberculin, under the skin
- In 2-3 days, the patient should return to the health care worker, who will check if there is a reaction to the test
- In some cases, a TB blood test is used to test for TB infection
- This blood test measures how a person’s immune system reacts to the germs that cause TB
The drug resistance will be shown by a drug susceptibility test. To tell if someone has TB disease, other tests may be needed:[1]
- Chest x-ray - X-ray of the lungs often show can show cavities or lesions that are typical of TB
- Sample of sputum (phlegm that is coughed up from deep in the lungs)
It is important to tell your health care provider if you have ever had a “positive” reaction to a TB skin test or TB blood test, or if you have been treated with TB drugs in the past.
Treatment Options
Typical treatment involves one or a few antibiotics for months. TB is notorious for having a lengthy treatment procedure. After two weeks of treatment, people are typically no longer contagious. Some of the medications given for TB have some negative side effects, especially in combination with other drugs. For these reasons, some patients find it very difficult to take their medicine for the necessary duration. However, doing so may make the bacteria resistant to antibiotics and make treatment even more difficult in the future. Treatment for multi-drug-resistant tuberculosis or extensively drug-resistant TB have different treatments with a far worse prognosis.
Multidrug-Resistant Tuberculosis
- TB is a treatable and curable disease. Treatment for multidrug-resistant tuberculosis must be confirmed by drug-susceptibility testing. However, since this testing can take weeks, treatment should be started with an empirical regimen based on expert advice as soon as drug-resistant TB disease is suspected. [1][2]
- When the testing results are known, the treatment regimen should be adjusted according to the results, in order to avoid suboptimal treatment. Patients should be monitored closely throughout treatment. [1]
- A common treatment regimen includes at least 5 drugs, to which the bacteria was shown to be susceptible.[3]
- Treatment regimens are commonly divided into 2 phases: the initial phase and the continuation phase.
- A fluoroquinolone is indicated in the treatment of patients with MDR-TB.
- Directly observed therapy should always be used in the treatment of drug-resistant TB to ensure adherence.[1]
Special Considerations
HIV-Infected Persons
- Treatment of drug-resistant TB in persons with HIV infection is the same as for patients without HIV.
- Management of HIV-related TB requires expertise in the management of both HIV and TB.
- Providers must monitor the interactions among many of the antiretroviral drugs.
- Rifampin should not be used with most antiretroviral drugs. Rifabutin, which has fewer problematic drug interactions, may be used in place of Rifampin.
- These recommendations are likely to be modified, as new antiretroviral agents and pharmacokinetic data become available.
Children
- Treatment for children who have TB disease after exposure to a drug-resistant case should be guided by the source-case susceptibility results.
- When a source is unknown and circumstances suggest an increased risk of drug resistance, children should be treated with a standard four-drug initial-phase regimen until their susceptibility pattern is known.
- Ethambutol can be used safely (15-20 mg/kg per day), in the likelihood of Isoniazide resistance.
- Streptomycin, kanamycin, or amikacin also can be selected as the fourth drug.
- Long-term use of fluoroquinolones in children has not been approved. However, most experts agree that these drugs should be considered for children with MDR-TB.
- Consultation with a specialist in pediatric TB treatment is recommended.
Pregnant Women
- Case management for pregnant women who have drug-resistant TB requires consultation with an expert because most second-line drugs can have harmful effects on the fetus.
- Pyrazinamide should not be used as part of the treatment regimen for pregnant women.
- Counseling concerning risks to the fetus should be provided.
Close Contacts of Drug-Resistant TB Patients
- Contacts of isoniazid-resistant TB.
- Persons who have been exposed to Isoniazid-resistant, Rifampin-susceptible TB and are known or suspected to have latent TB infection, a 4-month regimen of daily Rifampin is recommended.
- When Rifampin cannot be used, rifabutin may be substituted.
Contacts of MDR-TB
- For persons with known or suspected latent tuberculosis infection resistant to both Isoniazid and Rifampin, alternative regimens should be considered.
- Alternative regimens should include two drugs to which the TB strain is susceptible.
- A potential regimen should include a daily fluoroquinolone.
- Contacts who are not immunosuppressed may be treated for 6 months or observed without treatment.
- All persons with suspected MDR latent TB should be monitored for 2 years regardless of the treatment regimen.
Where to Find Medical Care for Tuberculosis?
Directions to Hospitals Treating Tuberculosis
What to Expect (Outlook/Prognosis)?
Symptoms often improve in 2 - 3 weeks. A chest x-ray will not show this improvement until later. The outlook is excellent if pulmonary TB is diagnosed early and treatment is begun quickly.
Multidrug-Resistant Tuberculosis
The prognosis of multidrug-resistant TB is worst than that of tuberculosis susceptible to common treatment. Therefore it is mandatory to perform a drug susceptibility test and to monitor adherence to the treatment regimen, in order to avoid new drug resistances and ensure a better outcome.
Possible Complications
Pulmonary TB can cause permanent lung damage if not treated early. Medicines used to treat TB may cause side effects, including liver problems. Other side effects include:
- Changes in vision
- Orange- or brown-colored tears and urine
- Rash
A vision test may be done before treatment so your doctor can monitor any changes in your eyes' health over time.
Prevention
On an individual basis, covering coughs and sneezes do reduce transmission. On a larger scale, adequate ventilation and the reduction of crowded areas can also reduce transmission. As with all infectious diseases, earlier identification of the disease is necessary to prevent spreading. A prophylactic antibiotic INH can cure latent TB before it progresses to active TB and should be given to people who:
- Have latent TB
- Are close contact with known infected patients
- Live in countries where TB is prevalent.
- Are at risk of TB infection
A vaccine called BCG prevents the spread of TB to other parts of the body but not the infection. It is recommended just for infants in countries known to have high levels of TB. BCG is known to interfere with TB skin tests, giving false positives, and other tests are needed to test for TB in these cases. It is not recommended for overall use in the US because it has limited effectiveness for preventing TB.[1] TB is not spread by [4]
- Shaking someone’s hand
- Sharing food or drink
- Touching bed linens or toilet seats
- Sharing toothbrushes
- Kissing
Travel warning and guidelines
Travelers who anticipate possible prolonged exposure to persons with TB (for example, those who expect to come in contact routinely with clinic, hospital, prison, or homeless shelter populations) should have a tuberculin skin test (TST) or TB blood test before leaving the United States. If the reaction to the TST or TB blood test is negative, they should have a repeat test 8 to 10 weeks after returning to the United States. Additionally, annual testing may be recommended for those who anticipate repeated or prolonged exposure or an extended stay over a period of years. Because persons with HIV infection are more likely to have an impaired response to both the TST and TB blood test, travelers who are HIV positive should tell their physicians about their HIV infection status. According to WHO, the list of countries having a high burden of TB includes:
- India
- Pakistan
- Bangladesh
- South Africa
- China
- Congo
- Columbia
- Cambodia
- Indonesia
- Korea
- Brazil
- Ethiopia
- Myanmar
- Mozambique
- Thailand
- Angola
- Vietnam
- Kenya
- Central Africa
- Russia
- Liberia
- Zimbabwe
- Namibia
- Philippine
- Nigeria
- Tanzania
- Sierra leone Zambia
- Papua New Guinea
- Lesotho
Multidrug-Resistant Tuberculosis
To prevent multi-drug-resistant tuberculosis, the following rules should be observed:[1]
- Take all medications exactly as prescribed by the health care provider
- No doses should be missed and treatment should not be stopped early
- Patients should tell their health care provider if they are having trouble taking the medications
- If patients plan to travel, they should talk to their health care providers and make sure they have enough medicine to last while away
- Avoid exposure to known MDR TB patients in closed or crowded places such as hospitals, prisons, or homeless shelters:
- In the case of health care workers who are more likely to have contact with TB patients, infection control or occupational health experts should be consulted
- Administrative and environmental procedures for preventing exposure to TB should be implemented. Once those procedures are implemented, additional measures could include using personal respiratory protective devices
Health care providers can help prevent MDR-TB by:[1]
- Quickly diagnosing cases
- Following recommended treatment guidelines
- Monitoring patients’ response to treatment
- Making sure therapy is completed
Sources
Center for Disease Control or Prevention
World Health Organization
References
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 "Tuberculosis Fact Sheet".
- ↑ 2.0 2.1 "Multidrug-resistant tuberculosis".
- ↑ Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.
- ↑ http://www.cdc.gov/tb/publications/factsheets/general/tbtravelinfo.htm Accessed on October 14, 2016