WORLD TB DAY 2023!
“YES WE CAN END TB!!!”
Overview
Tuberculosis (TB) is one of the most prevalent infectious diseases of human beings which significantly contributes to morbidity and mortality around the world.
It is a bacterial infection that primarily affects the parenchyma cells of the lungs and may spread to any part of the body – kidney, spine, lymph-nodes, liver and the brain. It is a communicable disease spread thorough inhaling tiny droplets from the cough or sneezes of an infected person.
It is the second most common infectious killer disease after HIV/AIDS, however, it is curable and can be treated with certain antibiotics.
Signs and Symptoms
- Persistent cough (more than 2-3 weeks)
- Blood in the sputum
- Chest pain, or pain with breathing or coughing
- Fatigue
- Night sweats
- Chills
- Weight loss
Causes
Tuberculosis in humans is caused by Mycobacterium tuberculosis, however, not everyone infected with it ends up developing active TB; in such infected persons, TB bacteria remains inactive in their lifetime without causing disease, but in persons with weak immune system, the bacteria becomes active, multiply and cause TB.
Forms of Tuberculosis
Tuberculosis usually goes through 3 infection phases:
- Primary TB Infection: also known as the initial tuberculosis infection occurs when a person breathes in the airborne bacteria from the cough or sneezes of an infected person.
- Latent TB Infection: In most persons, bacteria inhaled are attacked immediately by the immune system. However, in other persons, TB bacteria gets attached to a certain type of white blood cells – macrophages, and enter a dormant state. This is the latent phase of the infection.
The bacteria can remain in that dormant state for many years of even the lifetime of the infected person.
In populations, including the elderly, infants, those with a weakened immune system and those previously infected with TB bacteria, active tuberculosis can develop within few weeks of primary infection with symptoms of the disease.
- Active TB infection: In this phase, TB bacteria multiply in the body making infected persons present with symptoms of the disease, also the disease can be spread to others. The disease can be fatal if left untreated; it can spread to other parts of the body.
Immuno-compromised persons such as people with HIV/AIDS are at higher risk of mortality from TB infections than other actively infected populations.
Fortunately, TB is curable, yes!, we can end TB.
Types of Tuberculosis
- Pulmonary Tuberculosis: is the most common active tuberculosis infection. Mycobacterium tuberculosis primarily attacks the lungs which is the initial site of infection and can spread other parts of the body.
- Primary Pulmonary Tuberculosis: infection of a person who has no previous history of tuberculosis infection.
- Secondary Pulmonary Tuberculosis: infection of a person who has been sensitized or previously infected, also called reinfection or chronic tuberculosis.
2. Extra-pulmonary Tuberculosis: after pulmonary infection, TB bacteria can spread to other parts of the body causing systemic infection- Pleural TB, Lymph-node TB, Genito-urinary TB, Gastrointestinal TB, Skeletal TB, TB Meningitis, amongst other less common extra-pulmonary infection.
Risk Factors
Certain populations are prone to TB infection. They include:
- Elderly
- Infants
- Immuno-compromised persons (persons with HIV)
- Overcrowding
- History of previous TB infection
- Low socio-economic status
- Individuals with some morbidities (Diabetes, Kidney diseases etc)
- Alcohol and substance abuse
Diagnosis
Individuals presenting with certain pulmonary symptoms like productive cough lasting for more than 2 weeks, chest pain, blood insputum, can be further investigated to confirm TB infection.
Also, patients with a medical history of HIV infection, previous TB infection, Immuno-compromised patients from certain diseases and demographic risk factors of TB that present with pulmonary symptoms stated can be further investigated for TB infection.
Systemic symptoms of TB infection include fever, chills, night sweats, weight loss, fatigue and appetite loss.
Investigation
Laboratory tests and radiological examinations are carried out to confirm TB infection – Bacteriological smear tests, Sputum culture test, Tuberculin skin test, Chest X-ray examination and other biological examinations.
Treatment
The goals of treatment of TB include curing the patient of TB, preventing death from active TB or it’s latent effects, decreasing the transmission TB to others, preventing relapse of TB and preventing the development of acquired resistance.
The treatment of TB involves the use of antibiotics over a period of time (4 to 9 months typically), this is because TB bacteria grow slowly.
To avoid drug resistance TB infection, infected persons are advised to adhere to their drug treatment regimen, they can also be directly observed and monitored to ensure strict adherence (Directly Observed Treatment, short – course (DOTS)).
Usually, active non-drug resistant TB infection is treated with Isoniazid, Rifampicin, Ethambutol and Pyrazinamide, which are the first line treatment drugs for TB infection:
-Isoniazid + Rifampicin + Ethambutol for the first two months which is the intensive phase, and
-Isoniazid +Rifampicin + Ethambutol + Pyrazinamide for the next 4 months which is the continuous phase.
Preventive measures taken against TB infection include:
-Administration of BCG (Bacille Calmette Guerin) Vaccine to healthy infants within a few days after birth.
-Isolation of infected individuals
-Ventilation
-Use of nose masks
-Regular medical follow-up
Facts and Misconceptions About TB
Facts:
- TB is caused by a bacterium called Mycobacterium tuberculosis.
- TB is spread through the air when an infected person coughs, sneezes, talks, or spits.
- TB can be cured with a combination of antibiotics.
- TB can affect anyone, regardless of their age, gender, or race.
- TB is more common in low-income countries with poor living conditions, but it can also occur in developed countries.
Misconceptions:
- TB is a disease of the past: While TB rates have decreased in developed countries, it is still a major public health problem in many parts of the world, particularly in low-income countries.
- Only people with weakened immune systems can get TB: While people with weakened immune systems are more susceptible to TB, anyone can get infected.
- TB is always fatal: TB can be cured with a proper course of antibiotics. However, if left untreated, it can be deadly.
- TB can be cured with alternative medicine or home remedies: TB can only be cured with antibiotics prescribed by a medical professional.
- TB can be transmitted through sharing food or drinks: TB is not transmitted through sharing food or drinks, but rather through the air when an infected person coughs, sneezes, talks.
The Role of Pharmacists in the Treatment of TB
Pharmacists are crucial in the treatment of tuberculosis. When necessary, they can assess drug-drug interactions and suggest substitute medications. Also, they can inform patients about potential adverse effects and aid in their management should they arise.
The significance of drug compliance should be emphasized in pharmacist counseling at the beginning of treatment, including at hospital release. Pharmacists can assist in identifying patients who can benefit from direct observed treatment (DOT) and treatment compliance difficulties. Pharmacists need to keep in mind to take safety steps to stop the spread of TB.
AUTHOR: OMOLOLA ENIOLA
For PSN-YPG LAGOS
EDITOR IN CHEIF: EVWAIRE OGHENETEGA ISAAC
References
CDC. Trends in tuberculosis—United States, 2013. MMWR Morb Mortal Wkly Rep. 2014 ;63(11):229-233.
Kristin R. Tuberculosis: Current Treatments and Investigational Therapies. US Pharm. 2014;39(7)(Specialty&Oncology suppl):3-7.
