World Tuberculosis Day

World Tuberculosis Day

 Tuberculosis:

Tuberculosis (TB) is a potentially serious infectious disease that mainly affects the lungs, but it is a curable and preventable disease. The bacteria spread from person to person through the air (droplet). When TB infected person coughs, sneezes or spits, they propel the bacteria into the air. To get a TB infection, a healthy person needs only a few germs exhaled by an infected person.

People infected with TB bacteria have a 5–10% lifetime risk of falling ill with TB.

People with compromised immune systems, such as HIV, malnutrition, diabetes, or use tobacco, and alcohol have a high risk to get infected.

Epidemiology

 

Worldwide :

  • TB occurs in every part of the world. Worldwide, TB is the 13th leading cause of death and the second leading infectious killer after COVID-19 (above HIV/AIDS).

·          In 2020, the largest number of new TB cases in the WHO South-East Asian Region, with 43% of new cases, followed by the WHO African Region, with 25% of new cases, and the WHO Western Pacific with 18%.

·         In 2020, 86% of new TB cases occurred in the 30 high TB burden countries.

·         Eight countries accounted for two-thirds of the new TB cases: India, China, Indonesia, the Philippines, Pakistan, Nigeria, Bangladesh, and South Africa.

·         Globally in 2020, there were 1.9 million new TB cases that were attributable to undernutrition.

·         Alcohol use disorder and tobacco smoking increase the risk of TB disease by a factor of 3.3 and 1.6, respectively.

·         In 2020, 0.74 million new TB cases worldwide were attributable to alcohol use disorder and 0.73 million were attributable to smoking.

  • A total of 1.5 million people died from TB in 2020 (including 214 000 people with HIV).

  • In 2020, an estimated 10 million people infected with tuberculosis (TB) worldwide. 5.6 million men, 3.3 million women, and 1.1 million children.

 

National:

·         Around 117,000 people are living with TB disease in Nepal today.

·         Prevalence: 416 (314 - 518)/ 100,000, around 117,000 (88,000 – 145,000) people with TB disease are living in Nepal.

·         Incidence: 245 (147 - 367)/ 100,000, around 69, 000 (41,000 – 103,000) people developed TB disease in 2018.

·         In 2018 only 32043 cases were notified, indicating 54% of Cases are missing.

·         Annual reduction of TB incidence rate is 3%.

 

Signs and symptoms

Depend upon the stage how infectious you are, how active the bacteria is, and how strong your immune system is.

·         Coughing for three or more weeks

·         Coughing up blood or mucus

·         Chest pain, or pain with breathing or coughing

·         Unintentional weight loss

·         Fatigue

·         Fever

·         Night sweats

·         Chills

·         Loss of appetite

·         Swellings in the neck

Tuberculosis can also affect other parts of your body, including the kidneys, spine or brain, and signs and symptoms vary according to the organs involved. For example, tuberculosis of the spine might cause back pain, and tuberculosis in your kidneys might cause blood in your urine.

 

Causes

·         Mycobacterium tuberculosis (a bacteria that causes tuberculosis)

·         Droplet infection from an infected person with active TB (such as particles that transmit during a cough, sneeze, or spitting)

 

Lab investigations

·         Skin test also known as the Mantoux tuberculin skin test. A technician injects a small amount of fluid into the skin of your lower arm.

  • The blood test is also called interferon-gamma release assays (IGRAs), measure the response when TB proteins are mixed with a small amount of your blood.

  • A chest X-ray or CT scan to look for changes in your lungs.

  • Acid-fast bacillus (AFB) tests for TB bacteria in your sputum, the mucus that comes up when you cough.

 

Treatment:

Treatment depends on how infectious a person is.

  • In case of latent TB (TB without current symptoms), the doctor will give medicines to kill the bacteria so that the infection doesn’t become active, i.e isoniazid, rifampin, either alone or combined drugs for 9 months.

  • A combination of medicines also treats active TB. The most common are ethambutol, isoniazid, pyrazinamide, and rifampin for 6 to 12 months.

  • In the case of drug-resistant TB (when some drugs used to treat TB do not work against the bacteria), the doctor might prescribe one or more different medicines for much longer, up to 30 months, and they can cause more side effects.

Medicines course must be completed even though symptoms disappear in order to prevent drugs resistance.

 

Common Side Effects of Medication used for Tuberculosis:

1.      Isoniazid side effects include

  • Numbness and tingling in your hands and feet

  • Upset stomach, nausea, and vomiting

  • Loss of appetite

  • Weakness

2.      Ethambutol side effects may include

  • Chills

  • Painful or swollen joints

  • Belly pain, nausea, vomiting

  • Loss of appetite

  • Headache

  • Confusion

3.      Pyrazinamide side effects include

  • Lack of energy

  • Nausea and vomiting

  • Loss of appetite

  • Muscle or joint pain

4.      Rifampicin side effects include

  • Skin rash

  • Upset stomach, nausea, vomiting

  • Diarrhea

  • Loss of appetite

  • Inflamed pancreas

 

Tuberculosis Prevention

  • If latent infection, take all medication so it doesn’t become active and contagious.

  • If active TB, limit your contact with other people. Cover your mouth when you laugh, sneeze, or cough.

  • Wear a surgical mask when you’re around other people during the first weeks of treatment.

  • If you’re traveling to a place where TB is common, avoid spending a lot of time in crowded places with sick people.

  • BCG vaccination to the child at birth.

  • Always cover your mouth with a tissue when you cough or sneeze. Seal the tissue in a plastic bag, and then throw it away.

  • Wash your hands after coughing or sneezing.

  • Don’t visit other people and don’t invite them to visit you.

  • Stay home from work, school, or other public places.

  • Use a fan or open windows to move around fresh air.

  • Don’t use public transportation.

 

If you develop the following symptoms anytime during treatment, visit the doctor:

  • Fever for 3 or more days

  • Pain in the lower abdomen

  • Itchiness or a rash

  • Nausea, vomiting or no appetite

  • Yellowish skin or eyes

  • Dark or brown urine

  • Tingling, burning, or numbness of the hands and feet

  • Fatigue/tiredness

  • Easy bruising or bleeding

  • Dizziness

 

Consultation:

·         Infectious diseases specialist

·         Lung diseases (pulmonologist)

 

Diet and Nutritional requirements:

·         There are no any food recommendations for tuberculosis patients, and no diet can replace TB medication, however, support your recovery by maintaining a healthy and balanced diet.

·         It adversely affects nutritional intake, due to poor appetite, putting patients at risk for malnutrition.

·         Six smaller meals per day are advised instead of three meals.

·         The meals should provide enough energy and protein, and be appetizing in appearance and taste so as to encourage the patient to eat.

·         Include cereals, pulses, vegetables, fruits, protein-rich foods (milk, meats, eggs), energy-rich foods (oils, nuts, fats, seeds).

·         These can help get stronger as the medications keep fighting the infection.

·         While a healthy diet cannot cure you, a poor diet can make TB worse.

·         Weight loss and malnutrition can be an issue, so be careful. 

 

Tuberculosis Complications

  • Joint damage

  • Lung damage

  • Infection or damage of your bones, spinal cord, brain, or lymph nodes

  • Liver or kidney problems

  • Inflammation of the tissues around your heart

 

Prognosis of Tuberculosis:

The majority of patients with a diagnosis of TB have a good outcome. This is mainly because of effective treatment. Without treatment mortality rate for tuberculosis is more than 50%.

People with the following infection of TB:

  • Extremes of age, elderly, infants, and young children

  • Delay in receiving treatment

  • Radiologic evidence of extensive spread.

  • Severe respiratory compromise requiring mechanical ventilation

  • Immuno-suppression

  • Multidrug Resistance (MDR) Tuberculosis 

 

Luswang Shrestha

Registered Nurse

Danphe Care