TB mostly (80%) occurs in the lungs.
Extra-pulmonary TB:
TB can occur anywhere in the human body – from head to toe. When it occurs in organs other than the lungs, it is called extra-pulmonary TB. Depending upon the organ involved, it can present with any sort of tricky symptoms:
· Swollen glands and discharging sinuses around neck: cervical lymph nodes TB.
· Pain, swelling, abscess over backbone / along ribs with crooked posture / gait: backbone / rib TB.
· Pain, swelling, abscess over usually a single joint.
· Fluid collection in the abdomen (ascitis): TB of intestines, peritoneum or lymph glands etc.
· Constipation, vomiting, distension and pain abdomen: sub-acute intestinal obstruction.
· Painless bleeding, pus discharge in the urine: kidney TB.
· Failure to become pregnant (Primary sterility): TB of female reproductive organs.
· Non-healing skin wounds.
However, behind a confusing picture, you can commonly discern that familiar streak of “long duration of illness, low-grade fever and weight loss” provided you have learnt to maintain a high index of suspicion of this ailment at the back of your mind.
A temperature chart, weight records and listening carefully to the patient’s story often prove crucial towards arriving at a diagnosis.
Since presence of germ can’t usually be demonstrated, diagnosis of ‘TB in organs other than lungs’ is often not straight forward as is in lung TB. The clincher here is Biopsy of the affected organ and its histopathology and which is not always feasible. At times, there is no option but to treat on the basis of suspicion alone.
9. Myth: Exposure to a TB patient leads to infection and infection means sure disease.
Being infected is not synonymous with falling sick with TB. These are two different things.
Inhaling TB germs doesn’t necessarily lead to clinical disease. Robust body immunity is able to keep illness at bay. Fortunately, only 10% of those fully exposed to the germ will fall sick with TB. The rest (90%), though infected, remain forever healthy. That’s why after years of clinical work, most doctors and nurses remain fit.
Once they gain entry into the healthy lungs, TB germs may quietly settle down – as seeds of potential disease in future. As the time passes, the risk keeps receding. However, TB germs are known to remain dormant for several years without bothering the host and then suddenly may reactivate and cause sickness.
Can I lead a normal healthy life once I am infected with TB?
Yes. Of course, if you are an Indian adult, chances are that you already are doing so.
In India, since there is no dearth of sputum positive TB patients, 40% of the citizens, by the time they attain adulthood, tend to get exposed and infected unknowingly. Of them, very few actually fall sick; most continue to lead a normal life.
Doctors and nurses are highly likely to get infected. But, thanks to good body immunity, most of them remain fit and lead a normal healthy life.
It is estimated that one third of the globe’s population is infected with TB germ.
10. Myth: After a couple of months of proper TB treatment, symptoms subside and the patient feels much better. Thereafter, the patient can safely stop anti-TB medicines.
The root cause of man’s failure in TB control is nothing but this very misconception.We know that TB is curable. Effective anti-TB medicines have been available since 1950’s. However, there is one problem – Treatment of TB is pretty long. Medicines must be taken for a minimum of 6 to 8 months for complete cure.
Most patients discontinue medication prematurely, once their symptoms abate within a couple of months. In India, about 60% TB patients never completed the full course and risked relapse and complications.
This large-scale non-adherence to treatment is the single largest challenge to TB control worldwide and which has necessitated DOT – an instrument to keep a close watch over patient all along till he is fully cured. Death is not because TB is incurable; it is often due to premature discontinuation of treatment!
Please read: ADEM (14-16) I am OK now (Ashok).
11. Myth: To cough out blood with sputum (phlegm) means sure shot TB.
No doubt, some TB cases do cough out blood stained sputum or frank blood. Others may even vomit out blood. They may do so before being diagnosed, during the long course of TB treatment or even long after they have been fully cured. However, this is not a sure sign of active TB.
Please remember, presence of germs in the sputum (and not blood) is diagnostic criteria of TB.
Blood in spit may also occur due to several non-TB causes like – bleeding gums or teeth, sore throat, ulcers in mouth, nose bleed, pneumonia, peptic ulcer, bleeding disorders, cancer or idiopathic (of unknown origin). Blood with cough is NOT synonymous with TB. Look for germs in sputum.
12. Myth: I am educated and well off. I live in a posh colony. I can never catch TB – a disease of poverty. I don’t need to know a word about TB.
Nothing can be farther from truth. Educated, rich person like you who has access to the internet has greater social responsibility to the ignorant and poor around you.Besides, storms don’t send a post card of warning. And one can’t learn navigation in the midst of a storm. Now is the time to learn a little bit. Every two-wheeler rider is required to wear a helmet; not every one meets with accident. It is for prevention – just in case.
Similarly, if you live in a high burden country like India, smart thing is to gather sufficient knowledge about this common ailment, and right now, which would protect like a helmet. It would mean – a high index of suspicion, an early diagnosis, diminished transmission, correct treatment and full cure for someone, a kin or a neighbor – in other words prevention.
No doubt, a pre-requisite for TB ailment is to get infected with its germ, chances of which are higher in high TB burden communities of the third world. Obviously, the disease can’t occur without exposure to / entry of the causative germ. Since transmission is through air and each one breathes the same air, no one is immune to getting infected. However rich, you can possibly catch infection from your sick driver, servant, barber, tailor, domestic help or an office colleague. And once you are aware, you can help them immensely. And yourself.
Lack of awareness, unhygienic and congested living (e.g. in a slum) no doubt promotes chances of infection from an infective patient nearby or within the family