What is Tuberculosis (TB)?

Tuberculosis (TB) is an ancient disease that has silently killed more humans than both the world wars put together. It continues to be widespread in the third world. Nearly 1 Indian dies of it every minute. A scourge of the voiceless poor, man has neglected it. It is a chronic ailment mainly of the lungs, caused by a germ that transmits through air. Detected in time, it is curable; or else it results in prolonged suffering, consumption and death.

What are the symptoms of TB?

Suspicion of TB is the first crucial step towards its detection. One doesn’t have to be a doctor; anyone with a little common sense can notice early warning signs, think TB and thus expedite diagnosis.

You can do it. And you must, especially if you reside in a third world country. That way you can safeguard your children and family; you can be a watchdog in your neighborhood and community – a soldier in the global fight against TB.

Suspicion of TB should spring automatically in your mind.

How can you develop that sixth sense for TB?

All it takes is just 5 minutes!

Here we go:

A heart attack, appendix or kidney stone often arrive with a bang – with sudden excruciating pain and panic; the patient is rushed to a proper doctor.

In TB, there is no drama – no unbearable pains or high fevers, no panic. It sneaks in silently like a thief, settles down in the lungs and quietly gets to work; but it simply refuses to go away.

Diagnosis of TB is often delayed. Because, its symptoms are quite ordinary e.g. long-standing cough, low-grade fever and weight loss – often too mild to cause any alarm. The person keeps ignoring them as a common cold, seasonal flue or a smoker’s cough and fails for months to seek the advice of a proper doctor. However, please remember that if such symptoms persist for a long time (say over a month) and simultaneously cause some weight loss, it ought to arouse suspicion of TB in your mind.

1. Symptoms of Lung TB:

“Long-standing cough + low-grade fever + weight loss = think TB”.

Long-standing cough and low-grade fever coupled with weight loss are the commonest symptoms, because TB occurs mostly (80%) in the lungs.

So, the first real clue to TB is: A long duration of sickness (e.g. ‘cough & low grade fever’) with ‘weight loss’; more so if the person also has one of the following 2 conditions:

1. He has had in the past a close contact with an infective TB patient (say a family member).

2. Or, he has a risk factor that makes a person more vulnerable to TB, once infected e.g.:

Diabetes.

HIV infection.

Low immunity as is likely in poverty, under-nourishment, drug addiction, alcoholism etc.

Prolonged medication with:

Steroids (which are administered in asthma, skin disorders or fussy joint pains etc.).

Or some immunosuppressive drug (as given after organ transplant etc.).

In a high burden country like India where TB is common, all such high-risk individuals must remain extra vigilant and forewarned if ever “an illness of long duration with weight loss” should start to brew in them.

Please, always maintain a high index of suspicion in your mind, which is the key to early diagnosis. And don’t you worry; over-suspecting doesn’t hurt anyone; simple tests will easily rule out TB if that is so.

An illness of long duration + weight loss = suspect TB & investigate.

No awareness = No suspicion = No investigation = No diagnosis = No treatment = No cure.

Uncommonly, the person may cough out blood; the symptom triggers alarm – the ensuing panic in fact helps clinch early diagnosis – TB or no TB.

2. TB of organs other than lungs (Extra-pulmonary):

“Long duration of symptoms + low grade fever + weight loss = Think TB’

(Please notice ‘cough’ stands replaced here with ‘symptoms’, which could be any and wide-ranging)

Even though TB occurs mostly in the lungs, it can occur anywhere in the human body – from head to toe, e.g. lymph nodes, bones, joints, intestines, liver, kidneys or genitals etc. In such cases, local symptoms will naturally vary widely – according to the organ affected e.g.:

1. Palpable glands (often glued together in the form of a cluster) around the neck, underarms or groin etc.
2. Persistent swelling over a bone or a joint.
3. Deformity of backbone.
4. A palpable mass or fluid collection in the abdomen.
5. Chest pain, breathlessness and chest X-ray reveals fluid in pleural cavity or round shadows of glands.

The clinical picture, at times, can be quite confusing, even for doctors. However, a trained mind can discern the underlying “long duration of symptoms, low grade fever and weight loss”, which is invariably present, enough at least to arouse suspicion of TB – the first crucial step.

That’s why a temperature chart and weight records are invaluable tools for diagnosis.

‘Long duration of illness’ is the key pointer since TB is by nature a chronic disease. ‘What exactly are the symptoms’ is often less significant; ‘how long they have been troubling’ could be more suggestive of TB. Therefore, ask the patient “When were you absolutely alright?” This may turn out to be the most rewarding direct question by establishing the chronic nature.

How is TB diagnosed?

Lung TB:

Sputum positive cases: Suspecting TB is the first crucial step. Once ‘long duration of cough, low grade fever and weight loss’ give rise to suspicion of lung TB, the sick person is asked to cough deeply and forcefully and bring out his spit (called sputum), which is systematically tested under a microscope. Presence of the causative (TB) germs in his sputum irrefutably confirms the diagnosis of TB.

However, not all patients suffering from lung TB emit germs. In over half the cases, even repeated sputum tests would fail to demonstrate any germs. In such (sputum negative) chest symptomatic cases, the diagnosis is based upon indirect evidence – sighting abnormal shadows in his Chest X-rays.

Read More !

What are Do’s and Don’ts for a TB patient?

A TB patient must read, re-read and memorize this page; it will help protect his kids and family members.

These precautions are absolutely essential for a lung TB patient who is infectious i.e. his sputum tests positive for germs.

Do’s:

1.      Cover your mouth with a hanky (piece of cloth) while coughing. Wash and put this hanky in boiling water for 10 minutes daily before reuse.

2.      Spit only in a cup or a can and keep its lid closed. After 2-3 days pour kerosene oil, burn and bury it. Then take a fresh can. Don’t spit here and there.

3.      Or spit on small pieces of old newspaper and fold and collect them carefully in a corner; light a matchstick and burn them every evening.

4.      Give a good sputum sample for testing. Cough deeply, forcefully and repeatedly to bring out your phlegm; keep collecting the sputum for 2 hours and then hand over the cup with your name written on it to the laboratory.

5.      Take your medicines regularly and religiously as directed.

6.      Be an out door person. Spend most of your time out in the open – in a field, park, courtyard or roof. Don’t stay in closed, unventilated, crowded and congested rooms.

7.      Eat a healthy balanced diet that includes milk, green vegetables, pulses (daals), cheese, meat, eggs and fruits etc. Don’t waste money on non-seasonal costly fruits, which hardly provide any added advantage.

8.      Maintain your temperature chart; use thermometer twice a day and jot down the readings and prepare this chart.

9.      Maintain your bi-weekly weight chart.

Don’ts:

1.       Don’t give up treatment midway. TB treatment must always be taken for a minimum of 6 – 8 months. Incomplete treatment is a blunder. 60% patients discontinue medication as soon as symptoms subside and they begin to feel better. They are bound to suffer.

2.       No self-medication please.

3.       Don’t accept treatment from quacks. Consult only a qualified doctor (with at least an MBBS degree)

4.       Don’t ever miss even a single dose.

5.       Don’t leave behind even one tablet out of your quota of dose; swallow each and every pill religiously.

6.       Don’t accept substandard medicines. Take drugs manufactured only by well-known firms of international repute – reconfirm this diligently with your chemist and doctor.

7.       Don’t forget to check the date of expiry of medicines.

8.       Don’t change doctors and drug-regimes frequently and recklessly.

9.       No smoking, drinking alcohol, tobacco-chewing or drug addictions please.

10.   Don’t hesitate in giving your sputum samples repetitively, to record your weight every month or to seek a second opinion, if required.

11.    As long as you are still sputum positive, don’t pick up infants and small kids or kiss them. Don’t sleep with them or in the same room. Simply stay away from kids.

Within a month or two of effective treatment, sputum turns free from germs and the risk of transmission of infection recedes.

How can I protect my kids from catching infection?

Once you have carefully read and understood this 5-page ‘Know TB – no TB’ section, half the battle is won. Because, even this bit of knowledge can go a long way to prevent infection; a stitch in time saves nine.

In India, it is recommended that every newborn baby must be administered BCG vaccine at birth.

The disease is caused by a germ that spreads through the air – and not through touch, handshake, food or water. Since man-to-man transmission is through the air and we all breathe the same air, obviously no one – yes, no one – is immune to getting infected.

Now, if you learn how to spot a potential source of infection for you and your kid, and what to do towards prevention, it would be most useful.

1.  A sputum positive patient of lung TB is the primary source of infection:

When a full-blown patient of lung TB coughs, he throws out invisible germs into the air, exposing others who might inhale those germs and get infected. Once inhaled, the germ may attack the lungs and begin to slowly destroy tissues. No wonder TB mostly (80%) occurs in the lungs. And it is this form of disease i.e. lung TB which is capable of producing cough and germ emission and is thus notorious for the entire gamut of transmission – the primary concern for everyone engaged in TB control world over – public health institutions, governments and the WHO.

Not all TB patients emit germs; only those cases of lung TB are infective who, while coughing, spew germs into the air in the form of droplets of phlegm (sputum) – and which can be easily demonstrated through a simple sputum test in a laboratory.

However, most sputum positive patients too tend to turn germ free (non-infective) within a month of effective treatment. Meanwhile, they can minimize transmission by observing simple precautions

A useful thumb rule to work with TB patients is – No cough means no risk of infection.

2.  Please remember, several forms of the disease normally pose no risk of infection to others e.g.:

a.             Besides lungs, TB can occur anywhere in the human body from head to toe. When it occurs in organs other than lungs e.g. lymph glands, bones and joints, abdomen, brain or genitals etc., it is non-infective. Exception: A rare source of infection may be pus discharge from an open wound over a TB lesion in the skin, gland or bone, which may contain some active germs; so, don’t touch such a wound with bare hands, wash hands frequently and wash patient’s pus soaked clothes separately and in boiling hot water.

b.            Childhood TB.

c.            Even a lung TB patient under proper treatment whose sputum repeatedly tests negative for germs poses little risk to others.

3.  Animals:

TB also occurs in the animals. Some scientists point to history and blame the animal world as the source of origin of this scourge in humans – following domestication. Cat, dog, buffalo, and cow etc. are not immune. So, always pasteurize or boil the milk before drinking it and never sleep amidst a herd of cattle