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Tuberculosis Info"Tuberculosis Information - Tuberculosis Symptoms, Treatments and Causes Table of Contents Overview Is tuberculosis a problem in the United States? What caused tuberculosis to return? How do people catch tuberculosis? Tuberculosis Symptoms What is "active" disease? How is tuberculosis diagnosed? Can tuberculosis be cured? Why is it so important to finish all of the tuberculosis medicine? Tuberculosis Treatments How is tuberculosis prevented? Is there a vaccine for tuberculosis? How is M. tuberculosis infection different in people with HIV infection? How is research helping the fight against tuberculosis? Keeping on Top of Your Condition Overview Many people think tuberculosis (TB) is a disease of the past. But, tuberculosis is still a leading killer of young adults worldwide. Some 2 billion people – one-third of the world's population – are infected with the tuberculosis bacterium, M. tuberculosis. tuberculosis is a chronic bacterial infection. It is spread through the air and usually infects the lungs, although other organs are sometimes involved. Most persons that are infected with M. tuberculosis harbor the bacterium without symptoms but many develop active tuberculosis disease. Each year, 8 million people worldwide develop active tuberculosis and 3 million die. Is tuberculosis a problem in the United States? In the United States, tuberculosis has re-emerged as a serious public health problem. In 2001, based on provisional data reported to the U.S. Centers for Disease Control and Prevention, the number of cases has decreased for the ninth straight year to 15,991 cases of active tuberculosis (infection with full-blown disease symptoms). This all-time low is due largely to improved public health control measures. In addition to those with active tuberculosis, however, an estimated 10 to 15 million people in the United States are infected with M. tuberculosis without displaying symptoms (latent tuberculosis) and about one in ten of these individuals will develop active tuberculosis at some time in their lives. Minorities are affected disproportionately by tuberculosis: 54 percent of active tuberculosis cases in 1999 were among African-American and Hispanic people, with an additional 20 percent found in Asians. What caused tuberculosis to return? Cases of tuberculosis dropped rapidly in the 1940s and 1950s when the first effective antibiotic therapies for tuberculosis were introduced. In 1985, however, the decline ended and the number of active tuberculosis cases in the United States began to rise again. Several forces, often interrelated, were behind tuberculosis's resurgence: The HIV/AIDS epidemic. People with HIV are particularly vulnerable to turn infection with M. tuberculosis into active tuberculosis and are also more sensitive to developing active tuberculosis when they are first infected with the tuberculosis germ. Increased numbers of foreign-born nationals from countries where many cases of tuberculosis occur, such as Africa, Asia, and Latin America. tuberculosis cases among those persons now living in the US account for nearly half of the national total. Increased poverty, injection drug use, and homelessness. tuberculosis transmission is rampant in crowded shelters and prisons where people weakened by poor nutrition, drug addiction, and alcoholism are exposed to M. tuberculosis. Failure of patients to take their prescribed antibiotics against tuberculosis as directed. Increased numbers of residents in long-term care facilities such as nursing homes. Many develop active tuberculosis from infections with M. tuberculosis that occurred much earlier in life because their general health has declined. Other elderly people, especially those with weak immune systems, become newly infected with M. tuberculosis and can rapidly develop active tuberculosis. How do people catch tuberculosis? tuberculosis is primarily an airborne disease. The disease is spread from person to person in tiny microscopic droplets when a tuberculosis sufferer coughs, sneezes, speaks, sings, or laughs. Only people with active disease are contagious. It usually takes lengthy contact with someone with active tuberculosis before a person can become infected. On average, people have a 50 percent chance of becoming infected with M. tuberculosis if they spend eight hours a day for six months or 24 hours a day for two months working or living with someone with active tuberculosis. However, people with tuberculosis who have been treated with appropriate drugs for at least two weeks are no longer contagious and do not spread the germ to others. Adequate ventilation is the most important measure to prevent the transmission of tuberculosis. Tuberculosis Symptoms Between two to eight weeks after being infected with M. tuberculosis, a person's immune system responds to the tuberculosis germ by walling off infected cells. From then on the body maintains a standoff with the infection, sometimes for years. Most people undergo complete healing of their initial infection, and the bacteria eventually die off. A positive tuberculosis skin test, and old scars on a chest x-ray, may provide the only evidence of the infection. If, however, the body's resistance is low because of aging, infections such as HIV, malnutrition, or other reasons, the bacteria may break out of hiding and cause active tuberculosis. What is "active" disease? One in ten people that are infected with M. tuberculosis may develop active tuberculosis at some time in their lives. The risk of developing active disease is greatest in the first year after infection, but active disease often does not occur until many years later. Early symptoms of active tuberculosis can include weight loss, fever, night sweats, and loss of appetite, or they may be vague and go unnoticed by the affected individual. One in three patients with tuberculosis will die within weeks to months if the disease is not treated. For the rest, their disease either goes into remission (halts) or becomes chronic and more debilitating with cough, chest pain, and bloody sputum. Symptoms of tuberculosis involving areas other than the lungs vary, depending upon the organ affected. How is tuberculosis diagnosed? Doctors can identify most people infected with M. tuberculosis with a skin test. They will inject a substance under the skin of the forearm. If a red welt forms around the injection site within 72 hours, the person may have been infected. This doesn't necessarily mean he or she has active disease. Most people with previous exposure to M. tuberculosis will test positive on the tuberculin test, as will some people exposed to bacteria that are related to the tuberculosis germ. If a person has an obvious reaction to the skin test, other methods can help to show if the individual has active tuberculosis. In making a diagnosis, doctors rely on symptoms and other physical signs, a person's history of exposure to tuberculosis, and x-rays that may show evidence of M. tuberculosis infection. The doctor also will take sputum and other samples, to see if the tuberculosis bacteria will grow in the lab. If bacteria are growing, this positive culture confirms the diagnosis of tuberculosis. Because M. tuberculosis grows very slowly, it can take four weeks to confirm the diagnosis. An additional two to three weeks usually are needed to determine which antibiotics the bacteria are susceptible to. Can tuberculosis be cured? With appropriate antibiotic treatment, tuberculosis can be cured in more than nine out of ten patients. Successful tuberculosis treatment depends on close cooperation between the patient and doctor and other health care workers. Tuberculosis treatment usually combines several different antibiotic drugs which are given for at least six months, sometimes for as long as 12 months. Patients must take their medicine on time every day for the 6 to 12 months. Some tuberculosis patients stop taking their prescribed medicines because they may feel better after only a couple of weeks of treatment. Another reason they may stop taking their medicine is because tuberculosis drugs can have unpleasant side effects. Why is it so important to finish all of the tuberculosis medicine? If patients don't take all their medicine the way their doctor tells them, they can become sick again and spread tuberculosis to their friends and family. Additionally, when patients do not take all the drugs the doctor has prescribed or skip times when they are supposed to take them, the tuberculosis bacteria learn to outwit the tuberculosis antibiotics, and soon those medications no longer work against the disease. If this happens, the person now has resistant tuberculosis infection. Some patients have disease that is resistant to two or more drugs. This is called multidrug-resistant tuberculosis or MDR-tuberculosis because the tuberculosis germ, M. tuberculosis resists eradication with more than drug. This form of tuberculosis is much more difficult to cure. Tuberculosis Treatments Treatment for MDR-tuberculosis often requires the use of special tuberculosis drugs, all of which can produce serious side effects. To cure MDR-tuberculosis, patients may have to take several antibiotics, at least three to which the bacteria still respond, every day for up to two years. However, even with this treatment, between four and six out of ten patients with MDR-tuberculosis will die, which is the same as for patients with normal tuberculosis who do not receive treatment. How is tuberculosis prevented? tuberculosis is largely a preventable disease. In the United States, doctors try to identify persons infected with M. tuberculosis as early as possible, before they have developed active tuberculosis. They will give a drug called isoniazid (INH) to prevent the active disease. This drug is given every day for 6 to 12 months. INH can cause hepatitis in a small percentage of patients, especially those older than 35 years. A nurse may watch the patients take their medicine to make sure all pills are taken. Hospitals and clinics can take precautions to prevent the spread of tuberculosis. Precautions include using ultraviolet light to sterilize the air, special filters, and special respirators and masks. Until they can no longer spread the tuberculosis germs, tuberculosis patients in hospitals should be isolated in special rooms with controlled ventilation and airflow. Is there a vaccine for tuberculosis? In those parts of the world where the disease is common, the World Health Organization (WHO) recommends that infants receive a vaccine called BCG made from a live weakened bacterium related to M. tuberculosis. BCG vaccine prevents M. tuberculosis from spreading within the body, thus preventing tuberculosis from developing. However, the vaccine has its drawbacks. It does not protect adults very well against tuberculosis. In addition, BCG interferes with the tuberculosis skin test, showing a positive skin test reaction in people who have received BCG vaccine. In countries where BCG vaccine is used, the ability of the skin test to identify persons that are infected with M. tuberculosis is limited. Because of these limitations, more effective vaccines are needed and BCG is not recommended for general use in the United States. How is M. tuberculosis infection different in people with HIV infection? The World Health Organization (WHO) estimates that 10 million people worldwide are infected with the M. tuberculosis bacterium and HIV virus at the same time. The primary cause of death in these patients is from tuberculosis, not AIDS. In the United States, it is estimated that about 2 out of ten persons who have tuberculosis are also infected with HIV. One of the first indications that a person is infected with HIV may be that he or she suddenly develops tuberculosis. This form of tuberculosis often occurs in areas outside the lungs, particularly when the patient is in the later stages of AIDS. In the United States, it is much more likely for persons infected with M. tuberculosis and HIV to develop active tuberculosis than it is for someone that is only infected with M. tuberculosis. However, tuberculosis disease can be prevented and cured, even in people with HIV infection. People with MDR-tuberculosis that are also infected with HIV appear to have a more rapid and deadly disease course than do those patients with MDR-tuberculosis who are otherwise healthy. If no medicines are available for these patients as many as eight out of ten may die, often within months of diagnosis. Diagnosing tuberculosis in HIV-infected people is often difficult. HIV infected patients frequently have disease symptoms similar to those of tuberculosis, and may not react to the standard tuberculosis skin test because their immune system does not work properly. X-rays, sputum tests, and physical exams may also fail to provide evidence of infection with M. tuberculosis in HIV-infected individuals. How is research helping the fight against tuberculosis? tuberculosis research supports not only studies to better understand how M. tuberculosis infects and causes disease in humans but also how the human immune system responds to it. This research will help to develop new tools to diagnose tuberculosis, find better vaccines, and new medicines against tuberculosis. Below are some important advances that have been made in tuberculosis research: Diagnosis: Potential new tests to speed the diagnosis of tuberculosis from four weeks to two days; differences found in the DNA of M. tuberculosis and the bacterium used in the BCG vaccine may lead to a test to tell the difference between people who really have tuberculosis and those who only react to previous BCG vaccination. Treatment: Discovery of the molecules responsible for drug resistance, knowledge that will help doctors quickly select the best treatments for their patients; a new drug under study can be taken less often to help patients comply with their treatment regimen. Vaccines: More than 90 vaccine candidates have been developed and tested in animals. Keeping on Top of Your Condition Keeping in tune with your disease or condition not only makes treatment less intimidating but also increases its chance of success, and has been shown to lower a patients risk of complications. As well, as an informed patient, you are better able to discuss your condition and treatment options with your physician. A new service available to patients provides a convenient means of staying informed, and ensures that the information is both reliable and accurate. If you wish to find out more about HealthNewsflash's innovative service take the tour. " |
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