Tuberculosis

What is tuberculosis?

Tuberculosis or TB for short is quite a rare disease in the U.K. This is because we generally have good living conditions and levels of immunisation are high. However, in recent years there has been an increase in the number of people in the U.K. with TB. This is mainly due to the increase in people travelling around the world.

What causes tuberculosis?

TB is a disease caused by the bacterium Mycobacterium tuberculosis. The bacteria can attack any part of the body but it usually affects the lungs. TB can infect people of all ages. Most people infected with the bacterium never go on to develop active TB.

What is tuberculosis infection?

The majority of people who breathe in TB bacteria and become infected are able to fight the bacteria and stop them from growing. However, they might get a mild illness, which will often go unnoticed or passed off as a cold or flu. The bacteria then become inactive, but remain in the body, this is known as TB infection. Those with TB infection have no symptoms, don’t feel ill and can’t spread TB to others, but they are at risk of developing TB later in life. The majority of people with tuberculosis infection will not even know they are infected. If you are diagnosed as having TB infection your doctor may suggest you have regular check-ups or if you are at risk of TB becoming active (e.g. you have H.I.V.) you may be prescribed a course of anti-TB medication.

What is active tuberculosis (TB disease)?

TB bacteria become active if the immune system can’t stop them from growing. If the germs become active they begin to grow and spread. The germs can move through the blood to infect the lungs and other parts of the body, such as the kidney, spine and brain.

Some people develop TB disease soon after becoming infected, because their immune system can’t fight the TB bacteria off. Whilst other people, may get sick sometime later when for some reason their immune system becomes weak. This is usually due to growing old or developing another serious illness. You can have a weak immune system for many reasons, especially so if you are infected with the H.I.V. virus as your ability to fight infection is very low.

How is tuberculosis spread?

Active TB of the throat and lungs is infectious. If active TB affects other parts of the body it is not infectious. When people who are infected with active TB of the throat or lungs cough, sneeze, laugh, or even talk, millions of tiny water droplets come out of their mouth and remain in the air. People who breathe in these germs are then at risk of becoming infected with TB. Normally a person has to be in close contact with the person who has active TB for a long period of time. This is why TB is most commonly spread when people are sharing the same living/working space for example the office or at home.

What are the signs and symptoms of active tuberculosis?

Symptoms of TB are varied and usually depend on the part of the body infected, however, the lungs are the most common target. The symptoms you experience with TB may include any of the following:

• Persistent cough.
• Chest pains.
• Weight loss.
• Coughing up blood or phlegm.
• Shortness of breath.
• Loss of appetite.
• Weakness or fatigue.
• Fever.
• Night sweats.

These symptoms can also occur with other types of lung disease, such aspneumonia, so it is important to visit your doctor for advice if you are worried about any of these symptoms.

How can I prevent getting tuberculosis?

A vaccine is available called a B.C.G. (Bacille-Calmette-Guerin), which will minimize the risks of you catching TB. The vaccine is given to children aged 12-13 at high school. The vaccine usually lasts for at least 15 years and you can only have it once. At the present time there is a shortage of the B.C.G. vaccine, if your child misses out on having a B.C.G. vaccination for a few months it doesn’t really matter. The B.C.G. vaccine programme has been resumed but it may take a while to clear the backlog.

If you travel to countries where TB is still a problem (parts of Africa and southeast Asia) and you have not been vaccinated you should ask your doctor if it is possible for you to have the vaccine.

How is tuberculosis diagnosed?

There are several skin tests which may be used to identify TB. One is known as the Mantoux test and another as the Heaf test. The Mantoux test is the same test that is given prior to the B.C.G. vaccination. The Mantoux test is not very reliable as it will usually produce a positive result if you have previously had the B.C.G. vaccine. The Heaf test is usually the preferred test.

Both tests are similar, they involve injecting a small amount of testing fluid called tuberculin under your skin, usually in the lower part of your arm. An examination will take place 2-3 days later if you have the Mantoux test, and 7 days later if you have the Heaf test. If the doctor detects a positive reaction around the area injected, this usually means that you have TB infection but not necessarily that the TB infection is active.

If this test is positive, the doctor may want to determine if you have active TB disease by performing a number of other tests. These tests may include a chest X-ray and a test of the phlegm you cough up.

If you have recently spent time with someone who has infectious TB, you may need to repeat the skin test a few weeks after the initial test as it can take several weeks after infection for your immune system to be able to react to the TB skin test.

What treatments are available for tuberculosis?

The good news is most people are completely cured of TB by a course of antibiotics prescribed by your doctor. The medication consists of about three or four antibiotics. This combination of antibiotics will need to be taken together for at least 6 months. You are given a combination of drugs to prevent the risk of the bacteria becoming resistant to one or more drugs.

After a few weeks of medication you will begin to feel better, however, like all medication it is vital that you finish the full course to achieve a full recovery. If TB is left untreated the infection can destroy the lungs and may cause death.

Can I be cured of tuberculosis?

Almost 100% of people with active TB can achieve a permanent cure after correct treatment. If TB is left untreated it can remain a very serious condition. People with TB can return to normal everyday routines once they have had a few weeks of treatment and feel well enough. Very few people have to be admitted to hospital.

Smoking can seriously damage your lungs. If you have been diagnosed with TB you should not smoke at all. Smokers are three times more at risk of infection than non-smokers. If you are finding it hard to give up don’t be afraid to ask your doctor or pharmacist for help.