Tuberculosis is a transmittable and highly infectious disease. It can be difficult if not adequately identified, diagnosed and treated. The incidence of this disease is only growing and India now has one of the highest rate of people affected with it.
There are various certain constitutional symptoms of tuberculosis which are typical and are even rising like the evening rise of fever, weight loss, loss of appetite, weakness and fatigue. These typically would be over a period of time and one tends to take notice only after a few weeks or a month. However, with the pattern of tuberculosis changing and the emergence of drug-resistant TB, one would not necessarily get the classical symptoms of tuberculosis. Symptoms will be based on the part of the body affected, the other symptoms may vary. If the lungs are affected, one would also get cough which may be a dry cough or with sputum production, occasionally blood and breathlessness. If it affects the lining of the lung called pleural effusion, one may get a pain in the chest which is worse on taking a breath in along with cough and progressive breathlessness.
It may also affect the glands called lymph nodes, most commonly around the neck, one may get swelling with discolouration and discharge also. TB in the abdomen can present with non-specific abdominal pain, altered bowel habits, bowel obstruction, fluid in the abdomen. TB not only affects the glands the abdomen followed by bones are also highly affected. The bones can present as back pain, back spasms, less common symptoms would be unexplained small joint pain and swelling. One can also present with weakness of one or more limbs as a result.
TB of the brain can present with seizures, confusion and drop in consciousness levels. Less commoner occurrences can be in the eye, presenting with watering redness and reduced vision. TB affecting the uterus can present with menstrual cycle disorders and infertility. In summary, TB can affect pretty much any organ in the body. If you have any of the above symptoms, have had a course of treatment with antibiotics or other medication and your symptoms have not improved one should not wait and see a doctor at the earliest.
Also, if you have been in close contact with somebody diagnosed to have TB you must get yourself screened to check if you have contracted TB from the source. Especially if you have unexplained weight loss, cough, weakness. The contagious forms of TB are those affecting the lungs, larynx and airway and these need to be addressed promptly due to risk of cross infection.
How is tuberculosis transmitted is the question in hand. The commonest form of transmission of TB is when it affects the lung, airway or larynx. What determines infectivity is presence of a cough, cavity in the lung, sputum growing TB bacteria. Certain cautionary steps include the incidence is increased if a patient does not cover his or her mouth and nose when coughing. Not receiving treatment or having a prolonged illness, being non-compliant with medication and defaulting on medication are all increasing risk of contracting TB. One must maintain good hygiene which would include no spitting, cover your mouth when coughing and maintain cleanliness. For those already infected, emphasise on the importance of being compliant with treatment and maintain good hygiene. Densely populated areas including slums are at high risk, however there are no exclusions and it can cross-infect any strata of society.
There are various precautionary steps to indulge towards TB the various standard treatments for TB would include taking four different drugs for a period of six months to 12 months depending on the site. Compliance with these is a must, along with patient education. These drugs may have side effects and these would be explained when treatment is initiated. Eye testing is recommended prior to commencing treatment and if indicated, then blood tests to check kidney and liver function tests. If on testing, the patient is found to have mono/multiple drug resistance then the line of treatment differs. Depending on the amount of resistance, additional drugs including injections may be added and the duration can be extended upto 24 months. Surgery in extreme cases can be contemplated. If one does develop side effects, they must not stop medication under any circumstances and must consult their doctor at the earliest and follow their instructions.
The government has taken giant strides to create awareness and has had arrangements for free diagnosis and treatment under the RNTCP scheme, along with a public private initiative with private healthcare providers. Here, the registered healthcare provider can give vouchers to patients for diagnostics and also for treatment. They will notify the RNTCP team who will follow up on these patients.
– Dr Nimish Shah, Consultant Pulmonologist at Jaslok Hospital and Research Centre
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