Tuberculosis
What is Tuberculosis ?
Tuberculosis (TB) is an infectious disease commonly caused by the bacillus “Mycobacterium tuberculosis”. People also can get infected with other types of bacteria in the Mycobacterium group. In majority of cases, TB affects the lungs (Pulmonary TB). But it also can affect any part of the body (Extra pulmonary TB). Pulmonary TB can be sputum smear positive (which is infectious as sputum of the patient contains large amounts of tubercle bacilli) and sputum negative TB.
Why we are more concerned about TB ?
• TB is still considered as a priority public health problem in many countries of the World including Sri Lanka.
• TB is a disease associated with poverty.
• Around 1/3 of people in the world are infected with TB.
• In 2012, there were estimated 8.6 million new cases of TB in the world and over one million deaths occur due to TB in the world.
• Most of the people affected are in the economically active age group.
• TB is the second largest cause of deaths due to infectious diseases.
• TB accounts for ¼ of the deaths occurred among women.
• Around 10 million children have become orphaned as a result of parental deaths caused by TB in 2009
How does it spread ?
Tuberculosis spreads through air. When a patient with infectious pulmonary tuberculosis coughs, sneezes or laughs, bacilli are expelled into the air in the form of tiny droplets. When a healthy person inhales these droplet nuclei containing the tubercle bacilli, he/she may become infected.
An untreated sputum positive patient has the potential to infect 10-15 persons per year. The risk of transmission of infection from sputum negative patients and from patients with extra pulmonary TB is very much lower.
Who can get TB ?
Anyone can get TB, but it is a difficult disease to catch. Only around 10% of people infected with TB bacilli will develop the disease in their lifetime. Some people are at higher risk of getting TB. They are,
• Close contacts of TB patients
• Children
• Elderly people
• People with Diabetes
• People on steroids (e.g. Prednisolone)
• People on other drugs affecting the body’s defense system such as anti-cancer drugs)
• People who are HIV-positive
• People who are dependent on drugs or alcohol
• People who are malnourished.
• People living in overcrowded places without adequate lighting and ventilation.
What are the common symptoms of TB ?
Cough more than two weeks is the commonest presenting symptom of pulmonary tuberculosis. This may or may not accompany with hemoptysis, shortness of breath, chest pain, fever and night sweets, loss of appetite, loss of weight and fatigue.
Symptoms of the extra pulmonary TB depend on the organ affected and also can be associated with symptoms such as fever, night sweats, loss of weight and fatigue.
How do we diagnose TB ?
The most common method of diagnosing TB is sputum smear microscopy, in which bacteria are observed in sputum samples of a patient examined under a microscope.
In addition to that chest x-rays and sputum cultures are also used for diagnosis of TB. At present more advanced diagnostic procedures are also available for diagnosis.
How can we obtain a good sputum sample for microscopic examination?
A patient suspected of having TB should submit 3sputum samples for microscopic examination. The samples should be collected in a following manner.
First spot specimen – Supervised spot specimen at the first visit.
Early morning specimen – Patient is given a sputum container to collect early morning specimen on the following day.
How to get a good sample of sputum ?
Patient should
1. Rinse mouth with water
2. Inhale deeply 2-3 times with mouth open
3. Cough out deeply from the chest
4. Open the container and bring it closer to the mouth
5. Spit out the sputum into it and close the container
To avoid spreading infection to others, sputum should be collected in an open air and as far as possible from other people. If situation does not permit to collect sputum in out door, it should be taken in a separate room with adequate ventilation.
Is there a cure for TB ?
Yes, TB can be completely cured.
But you have to take treatment for 6 months regularly without any interruption.
What will happen, if a patient does not take treatment regularly or discontinue treatment ?
In such instance, TB bacilli become resistant to anti TB drugs. This situation is called as Multi Drug resistant TB (MDRTB). MDR TB is difficult to treat and needs more costly drugs for longer durations.
It also may lead to death of a patient.
What is Directly Observed Treatment (DOT) ?
Directly Observed Treatment is one of the most important strategies in TB control. This strategy is recommended by the WHO as most appropriate method of treatment and widely used by the most of the countries in the world.
In DOTs strategy, patient swallows the tablets under the direct observation of a health worker or a trained person. It ensures that a TB patient takes the right anti- tuberculosis drugs, in the right doses at the right intervals without interruption and ensures that the patient completes the full course of treatment.
Why it is necessary to directly observe the medication ?
Though a patient should take anti TB treatment for 6 months duration, most of the symptoms disappear after few weeks of commencing the treatment. Most of the patient may stop treatment when they get better without completing the treatment regimen. DOTS strategy is adopted to overcome this situation and to achieve the maximum compliance to treatment.
What tasks we have to do as DOT Providers ?
• We should observe the patient when he is swallowing drugs.
• We should fill the treatment card accurately once the patient swallows his drugs.
• We should encourage them to come for treatment regularly.
• We should ensure that, there are enough drugs for the patient to continue drugs.
• We should always seek advice from a health worker/ refer patients to a health worker when problematic situations occur.
• Should send patients for sputum examination on due dates.
What is the current situation of TB in Sri Lanka
• In Sri Lanka, around 9000 – 10,000 patients of TB are diagnosed annually.There were 9406 cases of TB in 2013.
• Out of them 8767 were new cases.
• Around half of them (4423) were sputum smear positive patients, who can transmit the infection to others.
• Majority of cases are reported from the urban settings. Colombo District accounts for the 20% of the cases detected in 2013.
What we can do to prevent spread of TB ?
• We can help people to learn more about TB, It will help them to seek health care if necessary.
• We know each other in the community where we live. Therefore, we can easily find people who are suspected having TB and direct them to a doctor/health worker/ health centre.
• We can identify people, those who are at higher risk for getting TB in our community and we can help health workers to arrange screening programmes for them.
• We can function as DOT providers for TB patients.
What are important messages that should be given to the community ?
• TB is an infectious disease which spreads through airborne droplets.
• Every person who has cough more than 2 weeks should be investigated for TB.
• Sputum smear microscopy is the best method of diagnosing TB and people can get their sputum checked at a microscopy centre, closest to his home free of charge.
• TB is completely curable and patient should take proper treatment without interruption for 6 months.
• Getting proper treatment regularly ensure complete cure and prevent acquiring Multi Drug Resistant TB.
• Daily DOTs ensures regular intake of treatment.
• TB is a disease of the poor. Overcrowding, poor living conditions favour the spread of the disease.