Tuberculosis

Tuberculosis (TB) is an infectious disease caused by the bacteria Mycobacterium tuberculosis. This
rod-shaped bacterium, also called Koch's bacillus, was discovered by Dr. Robert Koch in 1882.
Tuberculosis generally affects the lungs, but can also affect other parts of the body such as the
kidney, spine and the brain.
Other bacteria that cause TB include:

Mycobacterium bovis
Mycobacterium africanum
Mycobacterium canetti
Mycobacterium microti

Symptoms

Latent TB. In this condition, the patient has a TB infection, but the bacteria remain in the
body in an inactive state and causes no symptoms. Latent TB, also called inactive TB or TB
infection, isn't contagious. It can turn into active TB, so treatment is important for the person
with latent TB and to help control the spread of TB. An estimated 2 billion people have latent
TB.

Active TB. This condition makes the personsick and can spread to others. It can occur in the
first few weeks after infection with the TB bacteria, or it might occur years later.

Signs and symptoms of active TB include:

Coughing that lasts three or more weeks

Coughing up blood

Chest pain, or pain with breathing or coughing

Unintentional weight loss

Fatigue

Fever

Night sweats

Chills

Loss of appetite

Tuberculosis can also affect other parts of the body-called extrapulmonary TB-, including the kidneys,
spine or brain. When TB occurs outside the lungs, signs and symptoms vary according to the organs
involved. For example, tuberculosis of the spine may give the patient back pain, and tuberculosis in
the kidneys might cause blood in the urine.

Risk Factors
Once a person is infected with TB bacteria, the chance of developing TB disease is higher if the
person:

Has HIV infection

Has been recently infected with TB bacteria (in the last 2 years)

Has other health problems, like diabetes, that make it hard for the body to fight bacteria

Abuses alcohol or uses illegal drugs

Was not treated correctly for TB infection in the past

Causes
Tuberculosis is caused by bacteria that spread from person to person through microscopic droplets
released into the air. This can happen when someone with the untreated, active form of tuberculosis
coughs, speaks, sneezes, spits, laughs or sings. As the infectious dose of TB is very small (the
inhalation of 10 bacteria may cause an infection), it is very contagious through the droplets in air.
About 90% of those infected with M. tuberculosis have asymptomatic, latent TB infections
(sometimes called LTBI), with only a 10% lifetime chance that the latent infection will progress to
overt, active tuberculous disease.

Complications

Spinal pain. Back pain and stiffness are common complications of tuberculosis.

Joint damage. Tuberculous arthritis usually affects the hips and knees.

Swelling of the membranes that cover the brain (meningitis). This can cause a lasting or
intermittent headache that occurs for weeks. Mental changes also are possible.

Liver or kidney problems. The liver and kidneys help filter waste and impurities from the
bloodstream. These functions become impaired if the liver or kidneys are affected by
tuberculosis.

Heart disorders. Rarely, tuberculosis can infect the tissues that surround the heart, causing
inflammation and fluid collections that may interfere with the heart's ability to pump
effectively. This condition, called cardiac tamponade, can be fatal.

Treatment
With TB, antibiotics have to be taken for at least 6 to 9 months. Treatment for TB depends on
whether it is active or latent. Most common TB drugs:

Isoniazid

Rifampin (Rifadin, Rimactane)

Ethambutol (Myambutol)

Pyrazinamide

With latent TB, only one type of TB drug is required. However with active TB, several drugs have to be
taken at once.
Multidrug-resistant TB (MDR TB)
MDR TB is TB that is resistant to at least two of the best Food and Drug Administration-approved
anti-TB drugs, isoniazid and rifampicin. These antibiotics are considered first-line drugs and are the
first medicines used to treat all persons with TB disease. Healthcare providers have to give the
patients second-line drugs which have more side-effects, the treatment lasts much longer and the
cost may be up to 100 times more than first-line therapy.
People with MDR TB may have to take several antibiotics, at least three to which the bacteria still
respond, every day for up to two years. Even with this treatment, however, between 4 and 6 out of 10
patients with MDR TB will die, which is the same rate seen with TB patients who are not treated.
Surgical resection is recommended for patients with MDR-TB whose prognosis with medical
treatment is poor. Procedures include the following:

Segmentectomy (rarely used) removal of a segment of lung

Lobectomy removal of a lobe of the lung

Pneumonectomy removal of lung (lung transplant would be needed)

Pleurectomy for thick pleural peel (rarely indicated) removal of part of pleura

Extensively drug-resistant TB (XDR TB)

XDR TB is a relatively rare type of TB that is resistant to isoniazid and rifampin, plus any
fluoroquinolone and at least one of three injectable second-line drugs (such as amikacin, kanamycin,
or capreomycin).
Treatment options for XDR-TB are very limited, and XDR-TB carries a very high mortality rate.

Vaccine
The only available vaccine as of 2011 is Bacillus Calmette-Gurin (BCG). In children it decreases the
risk of getting the infection by 20% and the risk of infection turning into disease by nearly 60%.
It is the most widely used vaccine worldwide, with more than 90% of all children being vaccinated.
The immunity it induces decreases after about ten years. As tuberculosis is uncommon in most of
Canada, the United Kingdom, and the United States, BCG is administered to only those people at
high risk. Part of the reasoning arguing against the use of the vaccine is that it makes the tuberculin
skin test falsely positive, so is of no use in screening.

Sources Used
1. http://www.cdc.gov/tb/topic/basics/default.htm
2. http://www.cdc.gov/tb/publications/factsheets/general/ltbiandactivetb.htm
3. http://www.mayoclinic.org/diseases-conditions/tuberculosis/diagnosistreatment/treatment/txc-20188961
4. https://www.nlm.nih.gov/medlineplus/tuberculosis.html
5. http://www.niaid.nih.gov/topics/tuberculosis/Understanding/WhatIsTB/ScientificIllustration
s/pages/newtbdrugs.aspx
6. http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/tuberculosis/diagnosingand-treating-tuberculosis.html
7. http://www.niaid.nih.gov/topics/tuberculosis/Understanding/Pages/overview.aspx
8. https://en.wikipedia.org/wiki/Tuberculosis#Causes
9. http://www.webmd.com/lung/understanding-tuberculosis-basics
10. http://emedicine.medscape.com/article/230802-overview