Tuberculosis (TB) is a granulomatous disease of the lungs that is caused by inhaling a bacterial pathogen called Mycobacterium tuberculosis. It mainly affects the lungs but may also disseminate to other organs of the body.

You can make an appointment with a Pulmonologist in Karachi if you are suspecting a respiratory illness along with any of the signs and symptoms discussed below.

Prevalence

As per the figures documented by WHO in 2018, tuberculosis has affected about a quarter of the global population. TB is also accountable as the leading cause of mortality this year.

It has been studied that approximately 10% of recorded cases undergo secondary reactivation or miliary (spreading to other parts of the body) transformation, whereas 90% of them remain latent.

Risk Factors

Tuberculosis is carried mostly through aerosol, therefore overcrowding reduces the possibility of transmission, as does working in facilities such as nursing homes and hospitals, which raises the odds of coming into contact with TB patients. Anyone with a weakened or compromised immune system, such as HIV patients, diabetics, renal impairment, cancer, and malnourished patients, is at risk of contracting this condition.

Despite its rarity, a high occurrence of this disease has been correlated with climatic fluctuations throughout the year, such as low rainfall and low humidity.

Signs and Symptoms

The latent form of tuberculosis is asymptomatic. The active form can manifest the following symptoms:

  • Persistent cough lasting more than two to three weeks.
  • Hemoptysis (coughing up blood).
  • Chest pain.
  • Fatigue.
  • Night sweats.
  • Fever and chills.
  • Decreasing appetite.
  • Weight loss.

Miliary TB presents with signs and symptoms that correspond with the affected region.

Tuberculous meningitis is characterized by a constant or intermittent headache lasting more than a few weeks, with concomitant minor mental changes, and a fever that may or may not be present.

In terms of skeletal TB (also termed as Pott disease) can cause back pain and stiffness which if left untreated may lead to lower-body paralysis.

If tuberculosis disseminates to the genitourinary region, it manifests lower urinary tract symptoms (LUTS) such as dysuria, frequency, and urgency of urine. With any section of the gastrointestinal tract being affected, there are equal risks of developing ulcers, dysphagia, discomfort, malabsorption, diarrhoea, and hematochezia.

Diagnostic Workup

A thorough physical examination can yield important information to reach a diagnosis. The type of examination is determined by the organs involved. The presence of atypical breath sounds and crepitation in patients with pulmonary tuberculosis indicates consolidation. Mild mental disturbances, such as disorientation, can occur when the brain is involved. Lymphadenopathy is a painless lump that can be palpated in the mediastinal region.

The Mantoux tuberculin skin test is the most generally used diagnostic test which entails the injection of a small volume of fluid into the lower arm, followed by the observation of a reaction that is characterized by erythema (redness) and swelling. The patient is presumably positive in case of a reaction.

The consultant would tell you to get a blood test called interferon-gamma release assays (IGRAs) done that evaluates the response of TB proteins when combined with the blood sample withdrawn. The positive results can be reiterated by imaging modalities including a chest X-ray or CT scan to evaluate the lung tissue status.

The sputum of the patients can be run under acid-fast tests to check for the presence of M tuberculosis.

Complications

  • Brain damage
  • Inflammation of tissues around the heart
  • Joint damage
  • Liver or kidney problems
  • Lung damage
  • Spine damage

Treatment

To eradicate the dormant bacteria inside the body, the latent TB regimen includes isoniazid or rifampin, or a combination of the two for roughly 9 months. Depending on the severity of the TB infection, a four-drug regimen is followed for 6 to 12 months for active disease. Isoniazid, rifampin, pyrazinamide, and ethambutol are among the medications used to treat the disease. Additional drugs may be added to the treatment by the consultant if the strain is resistant or multi-resistant.

Prevention

Taking precautions while traveling and interacting on a regular basis can drastically reduce the pathogenic spread. When coughing or sneezing, one should always cover their mouth and avoid crowded locations, especially during the early phases of treatment. In places where tuberculosis is endemic, it is also critical to get immunized against it early in life through the BCG (Bacille Calmette-Guérin) vaccine.

You are recommended to visit a Pulmonologist in Lahore who can guide you through the prevention methods comprehensively.

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