Tuberculosis: Causes, Symptoms, Treatment and Prevention

Tuberculosis (TB) remains a major health problem, according to the World Health Organisation. In 2011, there were 1,533 new cases of TB reported among Singapore residents, which means that for every 100,000 people, 40 people were found to have active TB.


What is Tuberculosis?

Tuberculosis (TB) is an infectious disease caused by a germ known as Mycobacterium tuberculosis. Until about 50 years ago, there were no drugs to cure TB. Now, we have adequate facilities and the means to diagnose, prevent and treat it. Yet, we are still facing a worldwide epidemic. Worse, we are seeing an emergence of a TB germ that is resistant to the drugs used to treat the disease.

TB infections are spread by breathing in droplets containing the TB germs. When people who are infected cough or sneeze, they spray the germs into the air, infecting other people who inhale the germs.

Not everybody who is infected with the germ develops the disease. The body's immune system can block the TB germ, which can lie dormant in the body for years. TB develops in about 10 percent of those infected. 

Tuberculosis Causes and Risk Factors 

TB is an airborne disease transmitted through respiratory droplets from a person with the disease.

The risk of developing active TB is higher in:
People with prolonged close contact with someone known to have untreated TB
People with underlying medical conditions such as HIV infection and diabetes
People who have a weakened immune system, e.g. due to drugs or sickness
Persons who have poor nutritional status
Drug addicts

Tuberculosis Symptoms 

The following features raise the suspicion of TB:
A cough lasting longer than three weeks
Coughing up blood
Constant tiredness
Fever and night sweats
Loss of weight
Chest pain

Tuberculosis Complications

Tuberculosis can cause permanent lung damage if not treated early. It can also spread to other parts of the body such as the bones, intestine, brain and central nervous system, where it can lead to life-threatening complications. The most serious complication, however, is when TB infection recurs and the strains causing the disease are resistant to multiple anti-TB medications.

Tuberculosis Screening and Diagnosis

Consult your doctor if you have a cough that persists longer than three weeks, or any of the other symptoms. If you know of someone who has the same symptoms, encourage them to go as well. 

The common tests for TB are:
A chest X-ray which can show whether TB has damaged the lungs
A tuberculin skin test (Mantoux test), which shows if a person is likely to be infected with TB
A sputum test for smear and culture of TB germs

Tuberculosis Treatment 

Tuberculosis can be cured with anti-TB drugs. To be effective, the drugs must be taken exactly as prescribed. Treatment usually involves a combination of several different drugs. Because TB germs die very slowly, anti-TB drugs must be taken for six to nine months. You must continue to take your medicine until all the germs are killed, even if the symptoms of the disease go away and you start to feel better.

Incomplete TB treatment means that the germs in the body that survive continue to grow and multiply. But this time, they may develop resistance to the usual TB drugs. In such situations, a different set of drugs with more side effects must be taken for a longer period. The chance of a cure is also considerably reduced. What's more, the next person who gets infected, for example a family member, will have the same drug-resistant germs.

The World Health Organisation has advocated directly observed treatment (DOT) as the standard of care for TB patients. This means that TB treatment is supervised, usually at the polyclinics. Trained nurses will observe you taking the correct dosage and combination of medications under the Ministry of Health's DOT programme.

Tuberculosis Prevention 

TB is a preventable disease. People with the disease should be treated before it becomes active. One way to control the infection is to take careful precautions with people hospitalised with TB.

There are also measures you can take on your own to help protect yourself and others:
Complete the full course of your TB medications: TB bacteria have a chance to become resistant to most TB drugs if the full course of TB treatment is not completed. The mutant TB strains become deadlier and more difficult to treat.
Go for regular testing: skin testing is advised annually for those people whose immune system is weakened owing to HIV, or for those who have a substantially increased risk of exposure to the disease, such as healthcare workers.
Lead a healthy lifestyle: keep your immune system healthy by adopting healthy eating habits, exercising regularly and having enough sleep.
Prevent the spread of TB to family and friends: if you have active TB, you can help keep your family and friends from getting sick by:
Staying at home all the time, especially during the first two to three weeks of treatment
Covering your mouth with a tissue when you cough or sneeze, and wearing a mask in the presence of other people during the first few weeks of treatment
Disposing of dirty tissues by sealing them in a bag before throwing them away


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