Tuberculosis - Symptoms and causes

 Tuberculosis (TB) is a potentially serious infectious disease that primarily affects the lungs. The bacteria that cause tuberculosis are spread from one person to another through tiny droplets that are released into the air by coughing and sneezing.

Once rare in developed countries, tuberculosis infections began to rise in 1985, in part due to the emergence of HIV, the virus that causes AIDS. HIV weakens a person's immune system, so it cannot fight TB germs. In the United States, due to stricter control programs, tuberculosis began to decline again in 1993, but it remains a concern.

Many strains of tuberculosis are resistant to the drugs most used to treat the disease. People with active tuberculosis must take various types of medications for many months to eradicate the infection and prevent the development of resistance to antibiotics.

Symptoms

Although your body can harbor the bacteria that cause tuberculosis (TB), your immune system can usually keep you from getting sick. For this reason, doctors distinguish between:

Latent TB. In this condition, you have a tuberculosis infection, but the bacteria remain in your body in a dormant state and cause no symptoms. Latent TB, also called inactive TB or TB infection, is not 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 tuberculosis.

Active TB. This condition makes you sick and, in most cases, you can spread it to other people. It can occur in the first few weeks after infection with the tuberculosis bacteria or it can occur years later.

The signs and symptoms of active tuberculosis include:

  • Cough that lasts three or more weeks.
  • Coughing up blood
  • Chest pain or pain when breathing or coughing
  • Involuntary weight loss
  • Fatigue
  • Fever
  • Night sweats
  • Cold
  • Loss of appetite

TB can also affect other parts of your body, including your kidneys, spine, or brain. When tuberculosis occurs outside the lungs, the signs and symptoms vary depending on the organs involved. For example, tuberculosis of the spine can cause back pain, and tuberculosis of the kidneys can cause blood in the urine.

When to see a doctor

See your doctor if you have a fever, unexplained weight loss, heavy night sweats, or a persistent cough. These are often signs of tuberculosis, but they can also be due to other medical problems. Your doctor can run tests to help determine the cause.

The Centers for Disease Control and Prevention recommends that people who are at increased risk for TB be screened for latent TB infection. This recommendation includes people who:

  • Have HIV / AIDS
  • Using IV drugs
  • They are in contact with infected people.
  • They are from a country where tuberculosis is common, such as several countries in Latin America, Africa, and Asia.
  • Living or working in areas where tuberculosis is common, such as prisons or nursing homes.
  • Work in health care and treat people at high risk for tuberculosis.
  • They are children and are exposed to adults at risk of contracting TB

Causes

Tuberculosis is caused by bacteria that are transmitted from person to person through microscopic droplets that are released into the air. This can happen when someone with the untreated active form of TB coughs, talks, sneezes, spits, laughs, or sings.

Although tuberculosis is contagious, it is not easy to catch. You are much more likely to get TB from someone you live or work with than from a stranger. Most people with active tuberculosis who have received appropriate drug treatment for at least two weeks are no longer contagious.

HIV and tuberculosis
Since the 1980s, the number of tuberculosis cases has increased dramatically due to the spread of HIV, the virus that causes AIDS. HIV infection suppresses the immune system, making it difficult for the body to control tuberculosis bacteria. As a result, people with HIV are much more likely to contract TB and to go from latent disease to active disease than people who are not HIV positive.

Drug-resistant TB
Another reason TB remains a leading cause of death is the rise in drug-resistant strains of the bacteria. Since the first antibiotics were used to fight tuberculosis more than 60 years ago, some tuberculosis germs have developed the ability to survive despite drugs, and that ability is passed on to their descendants.

Drug-resistant strains of tuberculosis arise when an antibiotic fails to kill all of the bacteria that it targets. Surviving bacteria become resistant to that particular drug and often other antibiotics as well. Some tuberculosis bacteria have developed resistance to the most commonly used treatments, such as isoniazid and rifampin.

Some strains of TB have also developed resistance to drugs that are used less frequently in the treatment of TB, such as antibiotics known as fluoroquinolones and injectable drugs that include amikacin and capreomycin (Capastat). These drugs are often used to treat infections that are resistant to the most commonly used drugs.

Risk factors

Anyone can get TB, but certain factors can increase your risk of getting the disease. These factors include:

Weakened immune system
A healthy immune system often successfully fights off the TB bacteria, but your body cannot mount an effective defense if your resistance is low. Several diseases, conditions, and medications can weaken your immune system, including:
  • HIV AIDS
  • Diabetes
  • Severe kidney disease
  • Certain cancers
  • Cancer treatment, such as chemotherapy
  • Medications to prevent rejection of transplanted organs
  • Some medicines used to treat rheumatoid arthritis, Crohn's disease, and psoriasis.
  • Malnutrition
  • Very young or old age
  • Travel or live in certain areas
The risk of contracting TB is higher for people who live or travel to areas that have high rates of TB and drug-resistant TB, including:
  • Africa
  • Eastern Europe
  • Asia
  • Russia
  • Latin America
  • Caribbean Islands
Poverty and substance use
  • Lack of medical care. If you are on a low or fixed income, live in a remote area, have recently immigrated to the United States, or are homeless, you may not have access to the medical care necessary to diagnose and treat tuberculosis.
  • Use of substances. Using intravenous drugs or excessive alcohol weakens your immune system and makes you more vulnerable to tuberculosis.
  • Tobacco use. Tobacco use greatly increases the risk of contracting tuberculosis and dying from it.
Where do you work or live
  • Sanitary work. Regular contact with sick people increases your chances of exposure to the tuberculosis bacteria. Wearing a mask and washing your hands frequently greatly reduces your risk.
  • Live or work in a residential care facility. People who live or work in prisons, homeless shelters, psychiatric hospitals, or nursing homes are at higher risk of contracting tuberculosis. That's because the risk of the disease is higher anywhere where there are crowding and poor ventilation.
  • Living in or emigrating from a country where tuberculosis is common. People in a country where TB is common may be at high risk for TB infection.
  • Living with someone infected with TB. Living with someone who has TB increases your risk.
Complications
Without treatment, tuberculosis can be fatal. The active untreated disease usually affects your lungs, but it can spread to other parts of your body through the bloodstream. Examples of complications from tuberculosis include:
  • Back pain. Back pain and stiffness are common complications of tuberculosis.
  • Joint damage Tuberculous arthritis usually affects the hips and knees.
  • Inflammation of the membranes that cover your brain (meningitis). This can cause a long-lasting or intermittent headache that lasts for weeks. Mental changes are also possible.
  • Liver or kidney problems The liver and kidneys help filter waste and impurities from the bloodstream. These functions are affected if the liver or kidneys are affected by tuberculosis.
  • Heart disorders In rare cases, tuberculosis can infect the tissues around your heart, causing inflammation and fluid build-up that can interfere with your heart's ability to pump effectively. This condition, called cardiac tamponade, can be fatal.
Prevention

If you test positive for latent TB infection, your doctor may recommend that you take medications to reduce the risk of developing active TB. The only type of contagious tuberculosis is the active variety when it affects the lungs. So if you can prevent your latent TB from becoming active, you won't pass TB on to anyone else.

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