Tuberculosis – infectious disease caused by a bacterium; that most commonly affects the lungs. It is a crippling and deadly disease, and is on the rise in both developed and developing countries. In the entire history of humankind, it is believed that tuberculosis has killed more people than any other disease (in shorter periods of time, the epidemics of the Black Death and AIDS have killed more). Globally, it is the leading cause of deaths resulting from a single infectious disease.
Tuberculosis is an old Disease possibly as old as mankind itself. It was early known as consumptive disease because it slowly but steady decays the human body. It may have evolved from Mycobacterium bovis; acquired by humans from domesticated animals around 15,000 years ago. In 354-322 BC – Aristotle wrote “When one comes near consumptives… one does contract their disease… The reason is that the breath is bad and heavy…In approaching the consumptive, one breathes this pernicious air. One takes the disease because in this air there is something disease producing.”
Symptoms of Tuberculosis:
Stages of TB:
- TB infection or latent TB – The TB germ is present in the body but there are no symptoms. The person is not infectious.
- Active TB or TB disease
- Coughing with or without sputum and/or blood– Weight loss
- Loss of appetite
- Night sweats
- Chest pain
Management of TB- Salient features
- Identification of TB is difficult specially that of extra pulmonary and is usually delayed until the disease is fairly advanced
- More common in patients with HIV
- Rising MDR and XDR strains
- Treatment is long and four or more drugs required for the simplest regimen
- Socioeconomic risk factors and crowding prevails to propagate the disease
- Ideally person must be isolated until non-infectious
- Side effects and toxicity common
- May prolong treatment
- May prolong infectiousness
Sir John Crofton “It is often not realized how venial a sin can result in ultimate disaster. It might be suggested that giving a risky combination of drugs, or even giving a drug alone, will not matter if it is only for a short time. It is true that it may not matter in a number of patients, but in some it can matter very much and may make all the difference between survival & death”. Thus it is important to give right combination of drugs for right duration of time for effective management of tuberculosis.