What is tuberculosis?
Tuberculosis is an infectious disease caused by bacteria. They are mainly transmitted by air. Therefore, the lungs are usually affected. However, there are different forms of tuberculosis. Today, tuberculosis is curable, but there are also serious complications. These can lead to death, especially in immune-weakened people.
About 80 percent of the disease is primarily affected by pulmonary tuberculosis. But other organs such as the meninges (meninges), ribs (pleura), bones, urinary tract, digestive tract, skin and genital organs can also be infected by tuberculosis.
This occurrence in other organs (extra-pulmonary tuberculosis) arises either in the context of an initial infection, which is relatively rare, or by the fact that tuberculosis spreads after an infestation of the lungs through the bloodstream in the body.
Tuberculosis is mostly transmitted by air. This also explains the frequent occurrence of the lung as the most important entry site for the germs. The tuberculosis pathogens are transmitted very rarely via the digestive tract.
If one has injured itself on the skin, one can also infect with contact with infectious material also. The tuberculosis virus Mycobacterium bovis is transmitted by raw milk from diseased cows.
About one third of all people are infected with tuberculosis pathogens. About five to ten percent of them suffer from an active tuberculosis that needs to be treated. Almost all diseases and deaths (approximately 95 percent) occur in poorer countries.
According to the Tuberculosis Report of the World Health Organization (WHO) published in 2013, Asia and Africa are particularly affected. In India alone, more than two million new tuberculosis cases have occurred in 2012. Around seven million new cases were reported worldwide in the same year. Nearly one and a half million people died of tuberculosis during this period.
Any patient who suffers from tuberculosis has to be treated and has to be reported to health departmant. Personal data are registered and stored there. This obligation to register is also applicable if tuberculosis has led to death.
Affected persons should always deal with the questions “What is tuberculosis?”, “How is it treated?”, “What are the consequences of tuberculosis? This reporting obligation is also intended to prevent possible tuberculosis transmission and spread at an early stage.
Signs and symptoms of tuberculosis
In order to be able to answer the question of tuberculosis symptoms, one should first look at the individual stages. Signs of infection are found in tuberculosis also depends on the organs which are involved.
First stage of tuberculosis
After the first contact with a tuberculosis pathogen, special defence cells (T-lymphocytes) are sensitized after about eight weeks, which means that they react sensitively to a tuberculosis pathogen.
The pathogens are surrounded by defensive cells and are absorbed. Tuberculosis symptoms do not yet occur. This first stage of Tuberculois is also called latent tuberculosis infection (LTBI).
Second stage of tuberculosis
In the course of a tuberculosis, nodule-shaped, inflammatory changes can form that are enclosed by defensive cells. They are usually found in the lungs. If the adjacent lymph node is also involved, it is the so-called primary complex.
However, patients often do not show symptoms of tuberculosis. In some cases they complain of slight fever and unclear cough, dry or with little yellowish-green discharge. There may also be extreme night sweats.
As a result, affected people are forced to change their nightgown. In addition, the dizziness can cause loss of appetite, weight loss, fatigue and weakness. There is blood coughing and chest pain in severe chronicles. These tuberculosis symptoms are grouped under the term primary tuberculosis.
Third stage of tuberculosis
Sometimes the pathogens spread over the bloodstream. Little inflammation occurs in other organs, so-called “minimal lesions”. After years later, tuberculosis bacteria can still live there and can cause postprimary tuberculosis. If the shrinkage is not seen for decades after latent infection (LTBI), doctors also speak of a post-primary tuberculosis.
In about 80 percent of cases, the disease occurs again in the lungs. In the other cases of tuberculosis, pleura, lymph nodes outside the breast area, bones and joints are mainly affected.
Tuberculosis causes and risk factors
The shrinkage is caused by double-shaped bacteria that are mycobacteria. They can survive in certain defensive cells (mononuclear phagocytes). In addition, tuberculosis bacteria have a kind of wax tank. With over 95 percent, the Mycobacterium tuberculosis is the most common pathogen of tuberculosis in humans.
Other causes are M. bovis, which occurs mainly in cattle, M. africanum, M. microti, M. canetti and M. pinnipedii. These tuberculous pathogens are grouped into the Mycobacterium tuberculosis complex.
The tuberculosis incubation period, is usually between six and eight weeks. If the immune system works normally, the shrinkage will break out of only about five to ten percent of the infected within two years. However, the TBC can also become active years later, if the immune system is weakened. In addition, the number of tuberculosis pathogens is significant and how far these are harmful to humans.
Tuberculosis risk groups
Since the defence system plays a crucial role in, there are certain groups of the population who have an increased risk of developing tuberculosis. These include:
HIV-infected, AIDS patients
- Other patients in whom the immune system is suppressed (immunosuppressed).
- Drug addicts, smokers and alcoholics
- prison inmates
- Older people
- Diabetics and patients with renal failure
- Homeless and underprivileged
- Infants and children under four years (immature defense system)
- Inhabitants of countries with poor hygiene and extremely dense colonization
HIV infected people have a much higher risk of developing tuberculosis than HIV negatives. According to World Health Organization, almost 13 percent of all new Tuberculosis patients in 2012 also carry the HIV virus. Tuberculosis is considered to be the infection in which most AIDS patients die.
The most important thing is to think of a tuberculosis infection at all. The signs are not very characteristic. In approximately 15 percent of the cases, no tuberculosis symptoms occur. The infection is usually discovered accidentally, for example during a check-up at the family doctor or specialist for internal medicine.
Medical history (anamnesis) and physical examination
First, the doctor consults the patient after symptoms, for example:
Do you have mild fever?
Sweat at night very strong?
Have you lost a lot of weight lately?
In addition, already known tuberculosis infections are extremely important. In some cases, a new infection occurs due to tuberculosis bacteria in the body.
The doctor will also ask about past trips in order to learn the situation of a possible tuberculosis infection in abroad. Possible risk factors are just as important. The doctor also pays attention to known preconditions. These may be treated with medications that weaken the immune system and thus favour a tuberculosis infection.
Tuberculosis occurs mostly in the lungs, it is first examined by tapping and knocking. In this physical examination, the physician also goes to all other body regions.
If a doctor suspects a tuberculosis infection, a number of further investigative possibilities are available to him to confirm this suspicion:
Through a comprehensive examination of the blood, one checks values whose change speaks for the illness of a certain organ. In addition, inflammatory parameters (CRP, white blood cells) may be increased.
A radiograph of the chest can reveal possible inflammatory lesions.
CT (computed tomography)
If you can see nothing or only a little on a radiograph, doctors use a CT. Thus tuberculosis flocks can also be discovered, which are concealed for example by the clavicle. CT images are also helpful for inflammation elsewhere in the body (extrapulmonary tuberculosis).
IGRA (interferon gamma release assay)
This test is also a blood test. If a patient is infected with tuberculosis, special defense cells react. Therefore, special defense cells produce interferon gamma, which can be detected in test. This test is more accurate than the tuberculosis skin test.
If the X-ray image is conspicuous (shadows in the lung tissue) and the Tbc tests are positive, the bacteria must be detected directly. Specialists examine sputum, gastric, urine, menstrual blood and brain water (CSF) for tuberculosis pathogens. Doctors take tissue samples from the lungs or lymph nodes (biopsies) in some cases.
The aim of tuberculosis therapy is to heal. Each active tuberculosis must be treated. It does not matter whether it is an initial infection or a reactivated tuberculosis.
Take special care with open tuberculosis. Patients are generally hospitalized and isolated. If proper tuberculosis therapy has been initiated, the isolation can usually be abolished after three weeks. The affected person can then continue to be supervised at home (outpatient).
Tuberculosis treatment consist of two methods. These methods are medicine intake and surgery in some cases due to disease condition.
If a patient is treated correctly in time, tuberculosis is curable. If the patient is diagnosed several times and has a weakened immune system, the chances of a tuberculosis are reduced. In severe cases, pulmonary bleeding, lung collapse or blood poisoning with severe organ damage can occur.