Tuberculosis (TB): Types, Pathogenesis, Causes, Signs, Symptoms, Diagnosis and Treatment (Medical and Alternative Remedies)

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. It is the third leading cause of death from infectious diseases worldwide, primarily affecting individuals living in poor conditions, particularly in sub-Saharan Africa. Each year, over 8 million new cases are reported globally. TB incidence is significantly higher in Africa, with rates around 13%, compared to less than 1% in Asian countries. The disease is common among intravenous drug users and HIV patients. While TB can affect anyone, those most at risk include individuals living with active TB patients, the impoverished, residents of high-prevalence countries, nursing-home residents, prison inmates, alcoholics, intravenous drug users, diabetics, cancer patients, HIV-positive individuals, and healthcare workers. Due to frequent relapses and multidrug resistance, pulmonary tuberculosis remains a major public health issue in Africa and is a leading cause of death.


Causes


TB is mainly caused by the bacterium Mycobacterium tuberculosis or Mycobacterium Koch (BK). It spreads through inhalation of infected air from close contact with an infected person who coughs, sneezes, shouts, or spits. TB is not transmitted through casual contact or touching contaminated items. Once inhaled, the bacteria infect the lungs, leading to local lung infections (pneumonia) and potentially enlarging local lymph nodes. TB can also spread to other body parts. Atypical TB, caused by Mycobacterium bovis, is transmitted through unpasteurized milk but is now rare due to pasteurization. Other causative agents include Mycobacterium africanum and Mycobacterium canetti (mainly in Djibouti).


Signs and Symptoms


TB can remain dormant for years without symptoms. Common symptoms include generalized fatigue, fever, weight loss, coughing, and night sweats. The disease progresses in two phases:

Early Phase: Symptoms include evening fever, significant weight loss, fatigue, loss of appetite, absence of menstruation (in women), and night sweats.

Advanced Phase: Characterized by a chronic cough lasting over three weeks with muco-purulent or blood-stained sputum, chest pain, and shortness of breath, combined with early-phase symptoms.


Investigations


Diagnosis involves skin tests, chest X-rays, sputum analysis (smear and culture), and PCR tests to detect bacterial genetic material.


Treatment


Modern Treatment

Inactive TB: Treated with the antibiotic isoniazid (INH) to prevent activation.

Active TB: Treated with a combination of INH and other drugs, including rifampin (Rifadin), ethambutol (Myambutol), pyrazinamide, and streptomycin. Drug-resistant TB often arises due to poor patient compliance, undetected resistant strains, and inadequate therapy.

Herbal Treatment

Common herbs include Albizia lebbeck (stem bark), Cassia sieberiana (stem bark), and Zanthoxylum xanthoxyloides (stem bark).


Prevention and Control


The Bacille Calmette Guérin (BCG) vaccine, derived from an atypical Mycobacterium, offers some protection against active TB and is administered widely, especially to infants and children. Additional preventive measures include:

  1. Referrals to specialists or TB clinics to prevent disease spread.
  2. Covering the mouth and nose with a tissue when coughing.
  3. Avoiding spitting; instead, spitting into a lidded box containing bleach.
  4. Emptying the box contents into the toilet every night.
  5. Using separate covered containers during treatment.
  6. Sleeping alone in a well-ventilated room during the first month of treatment.
  7. Avoiding alcohol and tobacco.



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