This is no medical advice - please contact a doctor immediately if you or someone you know suffers from TB or thinks he / she does.
Tuberculosis - A short explanation (information from WHO and DAHW)
1. Clinical picture
infection and transmission
Tuberculosis (TB) is a contagious disease. Like the common cold, it spreads through the air. Only people who are sick with TB in their lungs are infectious. When infectious people cough, sneeze, talk or spit, they propel TB germs, known as bacilli, into the air. A person needs only to inhale a small number of these to be infected.
Left untreated, each person with active TB disease will infect on average between 10 and 15 people every year. But people infected with TB bacilli will not necessarily become sick with the disease. The immune system "walls off" the TB bacilli which, protected by a thick waxy coat, can lie dormant for years. When someone's immune system is weakened, the chances of becoming sick are greater.
• Overall, one-third of the world's population is currently infected with the TB bacillus.
• 5-10% of people who are infected with TB bacilli (but who are not infected with HIV) become sick or infectious at some time during their life. People with HIV and TB infection are much more likely to develop TB.
Global and regional incidence
WHO estimates that the largest number of new TB cases in 2008 occurred in the South-East Asia Region, which accounted for 35% of incident cases globally. However, the estimated incidence rate in sub-Saharan Africa is nearly twice that of the South-East Asia Region with over 350 cases per 100 000 population.
An estimated 1.7 million people died from TB in 2009. The highest number of deaths was in the Africa Region.
In 2008, the estimated per capita TB incidence was stable or falling in all six WHO regions. However, the slow decline in incidence rates per capita is offset by population growth. Consequently, the number of new cases arising each year is still increasing globally in the WHO regions of Africa, the Eastern Mediterranean and South-East Asia.
HIV and TB
HIV and TB form a lethal combination, each speeding the other's progress. HIV weakens the immune system. Someone who is HIV-positive and infected with TB bacilli is many times more likely to become sick with TB than someone infected with TB bacilli who is HIV-negative. TB is a leading cause of death among people who are HIV-positive. In Africa, HIV is the single most important factor contributing to the increase in the incidence of TB since 1990.
WHO and its international partners have formed the TB/HIV Working Group, which develops global policy on the control of HIV-related TB and advises on how those fighting against TB and HIV can work together to tackle this lethal combination. The interim policy on collaborative TB/HIV activities describes steps to create mechanisms of collaboration between TB and HIV/AIDS programmes, to reduce the burden of TB among people and reducing the burden of HIV among TB patients.
Until 50 years ago, there were no medicines to cure TB. Now, strains that are resistant to a single drug have been documented in every country surveyed; what is more, strains of TB resistant to all major anti-TB drugs have emerged. Drug-resistant TB is caused by inconsistent or partial treatment, when patients do not take all their medicines regularly for the required period because they start to feel better, because doctors and health workers prescribe the wrong treatment regimens, or because the drug supply is unreliable. A particularly dangerous form of drug-resistant TB is multidrug-resistant TB (MDR-TB), which is defined as the disease caused by TB bacilli resistant to at least isoniazid and rifampicin, the two most powerful anti-TB drugs. Rates of MDR-TB are high in some countries, especially in the former Soviet Union, and threaten TB control efforts.
While drug-resistant TB is generally treatable, it requires extensive chemotherapy (up to two years of treatment) with second-line anti-TB drugs which are more costly than first-line drugs, and which produce adverse drug reactions that are more severe, though manageable. Quality assured second-line anti-TB drugs are available at reduced prices for projects approved by the Green Light Committee.
The emergence of extensively drug-resistant (XDR) TB, particularly in settings where many TB patients are also infected with HIV, poses a serious threat to TB control, and confirms the urgent need to strengthen basic TB control and to apply the new WHO guidelines for the programmatic management of drug-resistant TB.
Therapy: Modern antibiotics make tuberculosis curable.
Nowadays tuberculosis is well treatable. However, it must be recognized for it on time and be treated properly. With closed tuberculosis the therapeutic measures are carried outpatiently, because no infection danger exists. The open tuberculosis is treated stationary because of the (very) high infection risk.
The treatment of tuberculosis can last several months. Special antibiotics are used. To these belong, e.g., Isoniazid, Rifampicin, Pyrazinamide, Ethambutol and / or Streptomycin. In most cases the therapy with a combination of several preparations for a period of six months is carried out. This combination therapy is on the one hand a measure for the prophylaxis against resistance. On the other hand, the drugs have different active manners and active areas, so that the Mycobacterium tuberculosis is attacked in different development stages and an increase is prevented. During the first both months of the medication all four preparations are given. Afterwards are only used Isoniazid and Rifampicin for the remaining period.
The patient has to hand over Sputum weekly. For that he coughs in a tube and hands over some sputum. This is examined in the lab whether still tuberculosis causes (acid-firm rods) are in it which means a constant infection. As soon as the Sputum result is negative 3 times one after the other (during 3 weeks), so no more active causes are found, the patient can leave the hospital and take the drugs up to the end of the therapy outpatiently at home.
3. What is especially important?
Especially important is the logical observance of the use duration and dosage of the antibiotics to avoid a recurrence or the development of resistant strains of bacteria.
Because tuberculosis causes show a very slow growth, an intake of antibiotics for a long period is necessary to put out of action all available causes.Mostly the complaints already decrease at the beginning of the medicinal therapy.
4. What happens further?
Because the tuberculosis belongs to the notifiable diseases, the health center must be informed. Furthermore the ill patient has to make out an installation from which the contacts with friends / family / colleagues arise. How often the patient has met or seen whom, how long this contact has lasted then etc. These people are invited by the health center to an examination (mostly X-ray examination and blood decrease) to exclude an infection with tuberculosis or to be able to treat tuberculosis.
5. What can I do myself?
With the treatment of tuberculosis strong drugs are used. These attack the liver and you often feel floppy and tired. It is important to support the body at his work. It is necessary to drink a lot (at least 3-4 liters the day). The kidneys are thereby supported at her work –the dismantling of the toxins–. Furthermore you should eat a lot of fruit and vegetables as well as fish (omega-3 fatty acids). You have to be careful with direct sunlight, because the drugs make the skin photosensitive. You should go outside only protected or stay in the shade.
Smoking damages to the lung very much. You should renounce the smoking or limit at least because the lung is already very sick.
6. How do I spend the time in hospital?
The tuberculosis is treated in hospital. This can last 3 weeks or also several months. Because you are not allowed to leave the room during this time, it is especially important to plan your time. In the beginning you are floppy and beaten off because of the drugs. In this time you should dedicate yourself to the fatigue. Also it takes some time until you have really turned inward that you have a very severe disease. Drugs fight against the disease chemically, but it is also your head which must co-operate. After maybe 2 weeks you should begin to divide the day into several blocks. You can ask for a phone, because it is also important that you have somebody to talk to. This can be a friend and relatives. You can use the time for reading, writing, you can paint. You should make a little sport, because by that little motion the muscles atrophy and the lung is coached less. Furthermore there are some women in the clinic who can help you with some small things, bring you newspapers and other things. Just ask!
6.1 From my own experience …
… I know how severe it is to be locked up in the room. I was in the clinic several months myself. You have the feeling not to stand it anymore. Just then it is especially important to remember that nobody is to blame for the fact that you are there. The orderlies and doctors do everything what they are able to do to heal and to help you. By the constant isolation you become touchy and impatient more easy. I often sat on the balcony and then one day I just started to paint. This felt well, because the time passed such as by fly. There are many things that you can do and you should see the time as a chance! If it is possible, you can also work from the clinic or learn a foreign language. You will never again have so much time to think about yourself. One day you will be able to go back home and then you will see clearly how strong you have been the last time! Anyway it is a very severe disease that luckily can be treated well, so that an operation is necessary only in rare cases.
7. NEWS: Xpert MTB/RIF - rapid TB test - WHO publishes policy and guidance for implementers
WHO Stop TB Department has issued a Policy Statement and further information on the new rapid TB test that was endorsed by WHO in December 2010. The rapid, fully-automated NAAT (nucleic acid amplification test) - also known as Xpert MTB/RIF assay - has been described as a major breakthrough in TB care and control. The table-top device can dramatically cut the time it takes to provide an accurate diagnosis of TB and rifampicin resistance for many patients - from up to three months to less than two hours.
Second-line screening by HeroRATs
Tuberculosis (TB) is a widespread disease. 1.7 million people die from TB each year. Only 50% of the patients with TB are diagnosed. Left untreated, a person with active TB can infect 10-15 new people each year. A faster, more accurate diagnostic technology is needed to help curb the spread of this deadly disease.
Trained HeroRATs can quickly and accurately sniff out TB in human sputum samples. In Tanzania, APOPO offers second-line screening to our partner hospitals, which has increased new case detection rates by over 40 percent.
Our rats can evaluate 40 sputum samples in just seven minutes, equal to what a skilled lab technician will do in a full day’s work. [...]
The concept is very simple: rats sniff a series of holes, under which human sputum samples are lined up for evaluation. They identify samples that contain TB bacteria by scratching at the hole. Their correct indications on known positive samples are rewarded with a food treat. Indications on unknown samples, if pinpointed by two rats or more, are confirmed using microscopy. Samples that are in fact positive with TB are then reported to the hospitals who then follow-up with the associated patient(s) for confirmation of diagnosis and treatment.
On a weekly basis, our rats find an additional 5 to 15 new TB-positive patients.[...]