Tuberculosis (TB) is a disease caused by Koch's bacillus (Mycobacterium tuberculosis) and is transmitted to people through the air. It typically affects the lungs (usually the first injection site), from where it then spreads to other organs. When it is in the latent phase, the bacterium remains dormant and no signs or symptoms are noticed, while when it is active the patient is symptomatic. However, the majority of TB infections remain latent. If not treated or treated properly, this disease can be deadly, so it is important to be able to recognize the signs in the airways.
Steps
Part 1 of 3: Knowing the Risk Factors
Step 1. Be aware of the geographic areas where the disease is endemic
If you live or travel to these areas, or if you come into contact with people who have frequented these places, you may be at risk of contracting the disease. In some parts of the world it is very difficult to prevent, diagnose or treat TB due to poor health policies, limited financial resources and overpopulation. These conditions prevent the detection and treatment of the disease, which in this way spreads easily. Due to isolated ventilation, air travel to and from the following locations can also result in bacillus transmission:
- Sub-Saharan Africa;
- India:
- China;
- Russia;
- Pakistan;
- Southeast Asia;
- South America.
Step 2. Pay attention to your working and living conditions
Overcrowded or poorly ventilated environments promote the transmission of bacteria from one person to another. Difficult environmental conditions can further aggravate if the people around you already live in poor health situations and do not have access to health checks. The contexts in which you need to be particularly cautious are:
- Prison;
- Immigration Offices;
- Nursing homes and hospices;
- Clinics and hospitals;
- Refugee camps;
- Homeless shelters.
Step 3. Assess your health
If you have a condition that lowers your immune defenses, you may be more likely to get the disease. If your immune system is not functioning properly, you are more vulnerable to any type of infection, including tuberculosis. Among the various pathologies or risk factors there are:
- HIV / AIDS;
- Diabetes;
- End-stage kidney disease
- Cancer;
- Malnutrition;
- Age (very young children who have not yet fully developed their immune system and the elderly are not always able to defend themselves against disease optimally).
Step 4. Consider using drugs or medications that can interfere with normal body functions
Any abuse of drugs, which includes alcohol, tobacco and injectables, can lower the natural immune system. Remember that, in addition to some forms of cancer, chemotherapy drugs also increase the risk of contracting TB. Steroids taken for a long time and medicines to prevent rejection in organ transplants can affect normal immune function. Medicines to treat autoimmune conditions such as rheumatoid arthritis, lupus, inflammatory bowel disease (Crohn's and ulcerative colitis) and psoriasis should also be considered.
Part 2 of 3: Recognizing the Signs and Symptoms
Step 1. Look for any kind of unusual cough
Tuberculosis typically affects the lungs, destroying their tissues. The natural response of the organism, in this case, is to remove the irritating agents with the cough. Try to remember how long you have been coughing. TB usually lasts more than 3 weeks, and you may notice some troubling signs, such as blood in your sputum.
Consider how long you've been taking over-the-counter cold / flu medications or antibiotics for respiratory infections without seeing any improvement. TB requires very specific antibacterial drugs, and a screening test that confirms the disease is required to initiate therapy
Step 2. Check for secretions when you cough
Do you notice sputum (sticky material) when you cough? If it smells bad and is dark, it could be a bacterial infection of any kind. On the other hand, if it is light in color and has no odor, it is probably a viral infection. Take note of any blood on your hands or tissues when you cough. When tuberculosis forms cavities and nodules in the airways, the surrounding blood vessels can rupture, causing hemoptysis - blood emissions through coughing.
You should always go to a competent doctor when you notice blood in your sputum. He will be able to advise you on how to proceed
Step 3. Pay attention to chest pain
This symptom can indicate different types of problems, but when it occurs in conjunction with other signs, it could be tuberculosis. If the pain is acute, it can be felt in a specific distinct area. Pay particular attention to whether you feel pain when you apply pressure to that area or when you breathe and cough.
TB forms lesions and nodules in the lungs and chest walls. By breathing, these hard masses can cause damage to surrounding tissues, inflaming the area. The pain tends to be sharp, localized to a single area, and recurs when you press on that specific point
Step 4. Take note if you accidentally lose weight and lose your appetite
The body reacts in a complex way to Koch's bacillus, it can lead to poor absorption of nutrients and an alteration of protein metabolism. These changes can last for months without you noticing.
- Look in the mirror to see if the body has undergone any changes. If you can see the bone profile, it means you don't have enough muscle mass due to the loss of protein and fat.
- Weigh yourself on a scale. Compare your weight from a long time ago, when you were feeling good, to your current weight. It can happen that you lose weight, but if you lose weight drastically, you need to talk to your doctor.
- Check to see if your clothes feel too baggy.
- Monitor how often you are eating and compare it to the last time you felt healthy.
Step 5. Don't neglect fever, chills, and night sweats
Bacteria usually develop at normal body temperature (37 ° C); the brain and immune system react by raising the body's temperature to prevent it from reproducing. The rest of the body notices this change, so it tries to adapt by contracting the muscles (tremors) and making you feel shivering. Tuberculosis also causes specific inflammatory proteins that trigger the febrile reaction.
Step 6. Watch out for latent infection
When TB is latent, it means that it is in a dormant state and is not infectious. Bacteria are present in the body but do no harm. However, they can reactivate in people with a compromised immune system, as listed above, or with advancing age, when the immune defenses weaken. Sometimes, however, the bacteria "awaken" in other patients for reasons still unknown.
Step 7. Learn to distinguish TB from other respiratory tract infections
There are many other pathologies that can be confused with this infection. You don't have to wait for the end of a simple viral flu to find out it's something more serious. To distinguish this pathology from other infections, try to answer the following questions:
- Does clear, liquid mucus come out of the nose? Inflammation or nasal and lung congestion can cause runny nose or mucus dripping from the nose. TB does not have these symptoms.
- What expectors with cough? Viral infections and colds typically cause a dry or white mucus cough. Bacterial infections that arise from the lower respiratory tract produce brownish phlegm. Tuberculosis, on the other hand, causes a cough that lasts at least 3 weeks and produces the typical sputum with blood.
- Do you sneeze? TB does not cause sneezing, this is a characteristic of colds and flu.
- Have you got a fever? Tuberculosis can cause fever to varying degrees, but flu patients typically have a body temperature above 38 ° C.
- Do your eyes itch and water? This is a typical symptom of colds, but not of TB.
- Do you have a headache? It is a characteristic of the flu.
- Do you experience joint and / or muscle pain throughout your body? Colds and flu cause these symptoms, although they are more severe with the flu.
- Do you have a sore throat? Look inside your mouth and see if your throat is red, swollen, and painful when you swallow. This is a symptom that occurs mainly with a cold, but it can also occur with the flu.
Part 3 of 3: Undergo Assessments
Step 1. Know when to see your doctor right away
Some signs and symptoms require immediate medical attention. Even if the symptoms do not lead to a diagnosis of TB, it can still indicate other serious problems. There are many conditions, more or less serious, that cause chest pain, but you should always report the discomfort to your doctor so that he can undergo an electrocardiogram.
- Significant weight loss can be a sign of malnutrition or cancer.
- Weight loss may more specifically indicate lung cancer if it is associated with coughing up blood.
- High fever and chills can also be caused by septicemia (blood infection), although it typically causes a drop in blood pressure, dizziness, delirium, and a rapid heart rate. This condition, if left untreated, can become life-threatening or lead to serious dysfunction.
- Your doctor will prescribe you intravenous antibiotics and blood tests to check your white blood cells (the immune cells that fight infections).
Step 2. Prepare for a screening test for latent tuberculosis, if asked
Even if you do not suspect that you have this infection, in some cases it is advisable to perform diagnostic tests to check for the presence of latent infection. Those who start working in the medical sector must undergo an annual screening test. If you are traveling to or returning from a country that is at risk for TB, if you have a compromised immune system, work or live in overcrowded or poorly ventilated environments, you need to undergo tests. Just make an appointment with your family doctor who will issue you the request for the test. With this you can go to the infectious disease clinic of the competent ASL.
When the infection is dormant it causes no symptoms or discomfort and does not spread to other people. However, between 5 and 10 percent of people with latent TB can develop the disease
Step 3. Ask to perform the Purified Protein Derivative (PPD) test
This test is also called tuberculin or Mantoux test. The doctor cleans the area of skin with a cotton swab and water, then injects the PPD just below the skin surface. A small lump should form due to the injected liquid. Do not cover the area with a band-aid, as this could alter the position of the liquid. Instead, let it soak in for a few hours.
- If you have antibodies to tuberculosis, the PPD should react and form a "lump" (a thickening or swelling around the area).
- Keep in mind that the redness of the area is not considered, but the hardening. After 48 or 72 hours, you need to go back to your doctor to measure the level of skin thickening.
Step 4. Learn to interpret the results
According to the category to which the patient belongs, there are different criteria for evaluating the maximum size of the nodule that falls within the normal parameters (negative test result). However, any thickening exceeding this size indicates that the person has TB. If you don't fall into a risk category, a lump up to 15mm results in a negative test. However, if there are risk factors, such as those described above, for the test to be negative, the nodule must not exceed 10 mm. If you have the characteristics described below, the test is negative when the lump is no larger than 5 mm:
- Take immunosuppressive drugs such as chemotherapy drugs;
- Chronic steroid use;
- You are HIV positive;
- You are in close contact with people with TB;
- You have undergone an organ transplant;
- Your chest x-rays show fibrotic changes.
Step 5. Ask for an IGRA test as an alternative to tuberculin
The abbreviation IGRA means "gamma interferon release assay"; it is a more accurate and faster blood test than PPD, although it is more expensive. If your doctor chooses to undergo this test, a blood sample will be taken and sent to a laboratory for analysis. You should get the results within 24 hours, after which you should go back to the doctor for interpretation. A high level of interferon (outside the laboratory's normal range) is a positive result and means you have TB.
Step 6. Learn more about the test results
A positive result on the tuberculin test or the IGRA test indicates, at a minimum, a latent infection. To find out if tuberculosis is active in your body, your doctor will prescribe a chest x-ray. A patient who shows a normal X-ray will be diagnosed with latent TB and will need to undergo preventive treatment. If the x-rays reveal lung abnormalities and the patient has tested positive for skin and blood tests, then this is a case of active tuberculosis.
- The doctor will also prescribe a sputum culture. If this fails, the infection is dormant, while a positive culture is a sign of active tuberculosis.
- Remember that this type of sample is difficult to collect in young children and infants and for this category of patients it is diagnosed without sputum culture.
Step 7. After diagnosis, follow your doctor's directions
If the x-rays and culture confirm that you have active TB, your doctor will prescribe therapy with several medications. If, on the other hand, the x-rays show no alterations, the disease is considered latent, but you will still have to strictly follow the doctor's instructions to prevent it from activating. This disease must be reported to the CDC and involves Directly Observed Therapy (DOT). In other words, the physician must make sure that the patient takes every dose of the drug.
Step 8. Consider getting the Calmette – Guérin bacillus vaccine
It is able to reduce the risk of infection, but it does not completely eliminate it. The BCG vaccine also causes false positive skin test results, so patients who have been treated in this way must have an IGRA blood test.
The Calmette – Guérin bacillus vaccine is not recommended in the United States, as this country has a low rate of TB cases and treatment interferes with PPD screening tests. However, people living in other less developed countries are subjected to this prophylaxis
Advice
- Military tuberculosis can manifest itself with the same symptoms as pulmonary tuberculosis, but it also has other signs specific to different organs.
- Not everyone who becomes infected with the tuberculosis bacterium gets sick. Some people have "latent TB"; although they are not contagious, they can develop the active form of the infection even after a long time, when the immune system is weakened. It is also possible to have latent TB for life without ever getting sick.
- The disease is spread by coughing and sneezing.
- TB has started to spread again and the CDC has changed the protocol for treating infected people. Previously, individuals up to 34 years of age were treated with isoniazid, while now the treatment is virtually extended to all those who tested positive. This is to ensure the safety of the patient himself and of other people. For your own health and that of those around you, follow therapy as prescribed.
- Military TB patients need to undergo multiple tests, including MRI of the affected organ and a biopsy.
- The BCG vaccine contributes to false positives in the skin test. People who have a false positive result do not show chest X-ray changes.
- It is important to know that people who have latent TB and have undergone drug therapy can also test positive, although this phenomenon is somewhat debated. This is something you need to discuss and evaluate with your doctor.
- For people who have been vaccinated with BCG and have had false positive skin tests in the past, an IGRA blood test is recommended. However, the doctor may prefer the PPD test due to its low cost and wide availability.
- When the patient is a child under 5 years of age, skin testing is preferred, as there are not enough studies on IGRA in this age group.
