Tuberculosis

WHAT CAUSES TUBERCULOSIS AND HOW DO YOU GET IT?

Tuberculosis (TB) is a disease that caused great suffering in Ireland in the days before antibiotics. It is very much still around. However, it is now completely curable with medications. TB is an infection caused by exposure to bacteria called Mycobacterium Tuberculosis. It may be spread to you by someone who has the infection. This is usually by a person coughing near you. TB may affect many parts of the body. Most commonly, it causes infection in the lungs. Not everyone who comes in contact with TB becomes ill. This is because the bacteria are normally destroyed by the body's immune system. You can be immune because of a higher standard of living, or because you have had BCG vaccination. BCG is a vaccine that most people receive shortly after birth, and again before entering secondary school. BCG does not totally prevent you from developing TB. It can greatly reduce your chances of doing so. Some people become ill after exposure. This can happen days, weeks or months after contact. The bacteria sometimes cause no immediate illness. It can lie asleep (or dormant) in the body for several years. They can then cause illness many years later. This may be when the body's immune defences are weakened by other major illnesses or old age. Years ago, having TB meant a very long period of time in hospital. TB was difficult to treat. Nowadays, the infection can be completely cured by several months of treatment. Also, treatment is taken mostly, or completely, at home.

HOW DOES TB AFFECT PEOPLE?

Many people can have TB for quite a long time before they know that there is something wrong. Symptoms can be very mild at first. TB can affect many parts of the body, but the lungs are most commonly affected. The first symptom is usually cough. This can be a dry cough, or a "wet" cough, where phlegm is produced. Sometimes, an affected person can cough up some blood. Other symptoms may include chest pain (where it "hurts" to breath). Other symptoms are lack of energy, loss of appetite, and loss of weight. Fever and sweating may be experienced. It is not unusual to have night sweats bad enough to soak the bedclothes. TB can sometimes cause fluid to build up around the lung. This can cause breathlessness. Lumps may appear in the neck or elsewhere. These lumps can be due to TB infecting lymph glands.

HOW DO DOCTORS DIAGNOSE TB?

As TB usually affects the lungs, most of the tests focus on this part of the body. A chest x-ray often shows shadowing. This strongly suggests TB infection in the lungs. If you are coughing up phlegm, this is sent to the laboratory. This is to see if TB bacteria are present. If you are not coughing phlegm, then samples from the lung may be taken. This is done during a procedure called a bronchoscopy. This can be done as a day case. It involves passing a small tube down the nose or mouth. The tube enters into your lungs, while you are gently sedated with a small injection. The procedure is painless, and quite safe. The very rare complications that can happen will be explained to you. A skin test is often done. This test can suggest the presence of TB. TB affecting other parts of the body, apart from the lungs, is sometimes difficult to prove. The doctors may need to take a sample of tissue (or biopsy) of the affected organ.

TB CAN BE COMPLETELY CURED! THIS IS HOW WE TREAT IT.

Nowadays, TB is treated with antibiotic tablets. This is usually for a six-month period. Sometimes, a longer course of treatment is needed. It depends on which parts of the body are affected. To make it easier for a patient to take their medications, drug companies have joined two or three antibiotics together into one tablet. IT IS VERY IMPORTANT THAT YOU NEVER MISS YOUR TABLETS. Always make sure to have enough tablets in the house. Remember to fill your prescription on time. If you forget your tablets in the morning, take them later that day. If you take your tablets as prescribed, then TB can be COMPLETELY CURED. However, if you miss your tablets, TB bacteria can become resistant to the antibiotics. This makes the infection much more difficult to treat. The doctor will let you know how long to take the treatment for. The full course must be completed, even if you are feeling well.

ARE THERE ANY PROBLEMS WITH THE TABLETS?

Tablets used to treat TB do not normally cause problems. Some people may experience side effects. Nausea and vomiting can occur. This usually settles after a few days. If necessary, medication to improve the nausea can be taken. A tablet called rifampicin can cause orange discoloration of urine and tears. It can also discolour contact lenses. Sometimes, the tablets can cause inflammation in the liver. You will need to have blood tests done to monitor the liver. If you develop a yellow colour (jaundice) in the skin or eyes while on treatment, let your doctor know straight away. Other side effects can include rash, dizziness, blurring of vision and pins and needles or numbness in the hands or feet. Let your doctor know if you experience any of these problems. The medication can then be changed. The medication will not be stopped, however, until the full treatment is finished. Let your doctor know if you are taking the oral contraceptive pill. The TB tablets can make the pill less effective. Alternative contraception can be prescribed.

CAN I GIVE TB TO OTHER PEOPLE?

If a person with TB is coughing, and has the bacteria in their phlegm, they are said to have "open" TB. This person can infect other people. Once you have been started on treatment, the risk of infecting other people decreases quickly. Generally, you stop being infectious after two weeks of treatment. If TB is not found in your phlegm, or if other parts of the body are affected, then you cannot infect other people. If you are diagnosed with TB, people in close contact with you (such as people living in the home with you, or, sometimes, colleagues at work) will be offered a check-up. This is to see if they have the infection. This is called contact tracing. Generally, a chest x-ray and a skin test will be needed. Most people tested in this way turn out not to have the TB infection. Most often no treatment is needed. But some people, if they are frail or have other major illnesses, will be given a simple course of TB treatment.

CAN I CONTINUE WORKING?

People with mild infection may not have to take any time off work. Some people may have to stay off work for a short time. This is when they are infectious, or if they need to get their strength back. Your employer will be told that a full recovery from the infection is expected.

WILL I HAVE MANY HOSPITAL VISITS?

At first, after you have been diagnosed as having TB, you will have to attend the clinic in the hospital every 3 to 4 weeks. You will have to attend less often after that. At the clinic, your progress will be assessed. This is done by checking your weight, doing chest x-rays and, sometimes, testing your phlegm (to see if the bacteria are still there). Once treatment has been finished, you will be seen once or twice a year for two years. This is to make sure everything is ok. After this, you will not need to be seen unless you are feeling unwell.

THE IRISH LUNG FOUNDATION LIMITED

Herbert Hall, 16 Herbert Street, Dublin 2. Tel: 676 3797 1 Eden Quay, Dublin 1. Tel: 874 9985 The Irish Lung Foundation is working throughout Ireland to improve the prevention, diagnosis and treatment of all lung diseases. Lung Foundation research is making advances which will benefit the half-million people in Ireland with a lung disease such as bronchitis, emphysema, asthma, sarcoidosis and pneumonia.