Tuberculosis (English)

Tuberculosis, an infection by a bacterium called Mycobacterium Tuberculosis, generally affects the lungs. Mycobacterium Tuberculosis are spread from person to person by coughing or sneezing.

What is tuberculosis?

Tuberculosis is an infection by a bacterium called Mycobacterium Tuberculosis.

The bacteria typically infect the lungs but may also settle in any of the organs, including bones and lymph nodes. Only tuberculosis in the lungs is contagious.

The bacteria grow slowly and it can take years for tuberculosis to develop.

How do you contract tuberculosis?

When a person inhales tuberculosis bacteria, the bacteria settle in the lungs. Two things may occur when the bacteria enter the lungs:

  • The immune system fights the bacteria and encapsulates them, but the infection can flare up at a later point in time and cause illlness.
  • The bacteria cause active tuberculosis.

Only 5-10% of the people who become infected develop active tuberculosis. The risk is greatest for infants and small children.

Even if the bacteria do not immediately make one ill, the encapsulated bacteria can later progress to active tuberculosis. 

There are two possibilities:

  • The person contracts tuberculosis of the lungs.
  • The bacteria migrate to other parts of the body and cause tuberculosis there. This might be in the lymph nodes or the kidneys. It may be in the spinal column or other bones. Any of the organs may be affected.

When tuberculosis has been treated, there are no longer tuberculosis bacteria in the body.

How is tuberculosis transmitted?

Tuberculosis bacteria are spread from person to person by coughing or sneezing.

Tuberculosis is not particularly infectious. Most vulnerable are people who spend a lot of time together with the sick person many hours a day. Practically speaking it is people who live or work together and spend time in a small space together for many hours every day.

  • Only serious tuberculosis of the lungs is infectious
  • After treatment for 14 days, one is no longer contagious
  • Patients with tuberculosis in other parts of the body are never contagious
  • Children are almost never contagious

People with inactive (encapsulated) bacteria in their bodies are not ill and cannot infect others.

Symptoms (signs of illness)

The most frequent signs of tuberculosis of the lungs are:

  • Coughing with spittle, which may contain blood
  • Breathlessness
  • Weight loss
  • Fatigue
  • Night sweats

If tuberculosis occurs in other parts of the body, the symptoms will appear there. This could be swollen lymph nodes, boils or abscesses, swollen joints, aching bones or other pains in the areas infected by the tuberculosis.

There are no symptoms during the early stages of the disease.

How does the doctor examine for tuberculosis?

There are three types of diagnostic tests:

  • X-rays of the lungs: Here, typical changes due to tuberculosis can be seen.
  • X-ray examination, scanning, or tissue samples(biopsy) from other organs, if the tuberculosis occurs outside the lungs.
  • Examination of saliva if coughing is present; pus or tissue samples (biopsy). Bacteria grow slowly and therefore it may, in some cases, take up to 2 months before the results of a test are available.

It is not always possible to identify tuberculosis bacteria, but if tuberculosis is suspected, treatment is begun immediately.

Treatment

Tuberculosis can be cured completely.

Treatment consists of two phases over a 6-month period:

First, the ill person takes four antibiotics (Isoniazid, Rifampicin, Etambutol og Pyrazinamid) for 2 months.

Following this, the ill person continues with two antibiotics (Isoniazid og Rifampicin) for another four months – in all six months of treatment. The treatment is identical regardless of where tuberculosis occurs.

In cases of very severe tuberculosis, treatment may be extended another three months.

Medication is in the form of tablets and is distributed free of charge by the hospital.

Side effects of the medication

As a rule, patients do not have any great problems with tuberculosis medication, but some experience the following side effects: Itching and skin rash that disappears when treatment is concluded and one stops taking the medication.

Isoniazid

Isoniazid may cause fatigue, mood changes, memory problems and difficulty concentrating. Rare side effects are hepatitis and neuropathy, particularly in the legs. Neuropathyis experienced as muscular weakness and burning sensations in the legs and feet.

Pyridoxin

Neuropathycan be counteracted by treatment with the B-vitamin Pyridoxin.

Normally, all side effects disappear once treatment is concluded.

Rimactan

Rimactan (Rifampicin) colors urine and feces red-orange and may discolor contact lenses permanently.

Rimactan can cause influenza-like symptoms such as fever, fatigue and painful joints. In rare cases hepatitis may be seen. Rimactan lowers the effect of birth control pills and other forms of contraception must be used.

Myambutol

Myambutol (Etambutol) may in rare cases cause impaired vision and affect color perception. As a rule, this stops by itself. All patients who receive Etambutol should contact their doctor immediately if problems with vision occur.

Pyrazinamid

Pyrazinamid may cause painful joints and increased acidity in the stomach. Hepatitis may occur as with Isoniazid and Rimactan.

If side effects are suspected, blood samples may be taken.

Other medications

Tuberculosis medication may influence the effects of other medications.

Be aware that:

  • Birth control pills do not work and other forms of contraception must be used.
  • Methadone is consumed more quickly by the body and a higher dosage can be necessary.
  • The dosage of anticoagulant medication must often be adjusted.
  • Some forms of epilepsy medication may become less effective, or may become more concentrated in the body, causing side effects.

It is therefore important that you inform your doctor of any other medication you are taking.

Alcohol

It is a good idea to decrease consumption of beer, wine and spirits during treatment but it is not necessary to completely avoid drinking alcohol.

What should one eat?

Many tuberculosis patients have lost weight before their illness was discovered. It is therefore important to eat plenty of good and nutritious food. All types of food may be eaten.

Check-ups

The patients must regularly come for a check-up at the lung clinic or outpatient department.

Check-ups include an interview by a doctor or nurse about how the treatment is going and whether there are side effects or other problems. The staff provides medication and takes x-rays of the lungs at regular intervals.

Saliva samples are also taken and examined for tuberculosis bacteria.

Once treatment for tuberculosis is concluded, tuberculosis seldom recurs. If this happens, it is usually during the first year following the end of treatment.

To achieve full recovery it is important that one takes the medication daily and that treatment is not interrupted or stopped.

Precautions against contagion

Not all tuberculosis is contagious. Only serious tuberculosis of the lungs is infectious. After treatment for 14 days, one is no longer contagious. Patients with tuberculosis outside the lungs are never contagious.

Patients with tuberculosis of the lungs may remain living together with their family. The greatest risk of contagion is prior to the start of treatment.

All patients must be on sick leave during the first 14 days of treatment.

This is partly because persons with lung tuberculosis are contagious but also to get them used to the medication. In special instances the sick leave may be prolonged. This applies to personnel in kindergartens and schools and other groups who have close contact with other people.

Prevention

It is important to limit the spread of contagion. Treatment of patients with tuberculosis of the lungs must therefore be started quickly. After 14 days of antibiotic treatment, the patient is no longer contagious.

Once treatment is begun it must be ascertained who infected the patient and whether he or she has infected others.

An examination of the person’s contacts (contact tracing) is therefore carried out. Contact tracings carried out in collaboration with the staff of the lung clinic or outpatient department.

Contact tracing

To find out whether others are infected an examination is carried out of the closest family members and perhaps one’s colleagues at work, classmates or others in close contact with the patient. Contacts may be given a skin test on their arm (Mantouxtest / tuberculin test), a blood sample may be taken or their lungs may be X-rayed.

Cleaning at home

It is not necessary to take special precautions in residences in which a patient with contagious tuberculosis has resided. The place should be aired out and normal cleaning carried out. Bedding should be cleaned in the usual manner.

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