Overview
Tuberculosis, or TB, is an infection caused by bacteria that most often affect the lungs, but can also settle in the lymph glands, spine, brain or kidneys.
Many people who breathe in the bacteria never become ill: the body keeps them in check, which is called latent TB, with no symptoms and no risk to others. Years later they can become active.
TB is curable, and in India testing and treatment are free at government health facilities.
Symptoms
TB in the lungs usually builds slowly over weeks:
- A cough that has gone on for more than two weeks
- Coughing up , sometimes streaked with blood
- Chest pain
- Fever, often in the evenings, and sweating at night
- Loss of appetite and weight
- Tiredness and weakness
When TB is elsewhere the symptoms follow that part: a painless swollen gland in the neck, back pain with fever, or a long headache with vomiting. A long fever with weight loss and no clear cause is always worth investigating.
When to see a doctor
See a doctor for a cough lasting more than two weeks, evening fevers and night sweats, weight that keeps falling, or a swollen gland that is not settling. Anyone living close to someone treated for TB should be checked even if they feel well.
Causes
TB bacteria travel through the air. Someone with TB in their lungs releases tiny droplets when they cough, sneeze or spit, and another person breathes them in. It usually takes close, repeated contact indoors.
TB outside the lungs does not spread between people. Latent TB can become active when the body's defences drop, for example with diabetes, HIV or poor nutrition.
Risk factors
- Living with or spending long hours near someone with untreated TB of the lungs
- Diabetes
- HIV infection
- Poor nutrition and low body weight
- Smoking and other tobacco use
- Heavy alcohol use
- Crowded, poorly ventilated homes and workplaces
Complications
Untreated or partly treated TB can scar the lungs and leave lasting breathlessness, and can spread through the blood to the spine, brain and kidneys. TB of the covering of the brain is the most dangerous form.
Treatment stopped early can leave bacteria that no longer respond to the usual medicines. This drug-resistant TB is treatable, but it takes longer.
Prevention
- BCG vaccination in infancy, which protects young children against the severest forms
- Testing everyone in the household when one person is diagnosed
- Preventive treatment for close contacts when a doctor advises it
- Covering the mouth when coughing, and not spitting in public
- Keeping windows open and rooms airy
- Completing treatment fully, which also stops TB passing on
- Treating diabetes and HIV well, and eating well
Diagnosis
For TB of the lungs, a sample of is tested. A rapid molecular test is advised first, because it finds the bacteria quickly and shows whether they resist one of the main medicines. A chest X-ray is usually taken too.
For TB elsewhere, fluid or a small piece of tissue is taken from the affected part. To check for latent infection, a skin test or a blood test may be used.
Treatment
TB is treated with a combination of taken every day, because one alone would not clear the bacteria and would encourage resistance. Treatment commonly runs for six months or more, and longer for TB of the brain, spine or bones.
Most people feel better within a few weeks, but the medicines must continue for the full period. Follow-up visits check that treatment is working and watch for side effects, so tell the doctor promptly about anything new.
Drug-resistant TB is treated with a different, longer combination chosen from the laboratory results. Good nutrition is part of the treatment throughout, and support schemes in India help with it.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“TB runs in families, it is hereditary.”What is true?
Fact
TB is an infection, not something inherited. It appears in several members of a family because they share the same rooms and the same air for long hours, not because of their genes. That is also why testing everyone in the household matters.
Myth“TB is a disease of poverty, so it cannot happen in a well-off household.”What is true?
Fact
TB spreads through the air, and anyone who breathes in the bacteria can be infected. Crowding and poor nutrition do raise the risk, and so do diabetes, HIV, smoking and heavy drinking, but no family is out of reach of the bacteria.
Myth“You can catch TB by sharing plates, food or a handshake.”What is true?
Fact
TB in the lungs spreads through the air, in tiny droplets released when someone coughs, sneezes or spits, and it takes close and repeated contact. It is not passed on by sharing utensils, food or touch, so separate dishes are not what protects a family. Fresh air, open windows and covering coughs are.
Myth“Once the cough stops and I feel better, I can stop the tablets.”What is true?
Fact
The cough usually settles long before the bacteria are cleared. Stopping early lets the illness return and, worse, gives the bacteria the chance to become resistant, which then needs longer treatment with harder medicines. Finishing the full course is the part that cures TB.
Myth“If you are not coughing, it is not TB.”What is true?
Fact
TB most often affects the lungs, but it can also settle in the lymph glands, the spine, the brain, the kidneys or the abdomen. Then there may be no cough at all, and instead a swollen gland, back pain, headache or a long fever with weight loss.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
How long am I infectious to my family?
People with TB of the lungs become less infectious once effective treatment is under way, and your doctor will tell you when the risk to others has passed. Until then, cover your mouth when you cough, sleep in a well ventilated room if you can, and keep windows open. TB outside the lungs is generally not passed on at all.
Does the BCG injection I had as a baby mean I cannot get TB?
No. BCG is given in infancy and protects young children against the severest forms of TB, but it does not give complete or lifelong protection. Anyone with a long cough, evening fever or unexplained weight loss should be tested, whatever vaccination they had.
I feel completely fine after two months. Why continue the medicines?
Feeling well means the treatment is working, not that the bacteria are gone. Some survive longer and need the remaining months of medicines to be cleared. Stopping now is the commonest reason TB returns, and it is how drug-resistant TB develops.
Someone at home has TB. What should the rest of us do?
Everyone living in the house should be checked, even those who feel perfectly well, because TB can be present without symptoms. Children and people with diabetes, HIV or low immunity need particular attention, and the doctor may offer them preventive treatment.
