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This information is intended to give general information about Tuberculosis. It is not intended as a substitute for the knowledge, expertise, skill, and judgment of physicians, pharmacists, and/or other health-care professionals in patient care. None of the information contained in this web site is intended to be used for decisions on diagnosis or treatment.

Tuberculosis is caused by a bacterium. It may cause disease in any part of the body but the lung is the most common site, where the bacterium slowly destroys the tissue of the lungs - this is called pulmonary tuberculosis. Only TB of the lungs or throat can be - but are not always - infectious.

Symptoms of TB:

All these symptoms can be signs of something else, it is therefore important that if you develop such symptoms that you get tested for TB at your nearest health clinic.

How is TB spread and am I likely to be infected?

TB can only be caught directly from someone with infectious TB in their lungs or throat. When an infected person coughs or sneezes the bacteria becomes airborne which will infect those who breathe it in. However it takes a lengthy and close contact with an infectious person to actually catch the disease.

Not everyone with TB of the lungs is infectious, plus those taking proper DOTS medication become non-infectious within two weeks of starting the medication.

Those most at risk of catching TB are:
▪ Those living in crowded conditions.
▪ Those who have been in lengthy contact with a infectious TB patient.
▪ Those who smoke or are addicted to drugs or alcohol
▪ Those who are unable to fight infection due to illness.

Forms of TB

TB can come in different forms which have different implications in terms of how it is treated and for how long.

Pulmonary TB	The most common form of TB which is present in the lungs. It causes a severe cough and the bringing up of sputum, which is sometimes blood streaked. This is cured with 6 months of medication.
Extra Pulmonary TB	When TB is present outside of the lungs, often in Lymph Nodes which swell up or in bones which causes pain. This requires a blood culture and X-ray to diagnose as the bacteria is not present in sputum. This also means it is not passed on in the air. Is also cures by six months of treatment.
Paediatric-TB	When TB is present in children under 5. Children are highly susceptible to TB as their immune systems are not yet developed to cope with it. It is also often missed in diagnosis as the symptoms are common to many other less serious diseases that are picked up in childhood. Late diagnosis can be fatal. However it is cured with a special course of TB medication, again six months but taking smaller quantities of the drugs. Furthermore if a child under 5 is living in a house with a TB patient it is recommended that the child also takes antibiotics for the complete time the other person is on medication, so as to prevent being infected.
MDR-TB	Multi-Drug Resistant TB is formed when a person taking TB medication fails to complete the six months of medication. This means the bacteria is not totally killed off and is given a chance to adapt so as to become resistant to common TB antibiotics. Furthermore all those infected from someone with MDR-TB will also be resistant to medication. New stronger antibiotics have been developed to cure MDR-TB, however the treatment course could be as long as two years. It is essential that MDR-TB is not given a chance to develop which means all those taking TB medication must complete the six months treatment course.
TB-HIV Co infection	TB is the most common opportunistic infection among people with HIV and is a leading cause of death among people who are HIV positive. Worldwide 30% of people with HIV get ill with TB and in some countries it can be higher than 80%. HIV weakens the immune system meaning the body is unable to deal with the TB bacteria. The development of active TB accelerates the progression of HIV disease towards full-blown AIDS. It is possible to Cure TB in HIV positive people. This not only improves their quality of life, and gives them several more years of life; it also reduces transmission to others in the community. Unfortunately due to the stigma surrounding AIDS many TB patients refuse to be tested for HIV and it is difficult to raise awareness about TB-HIV without creating a worse stigma for TB as well.

Diagnosis and Treatment of TB in India
To fight this global epidemic India initiated the Revised National Tuberculosis Control programme (RNTCP). Which uses the WHO recommended DOTS strategy in fighting the disease. In March 2006 India officially announced 100% coverage of the DOTS strategy; this means everyone has a health facility in their area that provides FREE DIAGNOSIS AND TREATMENT FOR TB

Diagnosis for TB is done at a Microscopy centre. Those who fear that they have symptoms of TB can go to these centres where three sputum samples are taken, these are examined under a microscope and will show if the person has pulmonary TB. More then 50% TB cases can be diagnosed in this way. For extra-pulmonary cases a chest x-ray is required, this is done if only one out of three of the smears is positive, but only after 10-14 days of antibiotics and three repeat negative smears.

Diagnosis Flow Diagram

Treatment for TB is done also at the Microscopy centre or by a specially trained DOTS provider working in the community. At the heart of the DOTS method is “directly observed treatment” in which the patient is given the medication and observed as it is taken. The treatment course for TB is usually six months, and is divided into two phases. Firstly the Intensive Phase where drugs are given three times a week under direct observation. Secondly the continuous phase where only the first does of the week is given under observation. A TB patient will start to feel a lot better after only a few months of treatment however it is ESSENTIAL that they continue to complete the 6 months medication course. If they do not they risk catching TB again and perhaps developing a form of TB that is less responsive to the medication and takes longer to cure. Known as Multi Drug Resistant TB (MDR-TB) During 2007, under the RNTCP, the Indian new sputum positive case detection rate was 70% and a treatment success rate of 86% was achieved.

For More information about Tuberculosis please visit the TB Alert UK site at:
http://www.tbalert.org/tuberculosis/tb.php

For More information regarding TB specifically in India please visit the Central TB Division for India Website at:
http://www.tbcindia.org/