Tuberculosis

What is it
Tuberculosis is a persistent infection caused by Mycobacterium
tuberculosis,which affects various organs,but particularly the lungs. A
fetus can get tuberculosis through its mother before birth, by breathing or
swallowing infected amniotic fluid before or during birth, or after birth, by
breathing air with infected droppers. About half of children of active TB mothers
develop the disease during the first year of life if they are not treated with
antibiotics or are not vaccinated. The World Health Organization (WHO)
estimates that 30 per cent of the world's population currently has latent
tuberculosis; in addition, it is estimated that 10 per cent will develop active
tuberculosis.
Tuberculosis is an infectious disease that peaked in the last century during
the Industrial Revolution,due to the displacement of people to cities, where
they lived in overcrowded and in painful hygienic conditions. Responsible for
this infection is the 'Mycobacterium tuberculosis' which, after its discoverer,
Roberto Koch, is called Koch bacillus.

Causes
Among humans it is transmitted through the air,by tiny droplets containing the
bacilli and that people infected without treatments, or who are in the first days of
incubation, eliminate when coughing, sneezing or talking. Food transmission
is not common,although unpasteurized milk can be a source of contagion in
countries where tuberculosis is very common.

Symptoms
The most common symptoms are:
 Intense tiredness.

 Malaise.

 Abundant sweating, especially at the time of day.

 Weight loss.

 Blood in the sputums.

 Dry, persistent cough.

 Body temperature ranging from 37 to 37.5 degrees.

However, sometimes no symptoms appear.
Prevention
Prevention involves early detection of the disease,so that transmission to
other people can be avoided. WHO recommends BCG vaccination for all
newborns with a high incidence of tuberculosis, including them in the children's
calendar on a systematic basis. It should be administered only once, as the
efficacy of revaccination is not proven. It is also not recommended for adults
moving to high-risk areas,as their effectiveness in this field has also not been
demonstrated. However, WHO recommends its administration in children and
young people who will spend long periods in advocacy zones. Joan Caylá, head
of the Epidemiology Service of the Public Health Agency of Barcelona
emphasizes in this regard that"the effectiveness of the vaccine is very
limited and does not reach levels of epidemiological prevention such as those
achieved, for example, with measles", for which he emphasizes that
"prevention involves the creation of strategies of contact control programs of
infected people", although he admits that these measures involve "the
elaboration of very expensive strategies use of many resources, which makes
prevention very complicated in poor countries."
BCG is contraindicated in people with AIDS,regardless of their age.
As for feeding,if you are travelling to an area affected by the disease, refrain
from drinking milk or any dairy product that has not been pasteurized. In
case of prolonged contact with an infected person who is not being treated, go
to a doctor as soon as possible and take the tuberculin test. The specialist will
assess whether you should be given specific treatment or chemoprophylaxis
against the disease.

Types
Two types of tuberculosis are distinguished: pulmonary and extrapulmonary.
Pulmonary tuberculosis can occur immediately after infection. This variety is
known as primary infection and especially affects children on the African
continent. When the child is in good health, the disease can develop local
abnormalities in the lungs and nodes. But if you are malnourished or have other
infections, such as AIDS, serious complications occur, including bronchial
obstruction, pleural effusion, or fluid buildup in the space between the
membranes lining the lung.
If TB occurs at least two years after infection, there is talk of adult post-
primary disease or tuberculosis. This indicates that the infection remained
dormant, making it more aggressive than primary infection, causing serious lung
damage and spreading more easily throughout the rest of the body.

Diagnosis
When bacilli enter the body, they spread and trigger the host's immune
response, which can be demonstrated by the 'tuberculin test' or Mantoux.
This test consists of the intradermal administration, on the anterior face of
the arm,of a protein derivative of the bacillus. The local reaction generated is
assessed within 72 hours of administration.
 Pregnant women are systematically given a skin test to check for
tuberculosis (tuberculin test). If a positive reaction is observed, a chest x-ray
should be performed.
Children whose mothers have been given positive to the TB test are also
tested for this test. However, some children have false negative results. If
tuberculosis is suspected, samples of cerebrospinal fluid and fluid from the
respiratory and stomach ducts for culture are sent to the laboratory. A chest x-
ray usually show if the lungs are infected. A biopsy of the liver, lymph node, or
lungs and surrounding membrane (pleura) may be needed to confirm the
diagnosis.
When the diagnosis is positive, it is advisable to follow the treatment prescribed
by the specialist correctly. Caylá points out that "although the treatment will
cause the patient to heal, its effectiveness will only be guaranteed if followed
correctly". It is also recommended that people in the environment have
diagnostic tests to find out if they have the disease, latently or actively.

Treatments
 Without treatment, tuberculosis irretrievably leads to death. A combination of
drugs,including isoniacide, rifampicin, pyrazine, stamiform and streptomycin, is
used for treatment. They are effective drugs but they have adverse effects,so
their use should be supervised by a specialist. Children with anaphylactic egg
allergies may require testing before administering the vaccine, although triple
viral is usually not contraindicated in these cases.
 If a pregnant woman has a positive tuberculin test, but has no symptoms
and chest x-ray is normal, she should take the drug isoniacidal orally, as it is
usually the only treatment needed to cure the disease. However, to begin such
treatment is usually expected until the last trimester of pregnancy or until after
delivery, because the risk of liver injury from this drug in the woman is higher
during pregnancy.

 If a pregnant woman has symptoms of tuberculosis,she is given the

antibiotics isoniacide, pyrazinemide and rifampin. If a variety of resistant TB is
suspected, additional drugs may be given. Apparently, all these drugs don't
harm the fetus. The infected mother is isolated from her baby until it is no longer
contagious. The baby receives isoniacide as a preventive measure.
 The newborn can also be vaccinated with the BCGvaccine. It does not
necessarily prevent the disease but generally reduces its severity. Because the
BCG vaccine is not 100 percent effective, in some countries it is not routinely
applied to children or adults. Once a person has been vaccinated, they will
always test positive for TB, so a new infection cannot be detected. However, in
many countries with a high rate of tuberculosis, BCG vaccine is routinely
applied. A baby with tuberculosis is treated with the antibiotics isoniacide,
rifampicin and pyrazinemide. If the brain is also affected, corticosteroids may be
given at the same time.