Tuberculosis: Causes, Symptoms, Diagnosis and Treatment

Tuberculosis: Causes, Symptoms, Diagnosis and Treatment

Health Lav89 - Tuberculosis: Causes, Symptoms, Diagnosis and Treatment. Tuberculosis is an infectious disease that usually attacks the lungs. The cause of tuberculosis is Mycobacterium tuberculosis. tuberculosis is a multisystemic disease with various clinical forms. Tuberculosis is the most common cause of death worldwide associated with infectious diseases.

Tuberculosis cases are increasing in all parts of the world. Tuberculosis is a disease that is often found in many countries, especially in developing countries. In addition, the prevalence of drug-resistant tuberculosis are also increasing throughout the world. The incompetence of antibiotic drugs against tuberculosis is due to co-infection with the human immunodeficiency virus (HIV) which is now increasingly widespread. Thus, the regimen of early detection of HIV and tuberculosis is cross-linked, namely patients affected by tuberculosis must be checked for HIV, and patients who are exposed to HIV must be checked for tuberculosis.

Causes of tuberculosis

The cause of tuberculosis is the Mycobacterium tuberculosis germ that is acid-resistant (basil) rod. This bacterium is dangerous because it does not only nest in the lungs, but also in other organs besides the lungs, from the lining of the brain to the bones. To avoid the possibility of exposure to tuberculosis bacteria, you should avoid contact with things that are exposed to the bacteria that cause tuberculosis as much as possible.

Signs and symptoms of tuberculosis

It should be emphasized that the signs and symptoms of pulmonary tuberculosis in children and adults are very different. In children, symptoms of pulmonary tuberculosis do not need to cough, but if at home or there is a history of exposure to people who have already experienced symptoms of pulmonary tuberculosis, and the child has symptoms of pulmonary tuberculosis in the form of growth disorders, decreased appetite, fever for 2 weeks, then It is best to do Mantoux Test at the nearest health center.

Whereas in adults, the classic clinical picture associated with symptoms of active pulmonary tuberculosis is as follows:

• Cough.
• Weight loss / anorexia.
• Fever.
• Night sweats.
• Hemoptysis / coughing up blood.
• Chest pain (also can result from acute tuberculous pericarditis).
• Fatigue.

Tuberculosis is a disease that must be watched out. In addition to the lungs, tuberculosis can spread to other organs such as the lining of the brain called tuberculous meningitis, to the bone called Pott's disease, in the urinary tract organs, of the joints, and so on. This depends on endurance and speed of diagnosis among patients.

Symptoms of tuberculous meningitis may include the following:

Intermittent or persistent headaches for 2-3 weeks. Mild mental status changes that can continue into a coma for a period of days to weeks. A fever that is not too high.

Symptoms of bone tuberculosis, called Pott's disease:

• Back pain or back stiffness.
• Lower limb paralysis below. Half of patients with Pott's disease are undiagnosed
• Tuberculous arthritis, usually involving only 1 joint (most often the hip or knee, followed by ankles, elbows, wrists and shoulders)

Symptoms of genitourinary tuberculosis may include the following:

• Low back pain.
• Dysuria.
• Frequent urination.
• In men, painful scrotal masses, prostatitis, orchitis and epididymitis.
• In women, symptoms such as pelvic inflammatory disease.

Symptoms of gastrointestinal tuberculosis refer to infected sites and may include the following:

• Nonhealing boils in the mouth or anus.
• Difficulty swallowing (with esophageal disease).
• Abdominal pain mimics peptic ulcer disease (with gastric or duodenal infections).
• Malabsorption (with small intestinal infections).
• Pain, diarrhea, or hematochezia (with infection of the large intestine).

If you find these symptoms, see your doctor immediately. Later, the doctor will check through a series of anamnesis (interviews) and physical examination. The physical examination findings associated with tuberculosis are dependent on the organs involved. Patients with pulmonary tuberculosis may have the following signs:

• Abnormal breath is heard, especially the upper lobe or the area involved. 
• Rales or bronchial breath signs, indicating pulmonary consolidation.

Signs of tuberculosis differ according to the network involved and may include the following:

• Decreased consciousness to coma.
• Neurological deficit.
• Chorioretinitis (inflammation of the retina of the eye).
• Lymphadenopathy.
• Skin lesions.

The absence of significant physical findings does not necessarily rule out the presence of active tuberculosis. The better immunity or immune power, the symptoms and signs tend to be more visible. However, the worse or weaker the immune system, the symptoms and signs may not appear. This is actually dangerous, because often tuberculosis are a new disease that shows symptoms when it appears in a heavier degree. Patients who tend to have weak immunity are HIV patients, patients who are undergoing chemotherapy, and patients with diabetes.

Diagnosis of tuberculosis

The screening methods for tuberculosis are as follows:

• Mantoux tuberculin skin test with purified protein derivatives for active or latent infection (main method).
• Checking phlegm patients in patients with symptoms of coughing.
• HIV serology in all patients with tuberculosis and HIV status is unknown: Individuals infected with HIV are at an increased risk for tuberculosis.
• Chest X-ray to see pulmonary features in tuberculosis patients.

If the results of the bacterial culture are positive there are tuberculosis bacteria, then it must be followed by testing what antibiotics are suitable for tuberculosis suffered by these patients. However, this test is usually done if the treatment of first-line tuberculosis does not work so patients are categorized into patients who fail first-line treatment for pulmonary tuberculosis.

Whereas if the lesion is outside the lung, the examination is more complex, which includes:

• Biopsy of bone marrow, liver, or blood culture.
• If tuberculous or tuberculoma meningitis is suspected.
• If vertebral (Pott's disease) or suspected brain involvement, CT or MRI is needed.
• If complaints about genitourinary, routine urine examination and urine culture can be done.

Treatment of Lung Tuberculosis

Actions that can be taken to treat pulmonary tuberculosis are:

• Ideally, the treatment of tuberculosis patients is isolated in a room with negative pressure.
• Using a disposable mask that is enough to filter basil.
• Continue isolation until negative smear for 3 consecutive phlegm examinations (usually after about 2-4 weeks of treatment).

The pulmonary tuberculosis treatment regimen has several categories and lines. For the first time tuberculosis cases, tuberculosis treatment was carried out for 6 months. Empirical treatment begins with a 4-drug isoniazid, rifampicin, Pyrazinamide, and Ethambutol or streptomycin regimen. This therapy will be adjusted according to the results of susceptibility and toxicity tests. Pregnant women, children, HIV-infected patients, and patients infected with drug-resistant strains require a different regimen.

Prophylactic treatment is a treatment given to patients who have not yet established a diagnosis of tuberculosis, but have the potential to contract. For example, pregnant women who are at home with a tuberculosis husband, or a small child whose parents live at home and contract tuberculosis.

Special considerations for drug therapy in pregnant women include the following:

• Pyrazinamide is reserved for women suspected of MDR tuberculosis
• Streptomycin should not be used.
• Prophylactic medication is recommended during pregnancy.
• Pregnant women who take isoniazid will experience liver toxicity (hepatotoxic).
• Breastfeeding can be continued during prophylactic therapy.

Special considerations for drug therapy in children include the following:

Most children with tuberculosis can be treated with isoniazid and rifampicin for 6 months, along with Pyrazinamide for the first 2 months, depending also on the results of the bacterial culture.For tuberculosis after birth, the duration of treatment can be increased to 9 or 12 months.Ethambutol is often avoided in children because of its disturbing effect on the sense of sight.

There are special considerations for drug therapy in HIV-infected patients in the form of dose adjustments and selected drug regimens.

The main problem in the treatment of pulmonary tuberculosis is the length of treatment so that the level of patient compliance tends to decrease. This triggers resistance to germs so the initial antibiotics do not work. Patients who experience resistance are called MDR tuberculosis cases. For cases of MDR tuberculosis, treatment will be much more difficult, with a longer duration, a higher mortality rate, and the drug is not just taken, but there are also injectable drugs. The spread of tuberculosis is faster because of the increase in HIV cases and the non-compliance of patients in taking tuberculosis drugs.