Tuberculosis - Symptoms, Causes, Diagnosis, Treatment, Diet and Home Remedies

Tuberculosis (TB) is a disease that affects the lungs and the respiratory tract of the person. The disease is caused by a bacteria named as Mycobacterium tuberculosis. This disease is curable and preventable. But its active form is highly communicable and can spread from one person to another through cough, sneezes, saliva etc. Due to its highly communicable form this disease has been the second deadly diseases globally.

The two variants of the TB are the latent TB and the active TB. The latent Tuberculosis is not contagious and the bacteria remain in the body in inactive form. In the active TB the bacteria is active and thus can be transmitted from person to person. The general symptoms of the disease are cough for more than 3 months, fatigue, fever, chills, sweating at night, chest pain breathing problem, loss of appetite. There are various medicines and antibiotic to stop the growth of the TB causing bacteria. Many variants of the disease have become drug resistant.

Some facts related to the disease are as follows:

• Fact 1: In 2017, there were an estimated 10 million people ill with tuberculosis worldwide, 5.8 million men, 3.2 million women and 1 million children. These were cases in all countries and age groups but TB is curable and preventable.
• Fact 2: A total of 1.6million people died of TB in 2017(including 0.3million with HIV).Worldwide, TB is one of the top 10 causes of death and the leading cause from a single infectious agent(above HIV/AIDS).
• Fact 3: In 2017, 1 million children fell ill with TB globally and 230,000 children died of TB. Childhood TB is often overlooked by healthcare providers and can be difficult to diagnose and treat.
• Fact 4: TB is the leading killer of people with HIV. In 2017, there were 464,633 reported cases of TB in people living with HIV, of whom 84% were on antiretroviral therapy.
• Fact 5: Multidrug resistant TB remains a public health crisis and a health security threat. Extensively drug-resistant threat is a form of TB that responds to even fewer available medicines.

• Latent TB:

  In the latent TB cases, the TB bacteria remain in a dormant mode in the body. It doesn’t cause any symptoms of the disease and so is not contagious. However, the latent TB bacteria can become active any point of time. About one third of the world population is believed to have latent TB.

• Active TB:

  Although there is only 10% chance that latent TB will get active, but people who have compromised immune system, have higher risks of triggering this latent disease. In active TB, the disease causing bacteria shows symptoms of TB and this illness is contagious.

• Lack of appetite and weight loss
• A high temperature (fever)
• Night sweats
• Extreme tiredness and fatigue
• Cough for more than 3 months
• Extreme tiredness and fatigue

Most TB infections affect lungs that can cause:

• A persistent cough that lasts more than three weeks and usually brings up phlegm, which may be bloody.
• Breathlessness that gradually gets worse.

TB outside the lungs:

• TB affecting other parts of the body occurs in people with weakened immune system. Less commonly TB occurs in areas outside the lungs such as the small glands that form part of the immune system (the lymph nodes),bones and joints ,the digestive system, the bladder and reproductive system, and the nervous system.

Symptoms include:

• Persistently swollen glands
• Abdominal pain
• Pain and loss of movement in an affected bone or joint
• Confusion
• A persistent headache
• Fits(seizures)

• TB is caused by a bacterium called Mycobacterium tuberculosis. It spreads when a person with active TB in their lungs coughs or sneezes and someone else inhales the expelled droplets, which contain TB bacteria. One would have to spend long periods in contact with infection to catch the infection.
• Not everyone with TB is infectious. Children with TB or people with a TB infection that occurs outside the lungs (extrapulmonary tuberculosis)don’t spread the infection.

People at the risk of getting TB include:

• Who live in, come from, or have spent time in a country or an area with high levels of TB.
• In prolonged close contact with someone who is infected.
• Living in crowded conditions.
• With a condition that weakens the immune system, such as HIV.
• Having treatments that weakens the immune system, such as chemotherapy or biological agents.
• Who are very young or very old

• In poor health or with a poor diet because of lifestyle or other problems such as drug misuse, alcohol misuse or homelessness.

Stopping the transmission of TB from one adult to another

This is done through firstly identifying people with active TB and then treating them. With proper treatment, one can overcome the infection and so can no longer infect others. If someone is not on treatment, then precautions like cough etiquette must be taken to stop the spread of infection from one adult to another.

Other TB prevention activities:

This is done through firstly identifying people with active TB and then treating them. With proper treatment, one can overcome the infection and so can no longer infect others. If someone is not on treatment, then precautions like cough etiquette must be taken to stop the spread of infection from one adult to another.

Cough Etiquette:

Patients having latent TB should be prevented from developing an active TB. The infection can be controlled by using masks and respirators in settings such as prisons and hospitals. The pasteurisation of milk also prevents the spread of bovine TB.Vaccination can be used, however it only plays a small role in preventing the spread of TB.

BCG vaccine

It means that if you have or might have TB, then when you cough or sneeze, you must cover your face with a tissue. You should put your used tissue in bin. If you don't have a tissue, then you must cough or sneeze in your upper sleeve or elbow. You should not cough into your hands. After you have coughed, you should wash your hands.

TB Education

It was first developed in the 1920s. It is the most widely used of the current vaccines, and it reaches 80% of all newborn children and infants where it is part of the national childhood immunisation programme.

Prevention in households

Houses should be adequately ventilated and Education on cough etiquette and respiratory hygiene

While smear positive, patients should:

• Spend as much time as possible outdoors
• If possible, sleep alone in a separate, in an adequately ventilated room.
• Spend as little time as possible on public transport.
• Spend as little time as possible in places where large number of people gather together.

• Screening for TB: People living with HIV, people who are malnourished, who have diabetes and cancer and people who are on steroid therapy should be regularly screened for signs and symptoms of TB. Enhanced case finding should be undertaken in certain ‘’high-risk’’ populations such as healthcare workers, prisoners and slum dwellers.
• Patients to be tested: A presumptive pulmonary TB patient is one with any signs and symptoms of TB.

• Most presumptive TB patients must start by having a smear examination and a chest X-ray. If the smear test is positive, then it is considered as microbiologically confirmed TB. If the bacteria that the person has are assumed to be drug-sensitive, then the patient should start on tuberculosis treatment with first line drugs as soon as possible. The smear test is not always a reliable test, so if it is negative but the chest X-ray is suggestive of TB, or CXR is not available, then the patient must go on to have CB-NAAT test.

• The CB-NAAT test must also be carried out if there is a high level of suspicion that the patient has TB. People who have HIV should undergo CB-NAAT test straight away. CB-NAAT RESULT: It is a test for TB and it also shows if the person is resistant to Rifampicin. There are also now some alternatives such as the TrueNat Test which should be cheaper as it has been developed in India.
• Sputum samples: These are very important in diagnosing TB. So paying attention to details of collecting good sputum samples is very important. A general opinion is that two samples are as good as three samples.

1. Treatment for new TB patients:

All new TB patients in India should receive an internationally accepted first line treatment regimen. The initial intensive phase must include eight weeks of the drugs Isoniazid(H),Rifampicin, Pyrazinamide(Z) and Ethambutol (E). The continuation phase should consist of the three drugs Isoniazid, Rifampicin and Ethambutol given for another 16 weeks. This is alternately written as 2HRZE/4HRE.

There will be no need for any extension of the continuation phase. The drug doses should be given as per the patient’s body weight. There are 4 weight band categories. All patients should receive their daily TB drugs under the direct observation (DOTS) scheme. Under DOTS, the patient has to take the medicines in front of a DOTS agent. The DOTS agent is usually a volunteer from the patient’s own community, and maybe a family member. DOTS do not say which drug is to be taken. DOTS apply when any Tuberculosis drugs are taken with the patient being observed by a DOTS volunteer.

• Fixed dose combinations

  A fixed dose combination (FDC) is called so when two or more drugs are combined in a single pill. They are helpful as they simplify getting TB drugs and the delivery of DOTS. They may also increase adherence. Individually worked out drug dosing should be only used for patients with toxicities or contraindications to one or more parts of the FDC.FDCs of 4 drugs (Isoniazid, Rifampicin, Ethambutol, and Pyrazinamide), three drugs (Isoniazid, Rifampicin and Ethambutol), two drugs (Isoniazid, Rifampicin) should be available.

• Daily Drug Treatment

  A fixed dose combination (FDC) is called so when two or more drugs are combined in a single pill. They are helpful as they simplify getting TB drugs and the delivery of DOTS. They may also increase adherence. Individually worked out drug dosing should be only used for patients with toxicities or contraindications to one or more parts of the FDC.FDCs of 4 drugs (Isoniazid, Rifampicin, Ethambutol, and Pyrazinamide), three drugs (Isoniazid, Rifampicin and Ethambutol), two drugs (Isoniazid, Rifampicin) should be available.

2. Previously Treated Patients

Each patient will receive through the RNTCP, a month’s supply of drugs. The patients will be supervised taking the drugs through the DOTS strategy. The daily regimen will have to be followed by patients for 6-8 months.

In December 2018, an announcement was made that all previously treated patients should receive a standard 6 month first line treatment if no resistance was detected to isoniazid or rifampicin. This brings the TB treatment in line with the WHO guidelines of treatment. Drug susceptibility test is important to be carried out to ensure that the previously treated patient does not have any drug resistance.

• Vitamin D: This as a supplementary treatment in patients with an advanced pulmonary TB improved the health of the patients. It can be found in dietary sources such as eggs, fortified milk, fish, and cod liver oil. Also available by basking in the early morning sunshine.
• Bananas: The high concentration of vitamins and organic compounds in bananas can rapidly reduce inflammation, coughing, high fever and excessive mucus production, which are all symptoms of the condition. Hence, eating a few bananas is known to cure the condition entirely.
• Pineapples: They are also known to be very effective in breaking up the mucus in the respiratory tracts and eliminating the congestion of lungs and the nasal cavities.
• Garlic: Though garlic’s allicin content is what gets the attention, in the case of TB, it is the sulphuric acid that is particularly potent for the TB bacteria.
• Gourds: Various types of gourds act as very effective immune system stimulators.
• Mint: It is able to break up the mucus build-up in the respiratory tracts, allowing clear passage of air. It also has immune stimulating properties and antioxidants that can directly impact any infection in the body.
• Indian Gooseberry: This coats the stomach and the respiratory tract and can offer relief from inflammation and discomfort, while also stimulating your immune system with its proven antibacterial properties.
• Oranges: The very high concentrations of vitamin C and other vitamins and antioxidants make oranges a very effective home remedy for TB. The saline action of orange juice can break up congestion in the lungs and the respiratory tracts and can lessen the amount of expectoration, coughing and blood in the sputum. Also, the antioxidants effectively seek out the bacteria causing the infection.
• Black pepper: It is an anti-inflammatory substance and it can also help to cleanse the lungs, reduce coughing and eliminate pain and discomfort.
• Walnuts: Wide range of vitamins and minerals in walnuts speed up healing and protect your body from secondary infections while the immune system handles the main infection.
• Green Tea: It has high polyphenol content to seek out the bacteria and keep it from spreading to the rest of the body.

• Foods Rich in Vitamins A, C and E: Fruits and vegetables like orange, sweet pumpkin, mango, carrots, guava, amla, tomato, nuts and seeds are rich sources of these.
• Portein Rich Food: TB patients tend to lose appetite .It is very important for them to indulge in foods like eggs, paneer and soya chunks as they are quite rich in protein. These foods can be easily absorbed by the body and can give you the required energy.
• Foods Rich in B Complex Vitamins: Whole grain cereals, nuts, seeds, fish and chicken must be consumed by TB patients.
• Foods Rich in Zinc: Nuts are a great source of zinc that can provide essential nutrients to the body. Nuts and seeds like sunflower seeds, chia seeds and pumpkin seeds and flax seeds quite beneficial for TB patients.