Pulmonary Tuberculosis

Definition, symptoms and treatments of pulmonary tuberculosis

By dr. Wahyu Pratama Putra

What is Tuberculosis ?

Tuberculosis or often abbreviated as TB is a contagious infectious disease caused by the bacterium Mycobacterium Tuberculosis that can affect various organs, especially the lungs. If this disease is not treated or the treatment is not complete it can cause dangerous complications to death. There are several species of Mycobacterium, including : M. Tuberculosis, M.Africanum, M.Bovis, M.Leprae where the group of germs is also known as Acid Resistant Bacilli.

       Globally, in 2016 there were 10,4 million cases of TB incidence which equivalent to 120 cases per 100.000 population. Five countries with the highest incidence of cases are India, Indonesia, China, The Philippines and Pakistan. Most of the estimated TB incidence in 2016 occurred in the Southeast Asia region (45%) where Indonesia is one of them and 25% occurs in the African region.

       Situation in Indonesia, the new cases of TB in Indonesia is 420.994 cases in 2017. Based on gender, the number of new cases of TB in 2017 for men is 1.4 times greater than in women. Even based on a survey, the prevalence of Tuberculosis in men is 3 times higher than woman. This is possible because men are more exposed to TB risk factors such as smoking and lack compliance to taking medication.

 

What are the causes an risk factors for Tuberculosis ?

Tuberculosis is an infectious disease that is transmitted through the air or referred to as an airborne disease. This infectious disease caused by Mycobacterium Tuberculosis. There are several species of Mycobacterium, among other: M.Tuberculosis, M.Africanum, M.Bovis, M.Leprae, but Mycobacterium Tuberculosis is considered  to be the most closely related as a cause of Tuberkulosis. In the United States most TB cases are also caused by M.Tuberculosis. This group of bacteria is also referred to as Acid Resistant Bacilli and this bacteria can withstand a variety of weak disinfectants and able to survive in dry conditions for weeks.

       The risk of Tuberculosis will increase when a person’s immune system decreases. The occurrence of an illness as a result of interactions between three components, namely host, cause (agent), and environment. In the host factor, susceptibility to Tuberculosis infection is strongly influenced by the resistance of a person at that time. Especially people with HIV/AIDS or people with poor nutritional status will be easier to get infected. Other condition called increasing the risk of infected with Tuberculosis include :

  • Children younger than 5 years of age
  • Persons who were recently infected with M.Tuberculosis (within the past 2 years)
  • Persons with diabetes mellitus, chronic renal failure, leukemia, cancer
  • Cigarette smoker and persons who abuse drugs and/or alcohol
  • Population defined locally as having an increased incidence of disease due to M.Tuberculosis, including medically underserved, low income populations

 

How is Tuberculosis transmitted ?

Tuberculosis is one of the airborne diseases, its transmission can occur through droplets. M. Tuberculosis can be carried in airborne particles called “Droplets Nuclei”, where these particles are very small size which are about 1-5 microns. Droplet particles will be produced when people suffering from pulmonary tuberculosis are coughing, sneezing. Depending on the environment, these small particles will remain in the air for several hours and M. Tuberculosis will be transmitted  through the air rather than by touch contact. Transmission occurs when a healthy person accidentally inhales a droplet containing M.Tuberculosis and then the droplet enters through the mouth/nose, towards the upper respiratory tract and bronchi to reach the alveoli.

Illustration Transmission of Tuberculosis

 

What are the symptoms of Tuberculosis ?

Tuberculosis can affect any body organs, but it most often affects the lungs. The symptoms  of pulmonary Tuberculosis in general are :

  • The main symptom is cough can be accompanied by phlegm which lasts for 2 weeks or more.
  • Cough can be followed by other additional symptoms of phlegm mixed with blood or coughing up blood.
  • Fever
  • Out of breath
  • Limp
  • Decreased appetide
  • Weight loss
  • Malaise
  • Sweating at night without physical activity
  • In HIV positive patients, coughing is often not symptom of typical Tuberculosis so the cough does not always have to be for 2 weeks or more.

 

How to diagnosed Tuberculosis ?

Your doctor will able to diagnose Tuberculosis through several stages, where the diagnosis of Tuberculosis is established based on clinical symptoms, physical examination, and laboratory examination. A patient who is suspected of suffering from Tuberculosis needs to be explored further in the history of his complaints such as cough (> 2 weeks), coughing up blood, shortness of breath, chest pain, and systemic symptoms such as fever, malaise, night sweats, decreased appetide, and weight loss.

       If the patient experiences these symptoms, its not certain that someone is suffering from Tuberculosis, so the doctor will do some additional examinations to support the diagnosis of Tuberculosis. The examination that is generally is sputum examination, where the sputum is carried out 3 times every morning (first: phlegm during visit, second: the next day, third: when delivering phlegm morning), the phlegm will be examined at laboratory. Finding acid resistant bacilli in sputum examination has a very important meaning in a diagnosis of Tuberculosis. Other test that can be done are radiological examinations (Chest X-ray) to see abnormalities in the lungs of someone suspected of suffering from Tuberculosis.

 

How is Tuberculosis treated ?

Tuberculosis can be cured if treated properly. The treatment needed after the patient tested positive for Tuberculosis is to consume several types of antibiotics consisting of 3-5 antibiotics. These drugs must be consumed for at least 6 months. In order for surfferer to achieve healing, the patient must routinely take the medication, not stop before treatment is complete, and check regularly even though the symptoms that have been felt are reduced. The main problem in the treatment of Tuberculosis is the length of treatment so that the level of adherence of patients tends to decreased. Patients who experience drug resistance are called MDR-TB. In this case treatment will be much more difficult, with a longer duration and a higher mortality rate. Dissemination of Tuberculosis is faster because the increase in HIV cases and patient not compliance in taking medicine are the main causes.

 

 

How to prevent Tuberculosis ?

Currently in Indonesia, BCG vaccines are available that can protect against infection with Tuberculosis. The BCG immunization program is included in the list of mandatory immunizations from infancy. Although he had received the BCG vaccine, its not impossible for someone not to be infected with Tuberculosis bacteria, but if you have already received a symptomatic vaccine, it will certainly be much lighter than Tuberculosis infection in people who have never receive a vaccine. Some other ways the patients can do to prevent transmission of Tuberculosis in people around them include: closing their mouths when coughing and sneezing, do not spit or dispose of phlegm carelessly, avoid direct contact with children , let sunlight into the room.

 

Library :

  1. CDC. Chapter 2 : Transmission and Pathogenesis of Tuberculosis
  2. NSW-Health. 2005. Tuberculosis: Indonesia
  3. Infodatin. 2015. Tuberkulosis: Temukan Obati Sampai Sembuh. Kementerian Kesehatan RI : Pusadatin
  4. Infodatin. 2018. Tuberkulosis. Jakarta: Kementerian Kesehatan RI
  5. Pedoman Diagnosis dan Penatalaksanaan Tuberkulosis di Indonesia (Konsensus TB)