Tuberculosis

(Survival Manual/ 6. Medical/ b) Disease/ Tuberculosis)

Important points to remember from this article:
•  More than two billion people, equal to one-third of the world’s total population, are infected with TB bacilli.
•  TB remains a disease of poverty and poor health services.
• [Should there occur a SHTF/ TEOTWAWKI event drastically lowering global living standards, expect Tuberculosis rates & overall numbers to increase. At present, Tuberculosis is a fringe disease for we who live in the affluent West, that could change. Just remember, if the global economy goes south and stays down for an extended length of time, people with “a cough that just won’t go away” may have contracted Tuberculosis. See “Signs and Symptoms”, below. Mr Larry]

A.  World Tuberculosis Day 2011
19 August 2011, Doctor NDTV, Aman subeditor
Pasted from: <http://doctor.ndtv.com/storypage/ndtv/id/5055/type/feature/World_Tuberculosis_Day_2011.html?cp>

World Tuberculosis (TB) Day, which falls on March 24 every year, aims to raise public awareness about tuberculosis, a preventable disease. Tuberculosis is still an epidemic in many regions of the world, annihilating the lives of many millions of people each year. Each year, over nine million people around the world get infected with TB and almost two million TB related deaths are recorded worldwide. The actual figures must be far larger than this.

For World TB Day 2011, we enter the second year of a two-year campaign – “On the move against tuberculosis”. The campaign aims to inspire innovation in TB research and care. The 2011 World TB Day campaign is focused on individuals around the world who have found new ways to stop TB and can serve as an inspiration to others. The basic idea is to recognise people who have introduced a variety of innovations in a variety of settings. The objectives of TB day are listed below:

• Research aimed at developing new diagnostics, drugs or vaccines
• Operational research, aimed at making TB care more effective and efficient
• New approaches to helping people gain access to TB diagnosis and treatment
• Novel partnerships between actors in the fight against TB
• Advances in integrating TB care into health systems
• New approaches to providing support from members of the community to people affected by TB
• Innovative ways of raising awareness about TB.

According to World Health Organization (WHO), here are some interesting facts about tuberculosis:
Fact 1 – Tuberculosis is contagious and spreads through air. If not treated, each person with active TB can infect on average 10 to 15 people a year.
Fact 2 – More than two billion people, equal to one third of the world’s total population, are infected with TB bacilli, the microbes that cause TB. One in every 10 of those people will become sick with active TB in his or her lifetime. People living with HIV are at a much higher risk.
Fact 3 – A total of 1.7 million people died from TB in 2009 (including 3, 80,000 people with HIV), equal to about 4,700 deaths a day. TB is a disease of poverty, affecting mostly young adults in their most productive years. The vast majority of TB deaths are in the developing world, with more than half occurring in Asia.
Fact 4 – TB is a leading killer among people living with HIV, who have weakened immune systems.
Fact 5 – There were 9.4 million new TB cases in 2009, of which 80% were in just 22 countries. Per capita, the global TB incidence rate is falling, but the rate of decline is very slow – less than 1%.
Fact 6 – TB is a worldwide pandemic. Among the 15 countries with the highest estimated TB incidence rates, 13 are in Africa, while a third of all new cases are in India and China.
Fact 7 – Multidrug-resistant TB (MDR-TB) is a form of TB that does not respond to the standard treatments using first-line drugs. MDR-TB is present in virtually all countries surveyed by WHO and its partners.
Fact 8 – There were an estimated 4, 40,000 new MDR-TB cases in 2008 [drug resistant] with three countries accounting for over 50% of all cases globally – China, India and the Russian Federation. Extensively drug-resistant TB (XDR-TB) occurs when resistance to second-line drugs develops. It is extremely difficult to treat and cases have been confirmed in more than 58 countries.
Fact 9 – The world is on track to achieve two TB targets set for 2015:
•  Millennium Development Goal, which aims to halt and reverse global incidence (in comparison with 1990); and
•  Stop TB Partnership target of halving deaths from TB (also in comparison with 1990).
Fact 10 – Forty one million TB patients have been successfully treated in DOTS programmes and up to 6 million lives saved since 1995, 5 million more lives could be saved between now and 2015 by fully funding and implementing The Global Plan to Stop TB 2011-2015

The global epidemic of tuberculosis (TB) 
It is estimated that 1.7 million people died of tuberculosis in 2009. There were an estimated 9.4 million new cases of tuberculosis in 2009 of which the majority were in Asia and Africa. It is thought that the rates of new tuberculosis infections and deaths per capita have probably been falling globally for several years now. However, the total number of new tuberculosis cases is still slowly rising due to population growth.

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B.  Control of Tuberculosis (TB)
October 24, 2005- February 11, 2006, About.com, by Jerry Kennard and the MEDICAL Review Board
Pasted from: <http://menshealth.about.com/od/diseases/a/tb.htm&gt;
and <http://menshealth.about.com/od/diseases/a/treatment_tb.htm&gt;

In the 1959s the US and many European countries introduced immunization programs. As a result the incidence of TB fell dramatically. In the late 1980s there was a resurgence of TB cases in the large cities of the US and in Europe. This has been for a number of reasons, among them;

Homelessness; overcrowding in shelters, prisons and in homes for the poor; increased immigration from countries with a high incidence of TB; drug abuse; HIV/AIDS.

Facts About Tuberculosis (TB)
According to the World Health Organization (WHO) each year around eight million people develop TB. Every year about 2 million people die from TB, a curable disease. Every second somewhere in the world someone gets infected with TB bacilli. The World Health Organization estimates that about one-third of the world’s population is currently infected with the TB bacillus.

In the USA the tuberculosis (TB) infection rate in the United States fell to a record low in 2004. A total of 14,511 active TB infections, or 4.9 cases per 100,000 people, were reported to the Centers for Disease Control and Prevention.

Tuberculosis (TB) is a contagious disease caused by the bacillus Mycobacterium tuberculosis. TB spreads through the air. The usual form is pulmonary TB, which affects the lungs. Only people who are sick with TB in their lungs are infectious.
It is important to know that not everyone infected with TB germs develops active TB. About 5-10% of people who are infected with TB bacilli become sick or infectious at some time during their life.

Although TB most commonly affects the lungs, TB germs can also spread to other organs in the body (extra-pulmonary TB). This air borne infection is spread through coughs, sneezes and spitting of infected material. It only takes a few inhaled germs to become infected but In general, you need prolonged exposure to an infected person before becoming infected yourself.
Someone with a compromised or weakened immune system is more likely to become infected with Tuberculosis. TB remains a disease of poverty and poor health services.
TB has been around for many thousands of years. It has been found in bones dating back at least 5,000 years.

Signs and Symptoms of Active Tuberculosis (TB)
Signs and symptoms of active pulmonary TB are usually
  A cough lasting three or more weeks
  Discolored or bloody sputum
  Weight loss
 Fatigue
  Slight fever
  Night sweats
  Chills
  Loss of appetite
  Pain when breathing or coughing (pleurisy)
Tuberculosis can also occur in other parts of your body. These include your joints, bones, bone marrow, muscles, urinary tract, lymphatic system and central nervous system.

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C.  Treatment and Control of Tuberculosis
October 24, 2005, About.com, Jerry Kennard and reviewed by the Medical Review Board
Pasted from: <http://menshealth.about.com/od/diseases/a/treatment_tb.htm> 

Treatment for Tuberculosis (TB)
Treatment for TB was only available from about 50 years ago. Active tuberculosis, if not treated, will infect on average between 10 and 15 people every year. If active tuberculosis is not treated it can kill and treatment currently reaches only about a quarter of people with Tuberculosis.

Antibiotics are used in the treatment of Tuberculosis (TB). Antibiotic treatment therapy is lengthy and you have to take them for six to 12 months to completely destroy the bacteria. The length of treatment and the type of drug that is needed is determined by your age, overall health, the results of susceptibility tests, and whether you have TB infection or active TB.

It is the length of drug treatment that causes so many difficulties in developing countries as well as in the West. Poor supervision, incomplete treatment, doctors and health workers prescribing the wrong treatment regimens, or an unreliable drug supply not only fails to treat TB but can lead drug-resistant TB.
Surgery is now very rarely used to treat TB.

Drug-resistant Tuberculosis TB Treatment
Strains that are resistant to a single drug have been documented in every country. A particularly dangerous form of drug-resistant TB is multidrug-resistant TB (MDR-TB) Rates of MDR-TB are high in many countries including the former Soviet Union.
People infected with the drug resistant strain will pass on the same drug-resistant strain when they infect others. While drug-resistant TB is generally treatable, it requires extensive chemotherapy, sometimes up to 2 years of treatment. The medication required for drug resistant TB is extremely expensive, often more than 100 times more expensive than treatment of drug-susceptible tuberculosis. Treatment is often more toxic to patients and not so well tolerated.

 

D.    Risk factors
Anyone can get tuberculosis, but certain factors can increase your risk of the disease. These factors include:
_1) Weakened immune system
A healthy immune system can often successfully fight TB bacteria, but your body can’t mount an effective defense if your resistance is low. A number of diseases and medications can weaken your immune system, including:

• HIV/AIDS
• Diabetes
• End-stage kidney disease
• Cancer treatment, such as chemotherapy
• Drugs to prevent rejection of transplanted organs
• Some drugs used to treat rheumatoid arthritis, Crohn’s disease and psoriasis
• Malnutrition
• Advanced age

_2) International connections
TB risk is higher for people who live in or travel to countries that have high rates of tuberculosis, such as:

• Sub-Saharan Africa
• India
• China
• Mexico
• The islands of Southeast Asia and Micronesia
• Parts of the former Soviet Union

_3) Poverty and substance abuse

• Lack of medical care. If you are on a low or fixed income, live in a remote area, have recently immigrated to the United States or are homeless, you may lack access to the medical care needed to diagnose and treat TB.
• Substance abuse. Long-term drug or alcohol use weakens your immune system and makes you more vulnerable to tuberculosis.
• Where you work or live
• Health care work. Regular contact with people who are ill increases your chances of exposure to TB bacteria. Wearing a mask and frequent hand-washing greatly reduce your risk.
• Living or working in a residential care facility. People who live or work in prisons, immigration centers or nursing homes are all at risk of tuberculosis. That’s because the risk of the disease is higher anywhere there is overcrowding and poor ventilation.
• Living in a refugee camp or shelter. Weakened by poor nutrition and ill health and living in crowded, unsanitary conditions, refugees are at especially high risk of tuberculosis infection.

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E.  TB Medical Advisory Board Statement on the Treatment of Active Tuberculosis in Adults
 Pasted from <http://www.in.gov/isdh/19686.htm>
Recommended Treatment Regimens
Unless there are contraindications, patients with active tuberculosis should be treated initially with four drugs: isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (EMB). Four drugs are recommended because (1) EMB helps to prevent the emergence of RIF-resistant organisms when primary resistance to INH may be present; (2) INH resistance continues to occur in our state, (3) foreign-borne persons from countries with high rates of drug resistance make up a growing number of TB cases in Indiana, and (4) six-month treatment regimens are not possible without the use of PZA.

 Use of Drugs Other Than INH, RIF, PZA, or EMB
There are no substitutes for any of the first-line agents. Before rifampin was available, TB patients had to take medication for 18-24 months. The combination of INH and rifampin allowed completion of therapy within 9 months. Routine addition of PZA during the first two months has shortened duration of therapy to 6 months for most cases. Ethambutol is known as a ‘companion drug,’ and has bacteriostatic activity. Its primary purpose is to suppress the further development of resistance in situations where INH resistance is already present at diagnosis. Ethambutol can be discontinued as soon as the organism is known to be susceptible to both INH and RIF.

The drugs are not interchangeable. Second-line agents must be used when patients cannot take first-line drugs because of resistance or intolerance. These second-line agents are substantially less active, and not without risks of toxicity. Patients taking second-line drugs in lieu of both INH and RIF require treatment durations of up to 2 years with frequent monitoring for side effects.

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F.  Prevention
Pasted from <http://www.mayoclinic.com/health/tuberculosis/DS00372/DSECTION=coping-and-support>
If you test positive for latent TB infection, your doctor may advise you to take medications to reduce your risk of developing active tuberculosis. The only type of tuberculosis that is contagious is the active variety, when it affects the lungs. So if you can prevent your latent tuberculosis from becoming active, you won’t transmit tuberculosis to anyone else.

Protect your family and friends
If you have active TB, keep your germs to yourself. It generally takes a few weeks of treatment with TB medications before you’re not contagious anymore. Follow these tips to help keep your friends and family from getting sick:

• Stay home. Don’t go to work or school or sleep in a room with other people during the first few weeks of treatment for active tuberculosis.
• Ventilate the room. Tuberculosis germs spread more easily in small closed spaces where air doesn’t move. If it’s not too cold outdoors, open the windows and use a fan to blow indoor air outside.
• Cover your mouth. Use a tissue to cover your mouth anytime you laugh, sneeze or cough. Put the dirty tissue in a bag, seal it and throw it away.
• Wear a mask. Wearing a surgical mask when you’re around other people during the first three weeks of treatment may help lessen the risk of transmission.

Finish your entire course of medication
This is the most important step you can take to protect yourself and others from tuberculosis. When you stop treatment early or skip doses, TB bacteria have a chance to develop mutations that allow them to survive the most potent TB drugs. The resulting drug-resistant strains are much more deadly and difficult to treat.

Vaccinations
In countries where tuberculosis is more common, infants are vaccinated with bacillus Calmette-Guerin (BCG) vaccine because it can prevent severe tuberculosis in children. The BCG vaccine isn’t recommended for general use in the United States because it isn’t very effective in adults and it causes a false-positive result on a TB skin test. Researchers are working on developing a more effective TB vaccine.

Coping and support
Undergoing treatment for tuberculosis is a complicated and lengthy process. But the only way to cure the disease is to stick with your treatment. You may find it helpful to have your medication given by a nurse or other health care professional so that you don’t have to remember to take it on your own. In addition, try to maintain your normal activities and hobbies, and stay connected with family and friends.

Keep in mind that your physical health can affect your mental health. Denial, anger and frustration are normal when you must deal with something difficult and unexpected. At times, you may need more tools to deal with these or other emotions. Professionals, such as therapists or behavioral psychologists, can help you develop positive coping strategies.