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Tuberculosis: An Overview
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Tuberculosis is caused by Mycobacterium tuberculosis and is one of the world’s most widespread illnesses. It is estimated to affect at least twenty percent of the world’s population is far more widespread in under-developed and developing where in some counties the incidence is sometimes as high as even forty percent of the population.

Although the disease is widespread throughout the world, it occurs chiefly among socio-economically disadvantaged groups such as, the malnourished, homeless, and those living in overcrowded and substandard conditions with poor hygiene and sanitation.

The disease occurs in all age groups, from infants to the elderly, and in both sexes but men are affected more than women. There is increased occurrence of tuberculosis among HIV-positive individuals and those with other immune-compromised states.

Tuberculosis infection is spread chiefly by inhalation. It is also spread through intimate contact such as kissing, and in the active stages of an illness, the infection spread through regular close contact such as using the utensils and items of the infected individual.

It is for these reasons that during the active stages of the disease, an important aspect of management involves the isolation of the affected individuals in order to minimize and limit the spread of the disease. It is important to highlight that exposure to the mycobacterium tuberculosis does not automatically results in infection or illness.

Newborns as part of standard immunization program, (practically in all countries and most regions) newborns and infants are given a vaccine which offers protection and minimize the risk of developing tuberculosis when exposed to the mycobacterium.

However, in some cases of exposure to Mycobacterium tuberculosis the disease will develop in susceptible individuals. There are different types of tuberculosis. The classification is based on the means of spread in the body and the organs which are affected.

Infection with Mycobacterium tuberculosis bacteria occurs when a susceptible individual inhales airborne droplets containing viable organisms. The bacteria reach the alveoli of the lungs. Infection occurs when the bacteria overcome the body’s defense mechanisms and in this specific case the alveolar macrophages of the lungs, which have antimicrobial activities.

At this stage of the disease there are no clinical or radiological (x-rays) signs of the disease and is the latent stage and is referred to as primary tuberculosis or latent tuberculosis infection. There are no symptoms and signs of tuberculosis because the fact that, in most persons with intact cell-mediated immunity, T cells and macrophages will surround the mycobacteria and form granulomas which will keep it localized and prevent spread.

The micro-organisms can therefore lie dormant for years or even decades. Individuals or infected persons, as stated earlier have no symptoms or signs of the disease and at this stage cannot transmit the organisms to others.

However, during conditions of stress, malnutrition or any condition that will cause reduction of the body’s immune systems then this latent infection will spread by haematogenous (blood) and lymphatic means to other parts of the lungs and body. This is when symptoms and signs occur.

The main symptoms and signs of tuberculosis are:

1. Chronic cough which is persistent over weeks and months. 2. Weight loss 3. Weakness or fatigue 4. Fever 5. Night sweats

The microorganisms can be identified in the sputum and there are infiltrates on the chest radiograph (x-rays). The typical location, of these changes on x-rays, is in the apical zones of the lungs.

Treatment of individuals with tuberculosis is multifactorial and first and foremost includes isolation of the affected individual from the home environment and community. A high calorie diet rich in proteins, proper rest and adequate ventilation should be ensured.

All these are done in conjunction with antimicrobial therapy using specific anti-tuberculosis drugs after tests have been done to determine the sensitivity of the micro-organisms to the different anti-tuberculosis agents which are available.

As a general rule at least two drugs are used in combination to increase efficacy and reduce the likelihood of resistance developing to the drugs by the Mycobacterium tuberculosis.

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