Tuberculosis – TBC

Tuberculosis, also called TB, is an infectious disease that primarily affects the lungs. In many parts of the world, TB is one of the most common infectious diseases, but in some parts of Europe, the disease is not so common. There are effective medicines for TB and most people usually become completely healthy with treatment.

Symptoms of Tuberculosis

Tuberculosis is most common in the lungs and lymph nodes, but can sometimes affect other body parts.

Tuberculosis in the lungs

In the case of tuberculosis in the lungs it is common for you to have the following symptoms:

  • You have a cough, which often lasts for more than three weeks.
  • You cough up mucus. There may also be blood in the coughed mucus.

You may also have one or more of these symptoms:

  • You have a poor appetite.
  • You have involuntarily lost weight.
  • You have a fever.
  • You sweat at night.
  • You feel weak and tired.
  • You have chest pain.

Tuberculosis in other body parts

If you get TB in any other part of your body, your problems depend on where in the body you have the disease. As with tuberculosis in the lungs, you can also lose weight, have a fever, sweat at night and feel tired and weak.

Tuberculosis in the lymph nodes often causes the lymph glands to swell, for example at one side of the neck or near the jaw. The glands are not sore and you do not feel particularly sick.

If you get tuberculosis in your lung sac it hurts when you breathe. You usually feel sick and tired and have a fever. 

You can get tuberculosis in parts of the skeleton. It can be, for example, in the hip, femur or in the vertebrae. Then you can get hurt there.

You can also get tuberculosis in the genitals, such as the fallopian tubes and uterus. Then you can have a harder time getting pregnant.

Tuberculosis of the stomach and intestines can cause severe and long-lasting problems, often similar to those of other diseases of the stomach and intestines. For example, you may get a swollen stomach, stomach pain, and diarrhea.

Children may have other symptoms of tuberculosis

Children younger than three to four years develop lighter TB after being infected and may also have more serious forms of the disease. The symptoms are often more general, such as fever. Tuberculosis can develop rapidly because younger children have a more undeveloped immune response.

In older children and schoolchildren before adolescence, tuberculosis often causes less trouble than in adults. They rarely cough. The symptoms are often fever for several weeks and the baby is tired and hungry. For example, during an X-ray examination of the lungs, a doctor can see swollen lymph nodes between the lungs.

The problems in teens are similar to those in adults, but the disease can develop faster.

Rare but severe forms of tuberculosis

The TB bacterium can cause meningitis. It is a serious form of TB that is uncommon in some parts of Europe. The symptoms of tuberculosis are similar to those of meningitis caused by other bacteria.

Another unusual but serious form of the disease is TB in the blood, called miliary tuberculosis. The bacteria are then spread with the blood to the entire body and affect several organs.

Meningitis and miliary tuberculosis can develop a short time after the infection. Children who have recently been infected are at extra risk. 

When should I seek care?

Contact a health care provider if you have symptoms that you believe are due to tuberculosis. If your child has symptoms that you believe are due to tuberculosis, contact a pediatric emergency room or medical center. The same applies if your child is less than five years old and has been exposed to TB infection, even if they have no symptoms.

Tell your doctor if you have been ill in TB before or if you know that you or the child has been infected with TB. Then it is easier for the doctor to investigate you and make a diagnosis.

You do not need to contact health care if you as an adult have been in contact with someone who has tuberculosis and you have no problems. Instead, healthcare makes a so-called contact tracking. Then a doctor or nurse will contact you and others who have been in contact with the person who has tuberculosis. Contact your health care provider if you have any problems or have not received a call within the next few months.

How Does Tuberculosis Infect?

Tuberculosis spreads with the tubercle bacterium. It transmits from person to person through the air.

A person who has TB in the lungs and tubercle bacteria in their coughs is contagious and can spread the disease. But only some people with tuberculosis in the lungs have bacteria in the cough. If there is no tubercle bacteria in the mucus, the person usually does not infect.

When a person with infectious tuberculosis coughs, sneezes or spits, small droplets containing the bacteria in the air are spread. If you breathe in the drops with the bacteria, you can become infected.

TB in organs other than the lungs and respiratory tract is not contagious. People who are infected but who are not sick are also not contagious. It is called that they have dormant tuberculosis. In the next part of the text, you can read more about dormant tuberculosis. 

Close contact is required

In order for you to become infected, repeated and close contact with a person with infectious TB is usually required. The bacteria are spread primarily to family, partners, and others with whom the sick person lives. Children become more easily ill than adults if infected, but children are almost never contagious.

Infectivity decreases rapidly during treatment

After two weeks of treatment for tuberculosis in the lungs, the infection is usually low or completely gone. Without treatment, tuberculosis in the lungs that is not contagious can develop into infectious.

Resting and active tuberculosis

Most people who become infected with TB do not get sick, that is, they do not get any symptoms and do not become infected. It is called that the tuberculosis is latent or that it lies dormant in the body. But tuberculosis can become active later and that’s when you get sick.

Barely every tenth adult who has been exposed to TB infection becomes ill. If you become ill, it is often within two to five years after you become infected. Sometimes you may become ill long after you become infected, for example, if the immune system is weakened later in life.

Anyone with dormant tuberculosis can receive preventative treatment to reduce the risk of getting sick.

Some groups are more easily ill

Among those who have a combination of HIV infection and dormant tuberculosis, tuberculosis breaks out significantly more. This is because the HIV virus weakens the immune system. The risk of becoming ill is reduced if you are treated with medicines for the HIV infection.

There are several factors that can increase the risk of the person being subsequently infected with TB:

  • Difficult living conditions can affect the body’s defense against the disease. Stress and poor access to good food affect the body’s resistance. Living on the run is one such example.
  • Younger children, teens and older people develop TB more easily if they have been infected compared to other age groups.
  • After giving birth, there is a slightly increased risk of becoming ill, but pregnant women are otherwise not more likely to have TB than other women.
  • The reduced immune system makes the disease easier to develop. Also, treatment with immunosuppressive drugs, such as cortisone or cytostatic drugs, as well as certain drugs used in rheumatic diseases increases the risk of getting sick.
  • Malnutrition, abuse of alcohol or drugs and smoking a lot affect the body’s resistance to TB.
  • People with diabetes can more easily develop TB if they become infected. 
  • Lung silicosis, so-called stone dust lung, and other lung injuries also make the disease progress more easily. 

Surveys

To diagnose tuberculosis, the doctor usually needs to do several examinations.

Exhalation test and chest x-ray

If your doctor suspects you have TB in your lungs, you may have to pass a cough test.

The coughing is examined to see if there are tuberculosis bacteria in the mucus. If there are bacteria these are grown. Using some methods, it is already possible within a couple of days to see if the bacteria are resistant or sensitive to the most important drugs.

The bacteria grow very slowly and it can take seven to eight weeks before the final culture response is obtained. During cultivation, the bacteria’s resistance to various drugs against TB is tested. Resistance is also called resistance.

You are also examined with a chest x-ray. You probably do not have TB in your lungs if the X-rays do not show anything that deviates from the usual. If there are typical changes in the lungs in the X-ray, it indicates that you have TB.

Bronchoscopy and gastric lavage

The doctor or nurse can examine you using an instrument called a bronchoscope. With the help of the bronchoscope, the doctor can see the inside of the trachea and take samples directly from the lungs. When examining the doctor, insert a tube through your mouth or nose into the lungs. The hose is flexible and thin. You get anesthesia in the nose and throat and soothing drugs. The examination may feel a bit unpleasant, but it does not hurt.

The doctor can also do a gastric lavage. This means that a little fluid from your stomach is examined. The doctor sucks up the fluid through a thin, flexible hose that runs down your stomach through your mouth. It doesn’t hurt but can feel a little uncomfortable. You get local anesthesia if you want.

Blood tests can show if you are infected

You can have a blood test. The blood test shows if your immune system has been in contact with and reacted to tubercle bacteria. It may be a sign that you have an infection with the bacteria. You may need to submit a new blood sample a few months after the first blood test, as part of the follow-up. The blood test results are not affected by a previous vaccination against tuberculosis.

Sometimes the blood test is combined with a so-called tuberculin test. The samples can be taken at the same time, or you can have blood tests when the tuberculin test is to be assessed.

Tuberculin

A tuberculin test can be used to see if you are infected with TBC. The test can also cause a reaction if you have previously been vaccinated against TB or have been infected by bacteria similar to the tubercle bacterium.

The test is done so that you get a small amount of tuberculin injected superficially into the skin, usually on the forearm. Tuberculin, also called PPD, is a fluid that contains specific proteins from the tubercle bacterium.

Three days after the PPD syringe you should return to the doctor for an assessment. If you have a slight rise and hardening on the skin, it shows that the body has encountered tuberculosis bacteria at some time before. Then you can have dormant tuberculosis, thus being infected but without being ill. If you are sick with tuberculosis when you are being tested, you will often get a big rash. You can also get that in response that you are vaccinated against TB.

A tuberculin test earliest results four to six weeks after the time when you were exposed to infection.

If the tuberculin test shows no reaction, it usually indicates that you are not infected.

Contact tracing

Tuberculosis is a notifiable disease. This means that the doctor who diagnoses TBC must report it to the infection control physician in the county.

Doctors and nurses responsible for a person who has infectious TB always make so-called contact tracking. It can also be called infection tracking. Then the health care staff will identify which contacts the sick person has had. In the first instance, those with whom the person has had repeated close contact are investigated. There may be children in the family, a partner, and other relatives.

If it turns out that family members or other close contacts have become infected, more people are being investigated. For example, there may be more within the family, but also friends, schoolmates, and workmates.

Children are examined as soon as possible

Whoever is called into control does not know who may have infected them. This is because the nurse or doctor has a duty of confidentiality and must not reveal the name of the person who is ill. Anyone who has had contact with the sick person is not called for control at once.

Children and people with impaired immune systems are always called for control as soon as possible.

If it turns out that someone has become infected, the doctor assesses whether the person should be given preventative treatment with TB medicines.

Treatment for active tuberculosis

Tuberculosis can be a serious illness, but there is an effective treatment.

You may need to be hospitalized for a few weeks at the start of treatment. In particular, it may be necessary if you are very ill, weak and tired. After that, most of the treatment can be done at home with regular visits to a reception.

Sometimes the whole treatment can be done at home in combination with visits to a reception.

Long processing time

Tubercle bacteria are slowly affected by drugs. Therefore, the treatment time is several months. To prevent the bacteria from developing resistance to the drugs, you must simultaneously take several different drugs that act in different ways.

The treatment is carried out in the same way regardless of which organ has been attacked by TBC. An exception is TBC in the meninges, which are treated at higher doses and for longer periods.

Children receive the same drug as adults, but the dosages are adjusted to the child’s weight.

It is important to take the medicines without interruption

The most important thing during treatment is that you follow the doctor’s prescription of medicines. You should take the medication as prescribed and throughout the prescribed period. This usually means that you may come to a reception or district nurse and get your tablets.

At the beginning of the treatment, you often need to come several times a week. Later it is usually enough once a week.

The standard treatment is six months.

You may take several medicines

You usually take four different medicines at the same time during the first two months or until the doctor has received an answer as to whether the treatment helps.

During the remaining months, you usually take only two drugs and one vitamin tablet.

You take all the tablets at a single time each day, preferably in the morning before breakfast.

When the treatment is completed, you are called a final check. It will be done within twelve months. After that, there will usually be no more visits. Only if you experience symptoms again do you need to contact a doctor?

Medicines for TB

The most important medicines you take during treatment contain the substances rifampicin and isoniazid. Examples of medicines containing rifampicin are Rimactan and Rifadin. Isoniazid is found in the medicine Tibinide.

The other two medicines you take contain pyrazinamide and ethambutol. They do not have a strong bactericidal effect but reduce the resistance of the bacteria.

Pyrazinamide has the greatest effect at the beginning of treatment and is therefore used during the first two months.

There are also combination drugs that contain two or more active substances against TB in the same tablet.

Resistance and drugs

Some tubercle bacteria are resistant or less sensitive to certain drugs.

In cases where the tubercle bacteria are resistant to several TB drugs, the treatment becomes more complicated. A very serious form is multi-resistant TB as the tubercle bacteria are resistant to both isoniazid and rifampicin. There are reserve funds, but they are not as effective.

If you get multi-resistant TB, you need to take medication for a longer period of time, such as a couple of years.

You may get side effects from the medication

Most of the side effects of TB drugs are mild. They can be relieved without interruption of treatment.

  • You may get tired and get discomfort from your stomach and intestines, especially during the first weeks of treatment. Sometimes the liver can react to the drugs. Therefore, blood tests are taken to check liver function during treatment.
  • Rifampicin can redden urine and tear fluid. It is completely harmless, but the red tear fluid, for example, can cause contact lenses to turn red. In this case, you should discuss with your ophthalmologist or optician if it is appropriate to continue with lenses during treatment.
  • Rifampicin can also increase the digestion of the sex hormone estrogen. The practical significance is that the effect of the pill is diminished or uncertain. Therefore, you should use some other type of contraceptive during medication for TB, such as a condom or spiral.
  • Ethambutol can occasionally affect the optic nerve. You should contact your doctor if the vision changes in any way, for example, if you find it more difficult to read. Visual acuity and color sense are always checked before and during treatment.
  • Isoniazid can cause vitamin B deficiency, B6. In some cases, it can lead to symptoms such as numbness in the legs. They are due to nerve inflammation caused by vitamin deficiency. Therefore, everyone who is being treated for their TB in some parts of Europe receives supplements of vitamin B6, called pyridoxine. 
  • Isoniazid can sometimes also affect your mood and make you feel depressed. You may also have difficulty concentrating.

Treatment in connection with HIV infection

If you are HIV infected and have TB, you will usually receive the same treatment as a person without HIV infection. But the brake medication for HIV can affect the TB medicines and vice versa. If you are being treated with brake medication, the doses of the TB drugs must be adjusted.

Low risk of relapse

The risk of recurrence is small if you have become ill from tubercle bacteria for which there are effective medicines and if you take your medicines in the way the doctor has decided.

If you interrupt treatment, you risk that the disease becomes active again and that it becomes more difficult to treat. The same applies if you do not take your medicines at all for periods.

The fact that you have been ill in TB once does not mean that you can never get sick again in TB. For example, you may get infected again and then get sick again.

Dangerous illness

Tuberculosis is a so-called generalized disease. This means that a person with TB must follow the doctor’s instructions in order for the disease not to become contagious or for the infection not to spread further.

A person cannot be forced into treatment but refusing to undergo treatment, the person may, after a court decision, be isolated at an infection clinic until they are no longer contagious. 

Preventive treatment for dormant tuberculosis

You can get preventative treatment to reduce the risk of getting sick if you have dormant tuberculosis.

This is especially true if any of these are true:

  • You are a youth or a child. 
  • You’re pregnant.
  • You have been infected for the past two to five years.

It is also important for a doctor to assess whether you should receive preventive treatment if you have any relatives who are ill in TB and who may have infected you.

Treatment greatly reduces the risk of you becoming ill, but not completely.

You get one or two drugs

The prophylactic treatment is given with one or two drugs. You are often given extra vitamin B during treatment.

The treatment lasts for either three months or six to nine months. It depends on what treatment you receive.

Just as with the treatment of active tuberculosis, it is important that you take your medicines when you need to. During the treatment, you have contact with a doctor and nurse and regularly go for checks.

Vaccine for tuberculosis

If you do not work with or spend time with people who have TB, the risk is very small that you will get the disease. You do not need to do anything special to avoid being infected.

Some children should be vaccinated

There is a vaccine against TB that the Public Health Agency recommends to some children.

The vaccine is recommended for children who have parents or other family members from a country where TB is prevalent. The vaccination reduces the risk of the child getting severe tuberculosis if they are infected when visiting the country or if the child meets older relatives who are originating in the country and who may be sick.

The vaccine is also recommended for children who will make a longer trip to countries where TB is common and where the child will have close contact with those living in the country. 

Contact a child care center if you have questions about the vaccination of your child.

Some occupational groups have an increased risk of being exposed to tuberculosis infection. This applies, for example, to the staff at lung clinics and infection clinics. For these groups, the most important thing to avoid contamination is to follow the hygiene rules and procedures to reduce the risk of infection that exists in the workplace.

The vaccine has limited efficacy

The vaccine against TB is called the BCG vaccine, the Bacillus Calmette-Guérin vaccine. The BCG vaccine has a varying protective effect. Against the most dangerous forms of TB, which mainly young children can get, the vaccine protects well.

Before 1975, it was recommended that all newborns in some parts of Europe should be BCG vaccinated against TB. As tuberculosis has become increasingly uncommon, that recommendation has changed. Previously, vaccines were also recommended for adults who, for example, worked in environments where the risk of infection was high or for longer trips to countries where TB is common. However, as the vaccine has been deemed not to be effective enough for adults, these recommendations have also been removed.

Tuberculosis and pregnancy

Both you and the fetus are affected if you are pregnant and have TB. Therefore, you are receiving treatment even if you are pregnant.

If you become pregnant and have had tuberculosis before, you may undergo an examination. Then it is assessed whether you are healthy and whether tuberculosis has given any limitations, such as scars on the lungs that affect your lung function.

What happens in the body?

Tuberculosis is an infectious disease caused by the tubercle bacterium, Mycobacterium tuberculosis.

First, you get a primary infection

If tubercle bacteria enter the lungs, the bacteria can grow in the lymph nodes in the chest and in the lung tissue.

Then you get a first infection that usually only gives mild symptoms. It is called primary infection. The immune system then encapsulates the tubercle bacteria and a special type of scar tissue, granuloma, is formed around the bacteria.

The disease can be dormant for many years

When the primary infection is over, the tubercle bacteria can be encapsulated in the lungs or other organs for many years, without any symptoms. This is when tuberculosis is called dormant or latent. Dormant TB does not infect. 

Untreated tuberculosis is serious

Without treatment, TB can be life-threatening. This is usually because the breathing of the sick person is severely affected and bleeding from the lungs.

Some with untreated TB become healthy, but the disease can cause damage to the lungs that does not disappear. The risk of getting sick again is also great. 

Tuberculosis in the world and in Europe

Tuberculosis is one of the most serious infectious diseases in the world. About one-third of all people in the world are infected with TB. This means that they carry the tubercle bacterium, but have no symptoms and do not infect. Of these, about eight to nine million suffer from tuberculosis each year.

Few are infected in Europe

Tuberculosis is a rare disease in some parts of Europe today. Every year, about 500 – 600 people get sick in TB in some parts of Europe. The number is among the lowest in the world in relation to the population. The vast majority of people who become ill are younger adults who come from countries where the disease is widespread.

Those who are born in Europe and suffer from TB are usually older people who were infected in adolescence or have relatives from countries where TB is common.

Influence and participate in your care

You can seek care at any medical center or open specialist clinic you want throughout the country. Sometimes a referral to the open specialist care is required.

You should understand the information

In order for you to be involved in your care and treatment, it is important that you understand the information you receive from the healthcare personnel. Ask questions if you don’t understand. For example, you should receive information about treatment options and how long you may have to wait for care and treatment. Children should also be involved in their care. The older the child, the more important it is.

You have the opportunity to get help from an interpreter. You also have the opportunity to get help from an interpreter if you have a hearing loss. 

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