Tuberculosis prevention and treatment strategies

Tuberculosis: Know, Prevent, and Treat the Global Health Problem

TB is a preventable and curable disease that has continued to exist as a major public health challenge in the world. The bacterium 'Mycobacterium tuberculosis' causes it and mainly attacks the lungs, but can attack other organs. The disease is one of the leading infectious killers in the world and, therefore, needs more continued awareness, prevention, and treatment efforts.

This article delves into the various dimensions of TB, including causes, modes of transmission, symptoms, global prevalence, challenges, and effective strategies for prevention and treatment. 

What Causes Tuberculosis?

TB is caused by 'Mycobacterium tuberculosis' a slow-growing bacterium that mainly attacks the lungs (pulmonary TB). It may however spread to other parts of the body including the brain, kidneys or the spine, leading to extrapulmonary TB. The bacteria can even survive in the body without manifesting symptoms for a very long time, often even years, a situation called latent TB.

TB has tortured the humankind for centuries. At that time, it was famous with the name "consumption" and was also considered one of the principal reasons of death before the innovation of antibiotics in the 20th century. The discovery of tuberculosis by Robert Koch in the year 1882 was followed by the development of Bacille Calmette-Guérin (BCG) vaccine in the 1920s was crucial milestones in fighting TB. 

How Tuberculosis Transfers?

TB is an airborne disease that transmits when an infected person releases the bacteria into the air while coughing, sneezing, speaking, or singing. Long-term exposure in confined or poorly ventilated spaces heightens the risk of infection.

 

Latent vs Active TB Debate 

• Latent TB: Those people carry the bacteria and are asymptomatic. They can't transmit the disease, but they remain at risk for developing active TB.
• Active TB: Symptoms are evident, and the disease is highly contagious. If left untreated, active TB can be fatal.

Tuberculosis Symptoms 

The symptoms of TB depend on the organs infected. 

Pulmonary TB Symptoms

• Cough that lasts over three weeks. 
• The cough leads to coughing of blood or sputum. 
• Chest pain is there. 
• The patient will develop weakness and fatigue. 
• Weight loss without medical cause. 
• The patient is experiencing fever and night sweating.

Extrapulmonary TB Symptoms

• Lymphadenopathy,swelling in lymph nodes.
• Pott's spine that leads to backache.
• Neurological manifestations when the TB affects the CNS. 
• Abdominal tenderness and abnormalities when the TB reaches the gastrointestinal tract.
  
  
   

Burden of Tuberculosis around the World

TB is still a significant health challenge, especially in low- and middle-income countries. The WHO reports:

• Over 10 million new cases of TB are reported annually. 
• TB is responsible for more than 1.5 million deaths annually. 
• TB is the leading cause of death for people living with HIV. 
• Multidrug-resistant TB is a growing concern; close to 500,000 new cases of MDR-TB are documented every year. 

At-Risk Populations End.

• People in congested areas, such as prisons, refugee camps, or urban slums. 
• Health care providers and service providers who are in close proximity with TB patients.

Tuberculosis Diagnosis 

Diagnosis of TB is an accurate and timely procedure that prevents TB. The following diagnostic tools are:  

1. Tuberculin Skin Test (TST)

A very small amount of tuberculin is injected under the skin. The site is checked after 48-72 hours for signs of a reaction to indicate TB infection.

2. IGRAs 

Blood tests that measure the body's response to TB-causing bacteria, providing a higher degree of specificity compared to TST.

3. Imaging Studies 

• Chest X-rays: These outline lung damage that can result from TB.
• CT scans: They produce high-resolution images, particularly in complicated cases.

4. Sputum Tests

Microscopic examination and culture of sputum samples detect TB bacteria and evaluate drug resistance.

5. Molecular Tests

Rapid tests like GeneXpert test for TB DNA and drug resistance against TB, allowing for prompt treatment.

Preventing Tuberculosis

1. Vaccination

BCG vaccination is often used to immunize children against serious cases of TB. The BCG vaccine is less effective, however, in preventing pulmonary TB among adults.

2. Infection Control

• Providing ventilation in indoor environments
• Wearing masks in risk regions.
• Early diagnosis and treatment to prevent spread. 

3. Latent TB Treatment

Antibiotic preventive therapy with isoniazid and other drugs can significantly reduce the chances of progression from latent TB to active disease.

 

TB and Drug Resistance

Drug-resistant TB (DR-TB) is the most significant challenge in TB control.

Multidrug-Resistant TB (MDR-TB)

MDR-TB: This occurs when the TB causing bacteria have developed resistance for at least two major first-line drugs, which include drugs like isoniazid and rifampicin, among others.

Extensively Drug-Resistant TB (XDR-TB) 

The XDR-TB does not show any response to any types of second-line drugs mainly due to drug resistance, resulting in a very difficult kind of way out.

Causes for Development of Drug Resistance: -

• Irregular or partial medication
• Overuse of antibiotics and wrong prescription.
• Very poor health facilities available due to economically developing regions.

Treatments for TB.

TB treatment is administered along with drugs in combination for several months.

Conventional Treatment

• The six-month regimen of the four first-line drugs which are isoniazid, rifampicin, pyrazinamide, and ethambutol.
• The drugs have to be completed; otherwise, drug resistance cannot be avoided.

Treatment of Drug-Resistant TB

• This comprises second-line medicines which are expensive and more side effects.
• The length of the treatment is up to 18–24 months in the case of MDR-TB or XDR-TB.
• DOT (directly observe therapy), Health care providers closely monitor patients while undergoing the treatment to ensure compliance so that the possibility of resistance and relapse is lower.
  
  
  

Challenges in TB Eradication 

Despite all efforts made, TB eradication has numerous challenges on the global platform:

• Social Stigma: Due to the problem of discrimination, many people delay seeking medicine.
• Funding gaps: Low-income countries face the problem of lacking funds in their respective countries, thus causing stumbling blocks for access diagnosis and treatment.
• New Strains: Developing resistance among drugs makes treatment a challenge. HIV Epidemic: HIV co-infection increases TB severity and mortality. 

Innovations and Future Plans 

Innovation in the way of overcoming challenges is emerging in the health community of the world: 

1. New Vaccines 

Researchers are working to develop vaccines that provide enhanced protection against pulmonary TB. 

2. Rapid Diagnostic Tools

Molecular tests and AI-driven imaging technologies are revolutionizing the diagnosis of TB.

3. Shorter Treatment Regimens

There are trials for both drug-sensitive and drug-resistant TB to explore shorter and less toxic treatment options.

4. Digital Health Solutions

Mobile apps and telemedicine platforms improve adherence through reminders and remote support.

Conclusion

Tuberculosis is a curable disease still that remains a global public health problem due to high prevalence, mortality, and multi drug resistance. To combat this pandemic, the need is to increase infrastructure of public health systems, awareness, and fund into research.

Through prevention, early diagnosis, and comprehensive treatment, this can bring the world close to the ambitious target set by the United Nations for eradicating tuberculosis by 2030 under the Sustainable Development Goals.

Thanks for reading,

Stay happy and healthy, 

Have a nice day 😊.