How is it transmitted?
- 92% by spatter (droplet) and contaminated air through the nose
- 7% by contaminated milk and dairy products through the mouth
- 1% by skin scratches which lead to ulcers.
When a person coughs, microbes contained in the spatter are transmitted through the nose to a healthy person then down the bronchial tubes and finally the bronchi. In most cases the microbe settles in the upper part of the lung where a battle begins between the microbe and the human immunological systems. If the amount of microbe is small, it survives in a focal point known as "Ghon's Focus". It remains dormant and provides immunity not disease. But, if immunity is low and the microbes are abundant, then the microbe multiplies and attacks the lung causing pulmonary TB.
Dust can also carry the microbes from one person to another.
The most prominent symptoms are:
Cough for more than three weeks, rise in temperature, night sweat and severe loss of weight. The lymph glands may also become infected through the lymphatic system then the disease may be transmitted by the blood causing severe infection and eventually Tuberculosis meningitis. The disease may become chronic if left untreated or is inadequately treated and in this case it may take several forms depending on the organ it attacks whether the kidneys and the urinary tract, bones and spine and causes deformities etc....
High risk persons:
1- Children, particularly those in contact with infected persons and in this case the infection is severe.
2- Chronic patients with Diabetes, renal failure, Leukemia, Leprosy, AIDS and Measles.
3- Victims of malnutrition
4- Smokers and alcoholics
5- Patients under chemotherapy or cortisone treatments.
6- Dark-skin races
Laboratory diagnostics of the disease:
To reach accurate diagnosis, the sample must be taken correctly.
First: Direct Diagnosis by Microscope:
This is considered the fastest and least expensive method. However, it is not very sensitive and cannot be relied upon when the number of microbes (TB bacilli) are less than 5000 (five thousand) per cubic centimeter. In addition, this method does not differentiate between live and dead organisms.
In the case of pulmonary TB, the patient s required to provide the early morning sputum (before breakfast) preferably after washing the mouth with warm water. As for children and the elderly (who cannot cough due to weakness), the sample may be collected by endoscopy. In all cases, the part of the sample with blood or pus is selected and placed on a slide and stained prior to examination.
In the case of urological TB, the first morning urine sample is to be collected for three consecutive days. The urine is sedimented by a centrifugation then spread on a slide and dyed with a special stain before examination.
Second: Cultivating the TB microbe:
Samples are cultivated in special media to isolate the TB bacilli. Then a sensitivity test is carried out to know the effective antibiotic against the microbe. This way, the microbe can be diagnosed even if present in amounts less than ten per cubic centimeter. However, this method may take six weeks or more to reach final diagnosis.
Third: Diagnosis by Amino Acids:
This is considered the fastest and most accurate method of diagnosis using a most advanced technique known as Polymerase Chain Reaction (PCR), which is able to diagnose the presence of one TB bacillus in a short time. It is an expensive method and is available in only very few laboratories in have the equipment and know-how to provide accurate results.
Fourth: Tuberculin Test:
This test is usually applied to children to aid in early and rapid diagnosis particularly if they have no symptoms. The patient is subcutaneously injected with a TB protein extracted from the microbe. During injection, a swelling appears around the tip of the needle. This indicates that the test is valid.
It is important to observe the injected area after 48 and 72 hours. Any redness should be ignored. However a solid swelling (like a button) underneath the location of the injection should be measured. If it is less than 10mms in diameter. Then the test is negative. If more than 10 mms, the test is positive and the patient must see his physician.
Treatment of TB:
Treatment is to be decided by a specialist. There are internationally well established medical protocols of two or more medicines such as: Izoniazid, Para amino salicylic acid, Streptomycin, Rifampin, Kanamycin, Ethambutol, Paraziniamide.
These antibiotics are dispensed in accordance with the laboratory microbe sensitivity results. Treatment may take up to nine months in certain cases.
Prevention and control of the disease:
By means of a national health awareness campaigns to educate people about the methods of transmission of the disease and how to prevent it. The campaign motto should be "TB is a Preventable and Curable Disease".
Spitting in the streets is a bad unacceptable habit particularly from smokers. Emphasis should be placed on the fact that spitting spreads the disease
Also, tissue paper used by the patient must be burnt immediately.
Ventilation of the schools, camps, homes and other crowded areas reduces risk of disease transmission. In addition sunning of the beds, towels, clothes etc. aids in killing the microbe.
Good nourishment and a well balanced diet are essential since malnutrition reduces the body's immunity to the disease.
Patients receiving chemotherapy or cortisone treatment or are immune-compromised should be kept isolated from TB patients since their immunity is low.
Perform routine examination of sputum (as well as PCR when needed) for persons who have symptoms similar to those of TB.
Treat TB patients with internationally recognized drugs under close medical
Conduct full periodical checkups to persons in contact with TB patients.
Vaccinate new-born infants immediately with BCG when they are Tuberculine-free.
Prohibit smoking and alcoholic beverages.