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Tuberculosis (Koch's Disease)

Tuberculosis (also known as Koch's disease) is a chronic systemic mycobacterial
infection caused by bacteria that belongs to the family of mycobacterium. These are
mycobacterium tuberculosis, and mycobacterium bovis.
The lungs are affected in most cases pulmonary TB, but other organs such as the skin,
bones, brain, lymph nodes, and intestine are also affected (extra-pulmonary tuberculosis).
If untreated, tuberculosis causes death and severe disability. After many years of
immunizing children against tuberculosis with the BCG vaccine, tuberculosis was almost
controlled. However, the HIV infection which can lead to AIDS has led to the resurgence of
tuberculosis.
The cases of AIDS related tuberculosis have risen and continue to rise. The prevalence of
tuberculosis increases as social and economic status decrease.
Mode of Transmission
Tuberculosis is spread from an infected person to a healthy susceptible host by droplet
infection. This happens when a person with pulmonary TB coughs out heavily infected sputum
into the air.
Though many people may thus become exposed to TB infection, only a few will progress
to develop actual disease. This is because the majority have acquired active natural immunity to
the disease. However if this immunity is depressed by for example, age or HIV infection,
tuberculosis may flare up again and cause obvious clinical disease.
Mycobacterium Tuberculosis
This is the main cause of pulmonary tuberculosis and extra-pulmonary tuberculosis.
Mycobacterium Bovis
This causes disease in cattle and is spread to humans through infected milk.
It also causes extra-pulmonary tuberculosis.
Types of Tuberculosis
List down three types of tuberculosis? Pulmonary-TB, Extra pulmonary-TB and Miliary TB
Clinical Features
The clinical features of tuberculosis can be divided according to the early and late signs and
symptoms.
Early Signs and Symptoms of Tuberculosis
  Productive cough lasting three or more weeks
 Night sweats
 Unexplained weight loss
 Loss of appetite
 Fatigue
 Evening fever (pyrexia)
 Positive tuberculin test
 Late Signs and Symptoms of Tuberculosis
 Coughing blood stained sputum (haemoptysis)
 Difficulty breathing
 Enlargement of lymph nodes
 Extreme loss of weight
 Signs and symptoms of other body organs affected for example meningitis, pleurisy,
pericarditis, peritonitis and pleural effusion
How to Diagnose Tuberculosis
The best way to diagnose tuberculosis is by means of a direct sputum smear examination (Ziehl
Nielsen staining technique for Acid Fast Bacilli - AFB test) in the laboratory. This is where If
possible, at least three early morning specimens must be examined within two days.
Other tests include Tuberculin skin tests such as the Mantoux test and chest x-rays.
Management
The Kenya National Leprosy and Tuberculosis Programme (NLTP) coordinate the
treatment of tuberculosis and leprosy. The NLTP, which is a Ministry of Health project, has
developed the treatment guidelines for these two diseases. Treatment regimen for tuberculosis
depends on the type of tuberculosis as well as the age of patient.
The drugs used for the treatment of tuberculosis are abbreviated as follows:
S-streptomycin
E-ethambutol(plain400mgtablet)
H - isoniazid (150g combined with ethambutol 400mg,tablet)
R-rifampicin(tablet or capsule)
Z-pyrazinamide(500mgtablet)
Rifater (RHZ): a combination of rifampicin 120mg, isoniazid 50mg and pyrazinamide 300mg
Rifinah (RH): a combination of rifampicin 150mg and isoniazid100mg
Ethizide: a combination of ethambutol 400mg and isoniazid 150mg
First Regimen
(For AFB smear positive or very sick patients.)
2ERHZ/6EH
- Intensive therapy phase > 2ERHZ
- Continuation therapy phase >6EH
Second Regimen
(For AFB smear negative and extra-pulmonary TB, and not severely ill patients.)
2RHZ/6EH
- Intensive Treatment phase > 2RHZ
- Continuation treatment phase >6EH
Third Regimen
(For defaulters and drug resistant cases.)
For re-treatment of resistant tuberculosis and treatment defaulters and opportunistic
mycobacterium infection as in AIDS associated TB.
Intensive Treatment Phase
- IM streptomycin daily for two months, and
- Oral Rifater daily for one month, and oral ethambutol daily for two months
Continuation Treatment Phase I
- Oral Rifater daily for one month, and oral ethambutol daily for one month
Continuation Treatment Phase II
- Oral Rifinah daily for five months and oral ethambutol daily for five months
 NB/ The treatment of tuberculosis keeps changing depending on current research findings

Common Complications of Tuberculosis

The following are some of the common complications of tuberculosis:
 Severe haemoptysis
 Respiratory failure
 Meningitis
 Kidney failure
  Pleural effusion
 Pericardial effusion
 Potts disease (collapse of the backbone)
Prevention and Control
The following measures are important in the prevention and control of tuberculosis.
 Immunizing the newborn babies with BCG vaccine
 Case finding and treatment (completing treatment)
 Health education to the patients so that they can stop spitting carelessly
 Encourage the patients with TB to use a sputum mug
 Health education to the community members to avoid overcrowding and to improve
ventilation in their houses
 Drinking only pasteurized or boiled milk