How to Manage Tuberculosis

Tuberculosis is an extremely contagious bacterial infection that is transmitted through the air. Tuberculosis infection TB is present in about a third of the global human population, though 90% of people infected with tuberculosis will never have clinically evident or "active" tuberculosis.^[1] Most people's immune response keeps the infection from causing symptoms or spreading to others, leading to a condition called latent tuberculosis infection. In some people, however, a person may develop active TB soon after infection or their latent infection may become active when their immune system weakens. This will lead to serious symptoms and can easily be spread to others. It is extremely important to undergo treatment for active tuberculosis infection immediately, to remove the bacteria from your body and reduce the risk of infecting others.

EditSteps

EditTreating Active Tuberculosis with Antibiotics

1. Understand what an active TB diagnosis means. If you are one of the more than 13 million people that have TB disease, you can potentially spread the disease to others. You will need to begin taking antibiotics immediately, and continue to do so for at least six months. Fortunately, you will begin feeling better within a month. Unfortunately, you may be required to stay at a hospital from two to four weeks to avoid spreading the disease.^[2]
   
   • Only 1/3 of people with active primary TB have symptoms, which is part of the reason it is so prevalent.^[3]
2. Cover your mouth and nose. If you have an active TB infection, the infection is spreading within your body, and the infection is extremely contagious. It will remain contagious for the first few weeks of treatment, and can easily be passed to others when you cough, sneeze, and even when you laugh, sing, or speak. Accordingly, take care to preventing spreading TB by avoiding contact with others until your doctor tells you that your infection is no longer contagious.^[4]
   
   • If you are diagnosed with active TB, your immediate contacts should be screened by a doctor, as they may also need to be treated or put on prophylactic treatment.
3. Take any prescribed antibiotics diligently. Treatment for active TB requires a regimen of multiple antibiotics. Based on the local sensitivities of TB to drugs in your area, you will most likely be started on four drugs (isoniazid, rifampin, pyrazinamide, and ethambutol), each to be taken every day. Then, after sputum cultures come back with more specific sensitivities for the strain of TB that you have, your doctor may decrease some of these antibiotic and will also decide at that time how long you need to be on them.
   
   • Most people are on all four for two months, then two (isoniazid and rifampin) for four months. If the TB becomes resistant to these drugs, then your treatment will be different and may be longer.
   • You will likely start feeling better in two weeks or so.
   • Even if you begin to feel better, you must always complete the course of antibiotics in order for them to fully rid your body of TB bacteria. Never stop taking them early because you feel better or to try and save them for later.
4. Consider getting assistance taking the antibiotics. Not only must you complete the course of antibiotics your doctor prescribes, you must take the drugs every single day. If this becomes challenging for you, work with your doctor to develop a plan to help you stay on top of your drug regimen.^[5]
   
   • For instance, someone from your treatment team may visit you in your home to ensure you’re taking your antibiotics, or you can set up a plan to visit a treatment facility everyday.
   • Stopping or forgetting to take your antibiotics may allow your infection to become resistant to antibiotics. This is not only extremely dangerous to you, it endangers those who may catch TB from you as well.
   • If nothing else, missing doses will likely lead to your having to take antibiotics for a longer period of time.
5. Watch out for recurring symptoms of TB. After completing your treatment and seeing a TB specialist to ensure your body is rid of the infectious bacteria, you will not need to get regular checkups; however, it is possible to catch TB again as a separate infection, so stay on the lookout for common symptoms, especially incessant coughing and pain in the chest.
   
6. Take antibiotics longer for extrapulmonary TB. The most common type of active TB infection is pulmonary TB, which predominantly affects your lungs; however, if your TB infection has spread beyond your lungs, your doctor will likely recommend the same types of antibiotics for a longer period of treatment.^[6]
   
   • Examples of extra-pulmonary TB include: infection of lymph nodes, meningitis (covering of the brain), pericarditis (covering of the heart), and bone (called "Pott Disease").
   • Often, extrapulmonary TB infections require a full year of antibiotic treatment.
   • If the infection has spread to you brain or heart, you may also be prescribed a corticosteroid. This will help reduce the swelling and inflammation caused by your infection, and potentially ease any symptoms affecting your nervous and circulatory systems.
   • You must complete the full course of antibiotics as prescribed in order to provide the best chance of a full recovery.
7. Talk to your doctor if you’re pregnant. If you’re pregnant or breastfeeding at the time of diagnosis, or become pregnant while taking TB medications, tell your doctor. Further, rifampin significantly diminishes the effectiveness of a number of different birth controls, making them almost completely ineffective.^[7] Make sure you are using a backup birth control (like condoms) if you are taking rifampin.
   
8. Watch out for the side effects of TB medication. Side effects associated with the antibiotics used to treat TB infections are rare. Nonetheless, take care to record any side effects that you experience and share this information with your doctor. In particular, achy joints, excessive bruising and bleeding, persistent fever, loss of appetite, tingly in your extremities or around your mouth, stomach discomfort, and yellow skin or eyes should all be reported next time you see your doctor.^[8]
   
   • If you are taking isoniazid, you must abstain from drinking alcohol even in small amounts. The the combination of the two together can cause hepatitis.
   • Rifampin may cause your urine to appear darker, or even orange. This is normal, and is not cause for concern.

EditDiagnosing and Treating Latent Tuberculosis

1. Get tested. If you believe you may have been exposed to tuberculosis or have simply spent time in countries or specific environments where tuberculosis is common, get tested. Initially, your doctor will likely administer a skin test. A needle will place a small amount of material just beneath the surface or your skin, and you’ll be assessed a few days later based on your body’s reaction to the test.^[9] A blood test may also be administered to ascertain a TB diagnosis.
   
   • If you live in an overcrowded environment, frequently visit or live impoverished environments, have ever been incarcerated in prison, have an immunodeficiency, or work in a hospital or other type of medical treatment facility, you should get tested for TB every few years.
2. Talk to your doctor about treating latent TB. Fortunately, you cannot spread tuberculosis while your infection is latent, and you will not feel sick, as your immune system is effectively preventing the infection from propagating. You are, however, at risk of developing active TB later in life, often as a result of a diminished immune system either due to disease or aging. You may quickly become contagious to others before you realize your infection has become active.^[10]
   
   • Your doctor may wish to take preventative measures to kill the bacteria in your body that are causing the infection to reduce the potential of TB disease. Expect treatment for latent TB to last from six to nine months.
   • Take TB drugs exactly as your doctor tells you to. It is extremely important to follow TB drug regimens exactly as you are directed.
   • Stopping too early, or failing to consistently take your medication may lead to a worsening of the disease, and your TB may even become resistant to the drugs you’re taking.
3. Treat latent TB if you are a high risk of developing an active TB. After your doctor establishes that your infection is latent, you will likely begin a nine-month drug regimen, likely of 25 mg of pyridoxine per day. If you suffer from a weakened immune system, you will likely be considered at high risk of your TB becoming active. In particular, the following conditions put you at greater risk:^[11]
   
   • HIV infection or another autoimmune disease
   • Contact with those who have active TB
   • Damage to your lungs
   • Organ transplants
   • Taking drugs that suppress your immune system
   • Recent immigration from a country with a high prevalence of TB
   • Injection drug use
   • Large amounts of time spent in a correctional facility, nursing home, homeless shelter, hospital, or any other high-density habitation, as either a resident or employee
4. Quit smoking. Smoking not only places you at greater risk of contracting a TB infection, it also causes inflammation in your lung tissue. This damage makes you more susceptible to the worsening of an infection from latent TB to active TB. Further, smoking also weakens the immune system generally, reducing your ability to fight infections such as TB.
   
5. Eliminate substance abuse. Alcohol and other drugs weaken the immune system, reducing your body’s ability to resist and fight infection. Long-term habitual use makes you especially predisposed to TB, as your level of immunity to catching infection will become lower and lower the longer you use drugs.
   
   • If you drink heavily, start by reducing the amount your drink everyday incrementally. Not only will you likely begin to feel better, you may also feel more motivated to steadily reduce the amount you drink.

EditMonitoring Symptoms of Tuberculosis

1. See a doctor for a persistent cough. If the infection remains latent, you may not even know you are infected with tuberculosis for years after becoming infected; however, the infection may become active, and needs to be identified as quickly as possible. If you experience any symptoms that might indicate an active tuberculosis infection, see a doctor immediately.^[12]
   
   • With a latent infection, you may have TB bacteria that are walled off inside your body, prevented from harming you by your immune system. If your immune system is weakened, however, you may develop an active TB infection.
   • An active TB infection will most commonly attack the lungs, resulting in pulmonary TB disease. X-rays are commonly used to assess whether your lungs have been damaged, and laboratory tests can also be run on any mucus, called “phlegm,” that you cough up.
   • If you have any type of cough that lasts more than three weeks, or are becoming increasingly short of breath, see a doctor immediately.
2. Pay attention to any chest pain. In particular, watch out for coughing that results in mucus or blood in your mouth, and/or chest pain while coughing. Chest pain usually occurs due to an infection of the lungs, which causes inflammation, swelling, and even permanent damage to the tissues of the lungs.
   
   • Watch closely for blood in anything you cough up. Blood stained sputum, as this substance is called, is a symptom of more advanced TB that occurs due to inflammation of the respiratory tract.
3. Watch for symptoms of extrapulmonary TB infection. When TB spreads, it may lead to noticeable symptoms affecting your lymph nodes, your bones and joints, your digestive system, your bladder and reproductive organs, and even your nervous system.^[13] In particular, watch out for enlarged lymph nodes, which may indicate that your immune system is struggling to fight a TB infection. The lymph nodes around your lungs and heart are those most likely to be infected.
   
   • Additionally, be on the lookout for pain in your stomach, pain or immobility in your joints, confusion, persistent headaches, and seizures.
   • If any of these symptoms develop in tandem with another, see a doctor as soon as possible.
4. Watch for general symptoms of TB disease. An active tuberculosis infection may also affect your kidneys, brain, and spine. Other symptoms that may indicate TB disease include persistent weakness, persistent fever, and heavy night sweats.^[14]
   
   • Check your temperature for fever. Fever occurs due to the presence of an infection in the body.
   • Keep track of any night sweats. Night sweats occur as a result of infection, as the body tries to get rid of the fever that is present in the body. More specifically, sweating is the body's way of removing the excess heat caused by fever.
5. Identify any loss of appetite or weight loss. TB affects many bodily systems, including the digestive system. When the digestive system is not working as it should, it can lead to a loss of appetite, which in turn leads to weight loss. Symptoms such as these will persist, and will usually worsen, without treatment. See a doctor immediately if you’re concerned you may have a TB infection.^[15]
   

EditWarnings

• Tuberculosis can be fatal, even while undergoing treatment, though fatalities from tuberculosis infections are becoming increasingly rare. In fatal cases, death usually occurs because the lungs have been damaged beyond their ability to provide sufficient oxygen to the body. Accordingly, see a doctor immediately if you experiences symptoms including severe coughing, chest pain, or trouble breathing.^[16]

EditSources and Citations

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