TB is a disease that is often found in many countries, especially in developing countries. In addition, the prevalence of drug-resistant TB is also increasing worldwide. So, how do you recognize the symptoms of tuberculosis?
Causes of TB
Before you recognize the symptoms of tuberculosis, other important things that should also not be missed are the causes of tuberculosis. Tuberculosis (TB) or also known as TB is an infectious disease that usually attacks the lungs.
The cause of tuberculosis is the bacterium Mycobacterium tuberculosis. This bacterium is ‘recalcitrant’ because it does not only nest in the lungs, but also in other organs besides the lungs, ranging from the lining of the brain to the bones.
TB is a multisystemic disease with various clinical forms. TB is the most common cause of death worldwide due to infectious diseases.
The inability of antibiotics to treat tuberculosis is due to co-infection with the HIV virus which is now increasingly widespread. Thus, the regimen of early detection of HIV and tuberculosis is crossed, that is, patients affected by TB disease must be checked for HIV, and patients who are infected with HIV must be checked for TB.
To avoid the possibility of exposure to TB bacteria, you should avoid contact with things that are exposed to the bacteria that cause TB.
Signs and Symptoms of TB
It should be emphasized that the signs and symptoms of pulmonary TB in children and adults are very different. In children, pulmonary TB symptoms do not need to be coughed, but if they live in one house or there is a history of exposure to people who have experienced pulmonary TB symptoms, and the child experiences pulmonary TB symptoms in the form of impaired growth, decreased appetite, fever for 2 weeks, then it is best to do a Mantoux test at the nearest hospital.
Whereas in adults, the classic clinical picture associated with symptoms of active pulmonary TB is as follows:
- Weight / anorexia.
- Night sweats.
- Hemoptysis / coughing up blood.
- Chest pain (also results from acute tuberculous pericarditis).
Some other symptoms of TB must also be watched out. In addition to the lungs, TB disease can spread to other organs such as the lining of the brain called TB meningitis, to the bones called Pott’s disease, to the urinary tract organs, to the joints, and so on. This depends on the durability and speed of the diagnosis between patients.
Symptoms of TB meningitis may include the following:
- Intermittent or continuous headaches for 2-3 weeks.
- Changes in mild mental status that can progress to coma for a period of days to a matter of weeks.
- Fever is not too high.
Symptoms of bone TB, called Pott’s disease:
- Back pain or back stiffness.
- Lower lower limb paralysis. Half of patients with Pott’s disease are undiagnosed.
- Tuberculous arthritis, usually involving only one joint (most often the hip or knee, followed by ankles, elbows, wrists and shoulders).
Symptoms of genitourinary TB may include the following:
- Low back pain.
- Frequent urination.
- In men, the scrotal mass is painful, prostatitis, orchitis, epididymitis or.
- In women, symptoms such as pelvic inflammatory disease.
Symptoms of gastrointestinal TB that refer to infected sites and may include the following:
- Nonhealing boils in the mouth or anus.
- Difficulty swallowing (with esophageal disease).
- Abdominal pain mimics peptic ulcer disease (with gastric or duodenal infection).
- Malabsorption (with small intestine infection).
- Pain, diarrhea, or hematochezia (with large intestinal infections).
If you find symptoms of TB, immediately consult a doctor. Later, the doctor will check through a series of history (interview) and physical examination. The findings of the physical examination related to TB are dependent on the organ involved. Patients with pulmonary TB may have the following signs:
- Abnormal breathing is heard, especially the upper lobe or the area involved.
- Rales or bronchial breath signs, indicate pulmonary consolidation.
Symptoms of tuberculosis differ according to the network involved and may include the following:
- Decreased consciousness to coma.
- Neurological deficit.
- Chorioretinitis (inflammation of the retina of the eye).
- Skin lesions.
The absence of significant physical findings does not necessarily exclude an active TB. The better immunity or immune power, the symptoms and signs tend to be more visible.
However, the worse or weaker the immune system, the symptoms and signs can not appear. This is actually dangerous, because TB is often a disease that only shows symptoms when it appears in a more severe degree.
Patients who tend to have weak immunity are HIV patients, patients who are undergoing chemotherapy, and diabetes patients.
The screening methods for tuberculosis are as follows:
- Tuberculin Mantoux test with purified protein derivative (PPD) for active or latent infections (main method).
- Check patient’s phlegm in patients with cough symptoms.
- HIV serology in all patients with TB and HIV status is unknown: HIV-infected individuals are at increased risk for TB.
- Chest radiograph to see lung features in TB patients.
If the results of the bacterial culture were positive there are TB bacteria, then it must be followed by what antibiotic test is suitable for tuberculosis suffered by these patients. However, this test is usually done if first-line TB treatment does not work so patients are categorized into patients who fail first-line treatment for pulmonary tuberculosis.
Whereas if the lesion is outside the lung, the examination is more complex, which includes:
- Biopsy of bone marrow, liver or blood culture.
- If TB or tuberculoma meningitis is suspected.
- If the vertebral (Pott’s disease) or brain involvement is suspected, CT or MRI is needed.
- If complaints about genitourinary, routine urine tests and urine cultures can be done.
- Treatment of tuberculosis
Actions that can be taken to treat pulmonary tuberculosis are:
- Ideally, the care of TB patients is isolated in a room with negative pressure.
- Use a disposable mask that is enough to filter the basil.
- Continue isolation until negative smear for 3 consecutive phlegm examinations (usually after about 2-4 weeks of treatment).
The pulmonary tuberculosis treatment regimen has several categories and lines. In the first TB case, TB treatment was carried out for 6 months. Empirical treatment begins with a 4-drug regimen of isoniazid, rifampicin, pyrazinamide, and ethambutol or streptomycin.
This therapy will be adjusted according to the results of susceptibility and toxicity tests. Pregnant women, children, HIV-infected patients, and patients infected with drug-resistant strains require a different regimen.
Prophylactic treatment is the treatment given to patients who have not erected their TB diagnosis, but have the potential to contract it. For example, pregnant women who are at home with husbands who are TB, or small children whose parents live at home and contract TB.
Special considerations for drug therapy in pregnant women include the following:
- Pyrazinamide is reserved for women suspected of MDR-TB.
- Streptomycin should not be used.
- Prophylactic treatment is recommended during pregnancy.
- Pregnant women who consume isoniazid will experience liver toxicity (hepatotoxic).
- Breastfeeding can be continued during prophylactic therapy.
Special considerations for drug therapy in children include the following:
- Most children with TB can be treated with isoniazid and rifampicin for 6 months, along with
- pyrazinamide for the first 2 months, depending also on the results of germ culture.
- For TB after birth, the duration of treatment can be increased to 9 or 12 months.
- Ethambutol is often avoided in children because of its effect on disturbing the senses of vision.
There are special considerations for drug therapy in HIV-infected patients in the form of dose adjustments and selected drug regimens.
The main problem in the treatment of tuberculosis is the length of treatment so that the level of patient compliance tends to decrease. This triggers bacterial resistance so that the initial antibiotics do not work.
Patients who experience resistance are called cases of MDR-TB. In this case, treatment will be much more difficult, with a longer duration, a higher mortality rate, and the drug is not just taken, but there are also injecting drugs. Dissemination of TB is faster because the increase in HIV cases and patient non-compliance in taking TB drugs are the main causes.