The ABC of TB Using Simulation-based training to

The ABC of TB

By Verah Mugambi

Tuberculosis is a life-threatening disease. It knows no borders and anyone can be infected with it. TB, as is referred to by many, is caused by a bacterium called Mycobacterium tuberculosis.

According to Dr. Andrew Owour, a Respiratory and Critical Care Physician at Kenyatta National Hospital, the disease affects all ages “but it’s more common in young people.”

This, he says, is because a majority of them are mobile; move around a lot, live in cognate settings, have poor nutrition, and are alcoholics.

The bacteria usually attack the lungs. However, TB bacteria can attack any part of the body such as the kidney, spine, and brain. Not everyone infected with TB bacteria becomes sick.

As a result, two TB-related conditions exist - Latent TB infection (LTBI) and TB disease. If not treated properly, TB disease can be fatal.

Latent TB Infection: The latent TB infection is when the bacteria live in the body without making one sick. For most people who breathe in TB bacteria and become infected, the body can fight the bacteria to stop them from growing.

People with latent TB infection have no symptoms, don’t feel sick, can’t spread the bacteria to others, usually have a positive TB skin test reaction or positive TB blood test. They may develop TB disease if they do not receive treatment for latent TB infection.

Sometimes people with latent TB bacteria remain inactive for a lifetime without causing disease and will never know they have the infection. TB

Disease: A TB bacterium becomes active when the immune system is weak and can’t stop them from growing. When TB bacteria are active (multiplying in your body), this is called TB disease. People with TB disease are sick. They may also be able to spread the bacteria to people they spend time with every day.

“Tuberculosis is airborne so it’s usually droplet infections which infects after someone has been exposed to someone who has active open pulmonary tuberculosis. TB affects every organ of the body except the hair… But the only one that is transmissible is the one that is in the lungs”, Dr. Owuor explained.

Some people develop TB disease soon after becoming infected (within weeks) before their immune system can fight the TB bacteria. Other people may get sick years later when their immune system becomes weak for another reason.

“Unfortunately majority of us who live in Kenya are already infected with TB because in Kenya the disease is prevalent. One gets a bug today and takes as long as two years to manifest,” he adds.

“One will be exposed to TB but since the immune system is intact it’s usually able to contain the infection.

Dr. Andrew Owuor, Respiratory and Critical care Physician- KNH

PHOTO | COURTESY

PHOTO | LALPATHLABS.COM

Inforgraphic on how TB is spread

The majority of people come down with the disease for one reason or another and it happens so because their immune system can no longer contain the infection.

“Certain groups of people are at risk of TB i.e., people who are HIV+, cancer patients, diabetic, patients on dialysis or kidney patients since their immune system is weakened or doesn’t work well so the risk becomes high”, Dr. Owuor explains.

The symptoms depend on the location of tuberculosis but by large the common symptoms patients might have are fever, loss of appetite, weakness or fatigue, weight loss, chills, and sweating at night.

For example, if the patient has pulmonary tuberculosis, they may have a cough, which may or may not be productive. Occasionally some of these patients may cough blood.

“TB can be pulmonary or extrapulmonary, which means inside the lung or outside the lung. It’s usually difficult to make a diagnosis especially if the tuberculosis is outside the lungs so the patient won’t have the obvious symptoms like coughing”.

Dr. Owuor says even though TB diagnosis is a challenge especially when it’s outside the lung, its treatment is a straightforward affair. In this case, the majority of the patients get a diagnosis from Biopsy.

“For example, there are patients who would present with Pleural Effusion; which is fluid inside the chest but outside the lung. The space between the chest wall and the lung, where fluid accumulates.

“Diagnosis depends on the type of TB and how they present themselves; pleural TB joint TB – biopsy, if a patient we suspect depending on how they present has a central nervous system or the brain, then the patient may require a CT scan, MRI or fluid tapped from their back (lumbar puncture) to try and see if we can make a diagnosis”. He explained.

Treatment is done for 6 months for all forms of TB. This is except for TB in the central nervous system and musculoskeletal. For these two cases, the treatment is administered for a year.

Managing TB

“Previously we used to give patients two weeks of isolation. But with the latest knowledge that the majority of the bacteria will be killed within the first few doses, isolation is no longer necessary. TB is curable, it’s treatable. Once you get the correct diagnosis, treatment is easy”. Dr. Owuor concludes.

Here at KNH, our respiratory department does Bronchoscopy; a procedure that lets doctors look at your lungs and air passages. It’s usually performed by a doctor who specializes in lung disorders (a pulmonologist).

The tuberculosis clinic is located next to Helipad and clinics are on Mondays to Fridays from 8 am to 4 pm.

Treatment is done for 6 months for all forms of TB. This is except for TB in the central nervous system and musculoskeletal. For these two cases, the treatment is administered for a year.