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An x-ray needs to be taken to establish whether your lungs are affected. You will be asked to stand in front of an x-ray machine. You will have to take a deep breath and then hold your breath for a few seconds. The x-ray image can provide information about any damage to the lungs, for example about so-called 'cavities' or 'infiltration'. These can be a sign of an infectious disease such as tuberculosis but can also be caused by other diseases. Repeated x-rays will allow your doctor to detect any improvement or worsening of the disease.
To gain more information about a possible infection with tuberculosis, the phlegm that you cough up needs to be examined. Tuberculosis bacteria in your 'sputum' - which is the medical word for 'phlegm' - can be dyed with a special dying method called Ziehl-Neelsen and then looked at under a microscope. Most centres now use a method called fluorescence microscopy that is recommended by the World Health Organisation. Microscopy is used to establish whether or not you are contagious when you cough. When bacteria are visible on microscopy you are contagious to others. Another more sensitive test, called GeneXpert or PCR, can be performed to detect even small numbers of tuberculosis bacteria in your sputum. This method takes a few hours but is not available in every health centre. Most health centres will also try to grow tuberculosis bacteria from your sputum sample. This method is called sputum culture. It is very accurate but – because the bacteria grow very slowly in the laboratory - it may take several weeks to three months until a result is available. Therefore, treatment for tuberculosis is usually initiated before the result of the sputum culture is available. The sputum culture is considered to be the most valid test for the diagnosis of tuberculosis. It also allows the testing for drug resistance that determines the combination of antibiotics that is required for treatment. During the course of treatment, the number of bacteria being coughed up reduces and this change can be seen under the microscope. It is very important that the sputum sample is coughed up from the deep parts of the lung. It should be spat in the container supplied. If you cannot produce phlegm spontaneously, the health care staff may ask you to breathe in salty nebulised fluid. This often helps to loosen the phlegm in your chest.
Testing of contacts
In many countries, the local health authority will contact all patients with tuberculosis. You will be asked about your contact with others and about the duration and intensity of these contacts. This can include family members, room- or house-mates, colleagues or friends. The health authority will then assess these contacts to determine whether they are also affected by tuberculosis. A blood test or a chest x-ray may be necessary. These investigations aim to rule out transmission of tuberculosis to your family or friends. Occasionally, the contagious source of a tuberculosis infection can be tracked down but unfortunately this is rarely possible. Contact persons may be monitored by the health authorities for several months if necessary. Unfortunately, not all countries have sufficient resources to search for tuberculosis contact persons. Nevertheless, it is important to early detect people who are infected or even ill. Therefore, tell your family, friends and colleagues that everyone should be checked for tuberculosis, especially those who notice the typical complaints that point towards tuberculosis: cough for several weeks, fever, night sweats and unintentional weight loss.
Tuberculin Skin Test (TST)
The Tuberculin Skin Test is applied to the soft skin on the inside of your forearm. A small amount of fluid called tuberculin is injected into the skin causing a small blister. The blister disappears but 2-3 days later, a nodule may appear at the injection site that can be easily felt. If the nodule is large enough, which is in most settings five or ten millimetres, this is called a positive skin test result. A positive test result can be found in persons who received the so called BCG vaccination against tuberculosis in the past. On rare occasions, the nodule can be much larger and may be accompanied by a localised rash or may even ulcerate which means that the skin breaks open. The Tuberculin Skin Test should be administered and interpreted by an experienced health care worker. If the result is positive, it does not necessarily mean that you have active or contagious tuberculosis, because many people get infected but do not fall ill. However, further investigations may be needed to exclude active tuberculosis requiring antibiotic treatment. Possibly, preventive therapy with an antibiotic drug may be recommended as described in the chapter on latent tuberculosis.
Interferon-gamma Release Assay (IGRA)
A newer test is the so called IGRA test that is performed on a blood sample. In the laboratory, the amount of a substance called interferon-gamma is measured in the blood. This substance is released by human blood cells in the test tube and can be used to measure your immune cells recognizing the bacteria. If sufficient numbers of defense cells produce interferon-gamma the test result becomes positive. One advantage of the IGRA test is that its result is not influenced by a previous BCG vaccination against tuberculosis. A positive test result does not necessarily mean that you have active or contagious tuberculosis. However, further investigations may be needed to exclude active tuberculosis requiring antibiotic treatment. Occasionally, preventive therapy with an antibiotic drug may be recommended as described in the chapter on latent tuberculosis.
Computed tomography (CT scan)
In rare situations, a CT scan is required to obtain further information about the changes in your lungs and other parts of your body. You will lie in the round opening of a CT machine for a series of special X-Rays to be taken. It is important not to move during the scan and to hold your breath when asked to. Sometimes, so called contrast medium is injected into the vein to improve the quality of the images produced. This may cause a temporary warm sensation in your body. The CT gives detailed information about any changes or destruction of your lungs and other organs. Even small alterations that are not visible on a plain X-Ray can be detected. These can point towards an infectious disease like tuberculosis.
In rare situations, you need to undergo an investigation of your lungs called a bronchoscopy. This allows the doctors to obtain mucus, fluid and possibly small tissue samples from your lungs. It is possible to diagnose tuberculosis from these samples using several different methods. Several weeks will pass before a positive or negative result is available. For the bronchoscopy, you will receive sedative medication to ensure that you sleep during the investigation. You will receive oxygen through a small tube in the nose and you will be monitored continuously. The most common side effects that occur after bronchoscopy are a sore throat, temporary hoarseness, coughing up small amounts of blood, nose bleeding or fever. If you notice pain or shortness of breath in the hours after bronchoscopy, please notify the doctor or nurse. This helps to detect more serious side effects early, such as a collapse of the lung or significant bleeding.
The World Health Organisation (WHO) recommends that every person infected with tuberculosis should be tested for HIV or AIDS. The reason is that people infected with HIV have a higher risk of developing tuberculosis because their immune system is suppressed. Infection with HIV can nowadays be treated with drugs that are well tolerated. This antiretroviral therapy is also extremely important in the treatment of tuberculosis in someone with HIV.
Tuberculosis a very old disease that affects millions of people world wide. Nevertheless, many details of the disease are poorly understood. For example, it is impossible at present to predict if and when someone becomes ill after he or she has been exposed to an infectious patient with tuberculosis. Many of the treatment recommendations, such as which antibiotic drugs need to be given for how long in drug resistant tuberculosis, are based on weak scientific grounds. If you are affected by tuberculosis, you may be able to help science understand and cure the disease better. You may be asked to participate in a so called clinical study to learn about the disease mechanisms or treatment options. Please consider your participation in such a scientific project if you are asked. Many thousand people worldwide may benefit from its results.
The inflammatory response in the body leads to the typical symptoms of tuberculosis. The disease progresses very slowly. Therefore, symptoms can persist for many months before you decide to see a doctor. Typical symptoms are a longstanding cough, fever, night sweats when sleeping and weight loss. Some people have to change their sheets several times per night because they sweat so heavily. Many people notice weight loss of up to several kilograms. You can help your friends and family by teaching them the typical signs of the disease. Tell them that anyone should be checked for tuberculosis who notices the typical complaints: cough for several weeks, fever, night sweats and unintentional weight loss.
Tuberculosis or TB is caused by bacteria. These are small and very resilient organisms which can be inhaled unnoticed and the bacteria travel to the lungs where they enter into immune cells. The immune cells are able to eliminate most bacteria. But the bacteria that cause tuberculosis - called Mycobacterium tuberculosis in medical terms - can survive inside the immune cells and even multiply there. The human body recognizes these infected cells and tries to eliminate them which causes an inflammatory response. Some people are able to control the tuberculosis infection for many years or even decades without any medical intervention. They do not develop symptoms and sometimes even recover completely. Unfortunately, the immune system often fails to stop the multiplication of the bacteria which results in an inflammatory response and then slow progression of the disease, followed by destruction of the lungs and other organs.
Chance of cure
The chance of a cure for people with fully sensitive tuberculosis is excellent. However, it is extremely important that the drugs are taken consistently for the whole duration of the treatment. If you stop taking the medication too soon or you do not take them regularly there is a risk that the disease will come back and might be a lot more difficult to treat. This prolonged duration of treatment is necessary even though after some weeks you might start feeling healthy and the bacteria can no longer be detected by the laboratory. This is because a small number of organisms still persist within your body. These “hidden” bacteria will be killed only if the treatment has the correct duration as recommended by your doctor. Stopping smoking is another way through which you can improve your chance of a cure. There are some forms of tuberculosis such as tuberculosis affecting the central nervous system (the brain and the membranes which surround it) which are more dangerous and even deadly in which early diagnosis and treatment are extremely important for a good outcome. The state of immunity and illnesses affecting it such as the infection with the human immunodeficiency virus (HIV) as well as other diseases can also have an influence on outcome. People who have resistant tuberculosis are more difficult to treat and the chances of cure are lower. This is due to the fact that the treatment options are limited and the drugs that the doctors can use in this situation are not so active on the bacteria and are more likely to have adverse effects. In addition, in some countries, some of the drugs might not be available at all. This is also a reason why the chances of cure for multidrug resistant tuberculosis differ between countries.
Latent Tuberculosis Infection (LTBI)
In persons with a positive IGRA test result or a positive tuberculin skin test, active tuberculosis disease needs to be ruled out by further investigations. Many patients get infected by the bacteria but do not fall ill. Even without active disease, antibiotic treatment may be recommended for some persons. This is called preventive therapy. The recommendation depends on the risk for the development of active tuberculosis after having been exposed to a contagious patient. Children and persons with an impaired immune system are more likely to fall ill after exposure. Preventive treatment can reduce this risk. Depending on the proximity and duration of your exposure, you may be advised to take preventive antibiotic therapy for several months. However, the guidelines and the resources for preventive treatment in latent infection vary among different countries. The decision should be guided by an experienced doctor or another health care worker.
Tuberculosis may affect any organ of your body. Most commonly, the bacteria cause damage to your lungs which is called pulmonary tuberculosis. If other body regions are infected this is called extrapulmonary tuberculosis. This course of the disease is more common in children or persons with an impaired immune system. Extrapulmonary manifestations include pleural tuberculosis, lymph node tuberculosis or urogenital tuberculosis that are covered in separate chapters. The term also includes other body areas: Tuberculous meningitis is a serious infection of the thin layer around the brain. Cutaneous tuberculosis is an infection of the skin. Ophthalmic tuberculosis describes an infection of the eye. Tuberculous osteomyelitis is the term for an infection of the bone. In some cases several organs are affected. This is called disseminated tuberculosis. For all types of extrapulmonary tuberculosis, the main treatment is the same as for lung tuberculosis: antibiotic treatment for several months.
Lymph node TB
Although tuberculosis usually affects the lung, some patients fall ill with an infection of the lymphatic glands or lymph nodes. Patients may detect painless swollen lymph nodes in their neck, their arm pit, their groin or in any other body compartment. Sometimes, the swelling may burst and release yellowish pus that contains tuberculosis bacteria. Please ensure that you keep the oozing wound clean and covered with a dressing. Swollen nodes caused by tuberculosis should not be opened surgically, and oozing nodes should not be closed by a surgeon. However, to discover the origin of a swelling it may be appropriate to draw a small amount of fluid with a syringe. This is called a lymph node biopsy or needle aspiration. It may take several weeks until the results of this investigation are available. The main treatment for lymph node tuberculosis is the same as for lung tuberculosis: antibiotic treatment for several months.
Although tuberculosis usually affects the lung, some patients fall ill with an infection of the thin internal skin that covers the lung. This layer of tissue that is located between the inside of the ribs and the outside of the lung is called pleura. The disease is called pleural tuberculosis or TB pleuritis. The inflammation of the pleura often causes the accumulation of fluid inside the rib cage which may impair your breathing. Often, several litres of fluid can be released from the chest with a small needle. This is called a pleural tap. It may take several weeks until the results of this investigation are available. However, the main treatment for pleural tuberculosis is the same as for lung tuberculosis: antibiotic treatment for several months.
Although tuberculosis usually affects the lung, some patients fall ill with an infection of the kidneys, the reproductive organs or bladder. This is called urogenital tuberculosis and can cause infertility or womb disorders in women and kidney impairment. Patients may notice blood in their urine, pain, fever and discomfort when passing water. The main treatment for urogenital tuberculosis is the same as for lung tuberculosis: antibiotic treatment for several months.
Newly diagnosed susceptible tuberculosis
The clinical and microbiological investigations have shown that you are suffering from tuberculosis. The bacteria that cause your disease are susceptible to the standard drugs used for the treatment of tuberculosis. The results show that the bacteria are not resistant to any drugs. Sometimes, more specific testing may take several weeks.
Newly diagnosed resistant tuberculosis
The clinical and microbiological investigations have shown that you are suffering from tuberculosis. The bacteria that cause your disease are resistant to some drugs. This means that not all of the drugs usually given for the treatment of tuberculosis will work in your case. You will therefore receive several different tablets and possibly injections. Injections can be given into your blood vessels – this is called intravenous or i.v. treatment through a drip. Sometimes, a small device, called a portacath, is implanted under your skin that allows convenient and painless access to the blood vessels. Alternatively, injections can be applied into your muscle – this is called intramuscular or i.m. injection with a syringe. If you are allowed to go home between injections, make sure that you do not miss any future appointments. Usually, the injection is given several times per week and is essential to achieve cure. Unfortunately, bacterial resistance requires a longer duration of treatment than bacteria that are susceptible to all drugs.
Once they have been inhaled, tuberculosis bacteria are able to multiply in the immune cells of the lungs. Parts of the lung may be destroyed by the human immune system in an attempt to eliminate the infected cells. This leads to holes in the lung tissue that are called 'cavities' and these are often visible on X- Ray. In the cavities, the bacteria are no longer accessible to the immune system. Furthermore, bacteria can be expelled from the cavities into the air when coughing, making a tuberculosis patient contagious to others. As long as patients are infectious to others, the patient and all visitors have to wear protective face masks or particulate respirators covering the mouth and nose. Examination of the sputum can usually determine whether or not someone is infectious.
Prevention of transmission
As long as bacteria are coughed up, one may be considered to be contagious to others. This is why you should cover your mouth and nose with a tissue when you cough or sneeze. Do not share your tissue with others. Put your used tissue in a waste basket, not into your pocket. If you don't have a tissue, cough or sneeze into your upper sleeve or elbow, not your hands. Also, do not spit on the ground but into a tissue. In many settings, contagious patients may be asked to wear a protective face mask covering the mouth and nose when meeting with others face to face indoors. You should also open the windows of your room regularly to allow sufficient ventilation and sunlight exposure. It is important to air your room frequently as the small bacteria can float in the air for many hours and infect others. For this reason, people in contact with you indoors should wear protective masks, too. These should be specially licensed particulate respirators fulfilling the standard FFP2 or N95 criteria. These respirators prevent bacteria being inhaled and offer good protection for your friends and relatives who visit you.
As long as you are infectious to others, you will be asked to follow certain rules in order to prevent the infection from being passed on to others. In some countries, you may not be allowed to leave your hospital room for some time. Also, discharge from hospital is not permitted in many countries as long as you are coughing up bacteria. You should be supplied with all your necessities in your hospital room. In other countries, particularly in areas where many people suffer from tuberculosis, patients are not necessarily detained in a room. They may be allowed to walk about outside or may be sent home. However, one rule applies universally: If you are infectious, you and your visitors should wear protective face masks indoors to avoid the risk of infection. This applies also, when you have to leave your room for a short time only - for instance for an investigation. You need to make sure that the mask covers both, your nose and mouth. It should be fitted to your face properly to prevent any lateral airflow bypassing the mask. The doctor or nursing staff can give you instructions as to how to use the masks that are also called particulate respirators.
Unfortunately, there is no vaccination available at present that can prevent all forms of tuberculosis. In many countries, where tuberculosis is common, small babies are vaccinated with a weakened bacterium called BCG. This is done because it is known that tuberculosis that occurs in vaccinated children causes less severe problems compared to non-vaccinated children. Although the vaccination does not stop the disease, it eases the course of the infection and improves the chances for complete cure. The vaccination will leave a small scar where it is applied, usually in the skin covering the shoulder muscle. If a vaccination card or passport exists in your country, please get it filled in for your child. In many countries where tuberculosis is nowadays rare, the BCG vaccination is not recommended anymore. This is because the risk for children of catching tuberculosis is very low in these countries.
If you are pregnant, tuberculosis may not only affect yourself but also the unborn child. TB may be more common in pregnancy because of the changes to the body’s immune system. The main risk for developing the disease is exposure to TB at any time, either from family members or coming from a country where TB is common. The symptoms of TB may be less clear as tiredness and sweating at night are common in pregnancy. A persistent cough for more than weeks and poor weight gain suggest tuberculosis. If you have a productive cough, testing the sputum for TB is sensible. A chest x-ray is safe in pregnancy. The radiation dose is now low and your baby can be shielded with a lead apron. Also, the tuberculin skin test and the blood IGRA test are safe. If tuberculosis is not treated, your child may have a lower birth weight compared to babies from healthy mothers. In rare circumstances, the newborn may even have tuberculosis. Standard treatment of tuberculosis is safe. As the drug rifampicin affects the contraceptive pill, many women have become pregnant on tuberculosis treatment and there was no increase in fetal abnormalities. Remember to take vitamin B6 if your treatment includes isoniazid. This also applies to any preventive treatment you may receive. If you have drug-resistant TB, it is more important to be cured than to run the risk of passing it on to your baby. It is important to know, that untreated tuberculosis is more dangerous than any potential side effects of anti-tuberculosis treatment. However, the injection drugs can affect the baby’s hearing and you will need to have treatment specific to your situation. Although it may be inconvenient, it is very important that you take your tablets regularly. If you do not take the tablets regularly, the treatment may not be successful. This can harm you and your baby.
Most children fall ill with tuberculosis because they were infected by an adult living in the same household. While most adults remain free of symptoms for many months or years, children can develop active tuberculosis quickly after having been exposed to a contagious patient. It is estimated that up to half of the children who were infected fall ill within two years time. Unfortunately, the typical symptoms of the disease - cough, fever and night sweats – are less common in children and unusual courses of the disease are more common. The lung, the brain and all other organs can be affected. For this reason, some countries recommend that all children below the age of five should receive antibiotic treatment when they have been sufficiently exposed to the disease. Most commonly, a drug called Isoniazid is given for such preventive therapy. The duration of this treatment varies but extends over several months. Many children find it difficult to provide a sputum sample for analysis when coughing. Therefore, a small tube may need to be fed down the child’s nose or mouth to obtain a fluid sample from the stomach. Even if no tuberculosis bacteria can be obtained during the investigations, children who are suspected to have tuberculosis are likely to receive an antibiotic drug for several months. The drugs are given according to the weight of the child. Please encourage your child to take the medication regularly. The chance of a cure is excellent if the treatment course is completed.
For many people who are suffering from tuberculosis, the disease is only one of many daily challenges. Other issues may appear more important when the disease is diagnosed. A common concern is that you could lose your job when falling ill or being admitted to hospital. This is particularly true if you work abroad or travel frequently. Also, people living abroad without being registered are afraid that they may be arrested or even sent back to their home country once tuberculosis has been diagnosed. For these reasons it is very common for people to defer their visit to a doctor for as long as possible. However, during this time, the disease progresses and may cause irreversible damage to your body. Once tuberculosis has been detected and treatment has begun, most patients start to feel much better soon. Although you may quickly feel strong enough to take up work again, to travel abroad again or to continue the life you lived before, the disease is not cured yet and the bacteria are not yet eradicated from your body. If you don’t complete the full course of treatment - that usually takes many months - the disease may come back and may be life-threatening for you, your family and your friends. You should therefore make sure that you can access your daily therapy throughout the whole course of treatment, even in another city or abroad. Please inform your doctor, pharmacist or another health care worker about your travels. They may be able to help you with the preparation of your journey by supplying you with the required drugs or finding someone who can assist you at your travel destination.
General information about therapy
Tuberculosis can be treated with a combination of particular antibiotic drugs. In most cases, the disease can be cured and none remains. Unfortunately, treatment takes many months and requires a lot of stamina. You will have to take tablets for many months. The therapy with antibiotics starts with a so called intensive phase of two or more months. During this period you will be treated with at least four drugs, while less drugs are required during following months in the maintenance phase. To ease this long therapy, so called fixed dose combinations are available in many countries. This means that there are two to four drugs combined in a single tablet. Other countries, however, do not have access to these combination tablets. In these countries, patients have to swallow several tablets each day. Although it may be inconvenient, it is very important that you take your tablets regularly. If you do not take the tablets regularly, the treatment may not be successful. The bacteria will start to multiply again and can become resistant to the antibiotics. This leads to an even more complicated and prolonged treatment. In the worst case, the disease can become untreatable and fatal.
Patient's contribution to recovery
You can contribute to your recovery with simple measures. It is important not to smoke. Recovery takes longer in smokers than in non-smokers. Fresh air and occasional exposure to sunlight appear to be helpful. You should air your room regularly. The most important factor is to take your prescribed medication regularly. You need to abstain from recreational drugs and alcohol. Any alcohol or drug dependency can impair the immune system. Ask your doctor for help if you feel that you cannot quit unhealthy habits on your own. This ensures that recovery from tuberculosis can be achieved as quickly as possible.
Usually, tuberculosis bacteria are killed by standard medication and the treatment takes six months. You will be given four different drugs, the active ingredients of these are called Isoniazid, Rifampicin (or Rifampin), Pyrazinamide and Ethambutol. Once the first two months of therapy have been completed, you will continue treatment with Isoniazid and Rifampicin for at least a further four months. In some countries, these compounds are combined in a single tablet. The success of your treatment is monitored through analyses of your phlegm and x-rays. This will determine the date when your treatment can stop. It is not necessary to stay in hospital for the entire duration of treatment. But it is possible that a hospital stay of several weeks or even months may be required.
Treatment of resistant tuberculosis
In resistant tuberculosis, the drugs that are usually prescribed do not work anymore. This type of tuberculosis is called MDR tuberculosis, which is an abbreviation for 'multidrug resistant tuberculosis', or XDR tuberculosis which stands for 'extremely drug resistant tuberculosis'. These conditions are treated with several different drugs for many months. The recommended duration of treatment is currently at least 20 months, which is nearly two years. Sometimes, even longer therapy is required. You may have to stay in hospital for a very long time to prevent the spread of the disease. In addition, you will receive regular intravenous treatment through a drip or injections into a muscle to treat the infection. In some situations, when there are numerous drug resistances, this may be required for the entire time of treatment.
Directly observed therapy (DOT)
Tuberculosis requires many months of therapy with a combination of several medications. Many patients find it challenging to follow the treatment course without help. t is therefore recommended that all patients receiving treatment for tuberculosis should take their medication under observation. This is called Directly Observed Therapy or DOT. Directly Observed Therapy can be set up at health centres, at home or any other location where a trained person can administer the medication. The supervision is usually done by health care workers but can also be performed by relatives or other trained individuals. Directly observed therapy aims to support the patient and at the same time ensure that all medication is taken. Also, direct observation ensures that drug side effects are detected early and all your questions regarding the treatment can be answered immediately. If you receive treatment for tuberculosis under direct observation, you should make sure that your carer knows where you are or how to contact you. Although it may be inconvenient, it is very important that you take your medication regularly. If you do not take it regularly, the treatment may not be successful. The bacteria will start to multiply again and can become resistant to the antibiotics. This leads to an even more complicated and prolonged treatment. In the worst case, the disease can become untreatable and fatal.
Isoniazid is one of the most important drugs for the treatment of tuberculosis. In many cases, this drug will be given throughout the whole course of your treatment. You will receive a dose that is adjusted to your body weight. Occasionally, some people experience an allergic reaction with rash and itching. This drug can affect your liver and blood tests may be required to monitor your liver function. To protect your liver, you should abstain from alcohol during your treatment period. Furthermore, Isoniazid may affect your nerves, leading to numbness in your hands and feet if your diet lacks vitamins. This can be prevented by giving vitamin B6 supplements. Please inform your doctor or pharmacist about any side effects that you observe. Your doctor may be able to adjust your treatment regimen accordingly.
Rifampicin or rifampin acts on both actively multiplying and resting bacteria. Therefore, it is one of the most important drugs of your standard tuberculosis therapy and it should be taken throughout the whole course of your therapy. You will receive a dose that is adjusted to your body weight. Rifampicin causes orange colouring of your urine and stool. Don’t worry about this. Occasionally, some people experience an allergic reaction, with rash and itching. The drug can affect your liver and blood tests may be required to monitor your liver function. To protect your liver, you should abstain from alcohol during the treatment period. Other side effects include nausea, fever or changes to certain cells in your blood. Please inform your doctor or pharmacist about any side effects that you observe. Your doctor may be able to adjust your treatment regimen accordingly. Rifampicin interacts with a number of other drugs. It is important that you mention your rifampicin treatment when talking to your doctor.
Ethambutol is a drug that is given during the initial intensive treatment phase in combination with other medication. The intensive treatment phase involves giving a large number of different drugs simultaneously in order to control the tuberculosis infection as quickly and as effectively as possible. You will receive a dose that is adjusted to your body weight. Ethambutol is not usually given throughout the whole treatment period. Please ask your doctor how long you will receive ethambutol for. If your vision deteriotates during your treatment with ethambutol, please consult your doctor . The drug can cause an inflammation of your eyes with subsequent deterioration of your vision. An early alarming side effect may be a change in your colour vision. Another occasional side effect is joint ache. Please inform your doctor or pharmacist about any side effects that you observe. Your doctor may be able to adjust your treatment regimen accordingly.
Pyrazinamide is a drug that is given during the intensive treatment phase in combination with other medications. During the intensive treatment phase a large number of drugs is given simultaneously in order to control the tuberculosis infection as quickly and as effectively as possible. You will receive a dose that is adjusted to your body weight. Pyrazinamide is not usually given throughout the whole duration of therapy, but this may be required in cases of drug resistant tuberculosis. Please ask your doctor how long you will receive pyrazinamide for. This drug can affect your liver and blood tests may be required to monitor your liver function. To protect your liver, you should abstain from alcohol during the treatment period. Other side effects include nausea and vomiting, aching joints and muscles, or facial flushing. Occasionally, your blood results may change - such as the level of uric acid in your blood - but usually this does not affect your health. Please inform your doctor or pharmacist about any side effects that you observe. Your doctor may be able to adjust your treatment regimen accordingly.
Moxifloxacin, levofloxacin, ofloxacin and gatifloxacin are back-up drugs that are used for the therapy of drug resistant tuberculosis. Because these drugs are very effective they belong to the best second-line drugs that are currently available. You will receive a standard dose of the drug in combination with other anti-tuberculosis drugs. Usually, the drug is tolerated well but occasionally, liver enzymes may increase during therapy. Therefore, your doctor or nurse should perform regular blood tests. A rare but serious complication may be cardiac arrhythmias, that is an irregular heartbeat. An ECG is often performed during therapy initiation to monitor your heart beat. Very rarely, these drugs may cause injury to your Achilles tendon at the back of your ankle. Please inform your doctor or pharmacist about any side effects that you observe. Your doctor may be able to adjust your treatment regimen accordingly.
Amikacin, kanamycin, capreomycin are used for the treatment of drug resistant tuberculosis. They belong to a group of medication called injectable second line drugs. Receiving an injection into the muscle or blood vessel for several months may cause some discomfort. However the drugs belong to the most powerful compounds that are available for the treatment of drug resistant tuberculosis. Due to the inconvenient administration of these drugs and their side effects most patients receive this therapy only during the first 8 months of treatment in the so called intensive phase. Your doctor will decide how long you need to be treated with an injectable drug. A serious side effect of this drug class is deafness. You should inform your doctor immediately if you notice that your hearing gets worse or changes in any other way. Also, your hearing should be tested at regular intervals to detect any impairment even if you do not notice any changes. Furthermore, your kidneys may be affected by the drugs. Therefore, regular blood tests are required to detect adverse side effects. Please inform your doctor or pharmacist about any side effects that you observe. Your doctor may be able to adjust your treatment regimen accordingly.
If you have an infection with the human immunodeficiency virus, HIV, this should be treated. You will receive at least three different drugs, some of which may be combined in a single tablet. Because the HIV virus suppresses the immune system, its treatment is very important to help you recover from tuberculosis. Anti-HIV treatment prevents multiplication of the virus in the body leading to a recovery of so-called 'helper cells' that belong to the immune system. These helper cells fight against organisms such as viruses, bacteria and fungi attempting to invade the human body. It is possible that in the first few weeks of anti-HIV treatment, these new helper cells are heavily engaged in the elimination of foreign organisms from your body. This can lead to a deterioration of your well-being. This is called immune reconstitution syndrome and is a sign that your immune system is recovering. You should inform the doctor if you start feeling unwell after the start of anti-HIV treatment.
Tuberculosis is caused by bacteria. These bacteria can acquire resistance to antibiotic drugs that are used for treatment rendering the drugs ineffective. Sometimes all available drugs are found to be ineffective. This means that the disease cannot be cured nor controlled in some patients. Since tuberculosis is transmitted by bacteria that are coughed up patients, these patients who suffer from an uncontrollable disease are contagious for others. This is a difficult situation for people affected by the disease, their relatives and their carers. The most important measure of protection in this case is the use of a face mask or particulate respirator for the patient, their visitors and health care workers. Also, in some countries, palliative care institutions care for the patients. This may be a dedicated hospital ward or a house where contagious patients are detained to protect the community. The patients are usually supplied with all necessities in their rooms.
An operation or other surgical interventions are rarely needed for the treatment of tuberculosis. The best available treatment is antibiotic therapy. However, in combination with antibiotic drugs, sometimes an operation may be helpful. This is particularly true in extrapulmonary tuberculosis, when the disease is affecting other organs but your lung, for example your bones or your stomach. If your brain is affected a surgeon may take a biopsy for diagnostic purposes. In rare situations, the antibiotic drugs are not strong enough to control the disease in your lung. In this setting, an operation may be considered to remove the contagious areas in your lung.