Dr. Tariq Jagnarine
Family Medicine, Endocrinology/Diabetes

Tuberculosis (TB) is an infectious disease that usually affects the lungs, though it can affect any organ in the body. It can develop when bacteria spread through droplets in the air. TB can be fatal, but, in many cases, it is preventable and treatable. In the past, TB, or “consumption,” was a major cause of death worldwide. Following improvements in living conditions and the development of antibiotics, the prevalence of TB fell dramatically in industrialised countries.
However, numbers started to rise again in the 1980s.
The World Health Organization (WHO) describes TB as an “epidemic”. It reports that it is the 13th leading cause of death globally, and “the second leading infectious killer, after COVID-19”. The WHO estimates that, in 2020, nearly 10 million people worldwide developed TB and 1.5 million people died from the disease, including 214,000 people who also had HIV.
In Guyana, the 2022 data indicates that 396 persons were newly infected with TB, with a mortality rate of 1.7.
Currently, antibiotic resistance is causing renewed concerns about TB among experts. Some strains of the disease are not responding to the most effective treatment options. In this case, TB is difficult to treat.
A person may develop TB after inhaling Mycobacterium tuberculosis (M.tuberculosis) bacteria, primarily from person to person. When TB affects the lungs, the disease is most contagious, but a person would usually become sick only after close contact with someone who has this type of TB.
TB INFECTION (LATENT TB)An individual can have TB bacteria in their body and never develop symptoms. In most people, the immune system can contain bacteria so that they do not replicate and cause disease. In this case, a person would have TB infection, but not an active disease. There is no risk of passing on a latent infection to someone else. However, a person with latent TB still requires treatment.

The body may be unable to contain TB bacteria. This is more common when the immune system is weakened due to illness or the use of certain medications. When this happens, the bacteria can replicate and cause symptoms, resulting in active TB.
People with active TB can spread the infection. Without medical intervention, TB becomes active in 5–10% of people with the infection.
According to the CDC, progression occurs within 2–5 years in about 50% of these people.

The risk of developing
active TB is higher in:
* Anyone with a weakened immune system
* Anyone who first developed the infection in the past 2–5 years
* Older adults and young children
* People who inject recreational drugs
* People who have not previously received appropriate treatment for TB.

* Latent TB: A person with latent TB will have no symptoms, and no damage will show on a chest X-ray. However, a blood test or skin prick test would indicate that they have TB infection.
* Active TB: An individual with TB disease may experience a cough that produces phlegm; fatigue, a fever, chills, and a loss of appetite and weight. Symptoms typically worsen over time, but they can also spontaneously go away and return.

A person should see a doctor if they experience these early warning signs:
* Persistent cough, lasting at least 3 weeks
* Phlegm which may have blood in it when they cough
* Loss of appetite and weight
* General feelings of fatigue and being unwell
* Swelling in the neck
* Fever
* Night sweats
* Chest pain

Beyond the lungs
TB usually affects the lungs, though symptoms can develop in other parts of the body. This is more common in people with weakened immune systems.

TB can cause:
* Persistently swollen lymph nodes, or “swollen glands”
* Abdominal pain
* Joint or bone pain
* Confusion
* Persistent headache
* Seizures

A person with latent TB would have no symptoms, but the infection can show up on tests. People should ask for a TB test if they:
* Spent time with someone who has or is at risk of having TB
* Spent time in a country with high rates of TB
* Work in an environment where TB may be present.

A doctor would ask about any symptoms, and the person’s medical history. The doctor would also perform a physical examination which involves listening to the lungs and checking for swelling in the lymph nodes. Two tests can show whether TB bacteria are present:
* TB skin test
* TB blood test
However, these cannot indicate whether TB is active or latent. To test for active TB disease, the doctor may recommend a sputum test and a chest X-ray. Everyone with TB needs treatment, regardless of whether the infection is active or latent.

With early detection and appropriate antibiotics, TB is treatable. The right type of antibiotic and length of treatment would depend on:
* A person’s age and overall health
* Latent or active TB
* Location of the infection
* Whether strain of TB is drug-resistant.
Treatment for latent TB can vary. It may involve someone taking an antibiotic once a week for 12 weeks, or every day for 9 months.
Treatment for active TB may involve taking several drugs for 6–9 months. When a person has a drug-resistant strain of TB, the treatment would be more complex.
It is essential for people to complete the full course of treatment, even if symptoms go away. If a person stops taking their medication early, some bacteria can survive and become resistant to antibiotics. In this case, the person may go on to develop drug-resistant TB.
Depending on the parts of the body that TB affects, a doctor may also prescribe corticosteroids.

Ways of preventing TB from infecting others include:
* Getting a diagnosis and treatment early
* Staying away from other people until there is no longer a risk of infection
* Wearing a mask, covering the mouth, and ventilating rooms.
In some countries, children receive an anti-TB vaccination — the bacillus Calmette–Guérin (BCG) vaccine — as part of a regular immunisation programme.

For people with HIV, doctors consider TB to be an opportunistic infection. This means that a person with HIV has a higher risk of developing TB, and experiencing more severe symptoms than someone with a healthy immune system.
Treatment for TB can be complex in a person with HIV, but a doctor can develop a comprehensive treatment plan that addresses both issues. TB can become a complication of HIV. Learn about other HIV complications here.

Tobacco use and secondhand smoke increase the risk of developing TB. These factors also make the disease harder to treat, and more likely to return after treatment.
Quitting smoking and avoiding contact with smoke can reduce the risk of developing TB.

Some other health issues that weaken a person’s immune system and can increase the risk of developing TB include:
* Low body weight
* Substance abuse disorders
* Diabetes
* Silicosis
* Severe kidney disease
* Head and neck cancer
* Some medical treatments, such as an organ transplant, can also impede the functioning of the immune system.

Without treatment, TB can be fatal. If it spreads throughout a person’s body, the infection can cause problems with the cardiovascular system and metabolic function, among other issues.
TB can also lead to sepsis, a potentially life-threatening form of infection.