TREATMENT
Case 1: Positive skin test, normal chest X-Ray and no TB symptoms
In this case, the person is likely to have a few TB germs in inactive state and is not contagious. An antibiotic known as isoniazid (INH) is used to prevent the TB from turning into an active infection. If INH is prescribed and taken for 6-12 months, it prevents the TB bacteria from becoming active in the future. However, if a person with a positive skin test does not take INH, there is a 5-10% lifelong risk that the TB bacteria will become active.
INH preventive treatment is recommended for individuals who have:
- Close contact with a person diagnosed with infectious TB
- Positive tuberculin skin test
- Abnormal chest X-Ray that suggests inactive TB
- Tuberculin skin test that changed from negative to positive within the past 2 years
- Positive skin test reaction and a special medical condition (e.g. AIDS, HIV or diabetes) or those who are on corticosteroid therapy
- Positive skin test reaction even with none of the above risk factors (under 35 years old)
Case 2: Positive skin test, abnormal chest X-Ray and sputum showing presence of TB bacteria
Here, the person has active TB and it is also contagious. Active TB symptoms include cough, fatigue, fever and weight loss. There are 2 forms of treatment.
1. Medication
Rifampin (Rifadin), ethambutol (Myambutol), and pyrazinamide are the drugs commonly used to treat active TB in conjunction with the aforementioned INH. The 4 drugs are often prescribed and taken for the first 2 months to help rid the body of any potentially resistant strains of TB bacteria. The number of drugs is usually reduced to 2 drugs for the remainder of the treatment. The drugs chosen for the continued course are based on the drug sensitivity of the patient which is available by then. Streptomycin is an injectable drug. It may be prescribed as part of the treatment, especially when the disease is extensive and/or when the patients cannot be relied on to take their oral medications diligently.
Treatment usually lasts for many months, and sometimes for years. This is because the TB disease organisms are slow in growth and in turn, they also die slowly. The success of TB treatment is largely dependent on the patient -- the main cause of failure to cure TB infection is the failure of the patient to take his or her medications as inconsistent medicinal intake leads to the rise of drug resistance.
2. Surgery
Surgery for tuberculosis is considered unusual because treatment with the proper antibiotics prescribed would usually be enough. However, in some cases, patients can opt for surgery to remove the infected areas. It is usually not recommended due to the high risks and complications that could result. If a person infected with active TB does not undergo any form of treatment, it may result to a lethal infection. Individuals exposed to someone with active TB, or suspect that they have been exposed to, should visit the doctor for an examination and a TB skin test.
PROGNOSIS
With treatment, most are able to make a full recovery. In addition, some may survive without treatment and may even fully recover from the disease. Without treatment, approximately half of those infected with active TB will eventually die within 5 years of the infection. This is because TB bacteria multiply quite slowly compared to most other bacteria, and active TB bacteria can cause an illness to worsen overtime, leading to other complications.
Patients infected with drug-resistant TB may have a lower possibility of being cured. The percentage recovery is dependent on the drugs they are resistant to and also, the amount of lung damage they have before the start of effective treatment.
If tuberculosis is coupled with other diseases such as HIV/AIDS or other serious illness, the resultant outlook is more inclined to worsen.
Deaths and Mortality Rates
- 8 million people worldwide develop active TB
- Out of the 8 million infected with active TB, 3 million die from it
- 18,361 annual cases notified in USA 1998
- 17,531 annual cases notified in USA 1999
- 930 reported deaths in USA 1999
- 5.50 cases of active TB per 100,000 in Canada (2001)
COMPLICATIONS
If not properly monitored, active TB may lead to other complications. Below is a list of some complications patients may experience:
- Pneumothorax [1]
- Pleural effusion [2]
- Intraspinal abscess / granuloma
- Meningitis
- Kidney disease
- Pericarditis
- Lymph node infection
- Hepatomegaly
- Cranial nerve disorder
- Poncet's disease
- Addison's disease
- Death (high death rate of 40-60% if left untreated)
[1] Pneumothorax
[2] Pleural effusion
