Tuberculosis (TB) is a disease caused by infection with the bacterium Mycobacterium tuberculosis and is transmitted from one person to another through the air. Although it can affect other organs in the body, TB generally affects the lungs (which are usually the main sites for bacterial growth). In the latent phase, the bacteria will live dormantly without any signs or symptoms, while in the active phase, signs and symptoms of TB will appear. Most TB infections are latent. However, if left untreated or not properly treated, TB causes death, so you should be able to recognize the signs of pulmonary TB.
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Part 1 of 3: Knowing the Risk Factors
Step 1. Be aware of the areas that make you susceptible to TB
You are at risk if you live or have traveled to the areas below, or even come into contact with people with TB. In many parts of the world, TB prevention, diagnosis and treatment is difficult due to health care policies, limited funds/facilities, or overpopulation. This causes TB to go undetected and untreated, so that its spread is widespread. Traveling by airplane to or from these areas is also at risk of transmitting TB due to blocked airways.
- Sub-Saharan Africa
- India
- China
- Russia
- Pakistan
- southeast Asia
- South America
Step 2. Check the conditions of your working and living environment
A room that is too crowded with airflow that is not smooth allows bacteria to easily spread from one person to another. This already dire situation can be exacerbated if the occupants have a worrying history or medical examination results. The environment that must be considered include:
- Jail
- Immigration office
- Nursing home
- Hospital/health center
- refugee shelter
- Halfway house
Step 3. Consider your own resistance
Health problems that cause a decrease in the body's immune system make you more at risk. You are susceptible to all kinds of infections, including TB if your immune system is unable to function normally. The causative conditions include:
- HIV/AIDS
- Diabetes
- End stage kidney disease
- Cancer
- Malnutrition
- Age (the baby's immune system is not yet perfect, while the elderly's immune system is no longer functioning optimally)
Step 4. Consider taking medications that affect immune system function
Drug abuse, including alcohol, cigarettes, and injectable drugs can lower the immune system. Meanwhile, some types of cancer and their chemotherapy treatments put you at higher risk for TB. Long-term use of steroids, including drugs that aim to prevent rejection of transplanted organs can also affect the immune system. Likewise, drugs used to treat autoimmune diseases such as rheumatoid arthritis, lupus, inflammatory bowel disease (Crohn's disease and ulcerative colitis), and psoriasis.
Part 2 of 3: Recognizing the Signs and Symptoms of Pulmonary TB
Step 1. Watch for an unusual cough
TB usually infects the lungs and destroys the tissues. The body's natural response is to expel these annoying bacteria through coughing. Pay attention to the length of time you cough. Cough due to TB usually lasts more than 3 weeks and may be accompanied by worrisome signs such as bloody sputum.
Consider how long you've been taking cold medicine or antibiotics for a respiratory infection, but it's not getting better. TB requires special antibacterial drugs, and you'll need to be tested beforehand to confirm the diagnosis
Step 2. Pay attention to the phlegm that comes out when coughing
Is there sticky phlegm that comes out when you cough? If the phlegm that comes out smells and is dark in color, the cause could be any bacterial infection. If the color is clear and odorless, the cause is likely a viral infection. Watch for any blood left on your hands or handkerchief to cover your mouth after coughing. When TB nodules and cavities form, the surrounding blood vessels are destroyed and cause hemoptysis (coughing up blood).
You should always seek professional medical attention if you are coughing up blood. The doctor will give advice on the next steps
Step 3. Watch for chest pain
Chest pain can signal a variety of health problems, but may indicate TB if it is accompanied by other symptoms. If you feel a stabbing pain in a certain area, pay attention to whether it hurts when you press it, or when you inhale and exhale, or when you cough.
TB forms hard cavities and nodules in the lung/chest wall. When we breathe, this hard mass can damage the part and trigger inflammation. The pain that is felt is generally sharp in certain parts, and feels back when pressed
Step 4. Watch for involuntary loss of weight and appetite
The body will provide a complex response to infection with Mycobacterium tuberculosis bacteria. This response results in poor nutrient absorption and impaired protein metabolism. These changes can go on for months without you noticing.
- Look in the mirror and notice the changes in your body. If the bone skeleton is visible, it means that there is not enough muscle mass in your body due to a lack of protein and fat.
- Weigh your weight. Compare with previous weight measurements taken when you feel well. Your weight may fluctuate frequently, but you should discuss drastic changes with your doctor.
- Notice if your clothes feel loose.
- Watch your eating frequency and compare it to when you feel healthy.
Step 5. Don't ignore fever, chills, and night sweats
Bacteria usually reproduce at normal body temperature (37 degrees C). To prevent this, the brain and immune system respond by increasing body temperature. The rest of the body detects this change, and then tries to adjust to the increased temperature through muscle contractions (shivering), which makes you feel cold. TB also causes the production of a special protein that triggers fever.
Step 6. Watch for latent TB infection
Latent TB infection is dormant and non-infectious. Bacteria only live in the body and do not cause problems. Bacteria will reactivate if the immune system weakens as a result of the problems described above. Bacteria can also be reactivated due to aging and a weakened immune system. However, the bacteria may also reactivate due to other unknown reasons.
Step 7. Differentiate TB from other respiratory infections
Many other health problems resemble TB. Don't let an illness that you think is harmless is actually serious. To differentiate TB from other diseases, consider the following:
- Is there any snot coming out of the nose? The flu will cause nasal congestion or inflammation of the nose and lungs which results in mucus discharge. However, TB is not accompanied by these symptoms.
- What does phlegm look like when you cough? Viral infections and flu tend to cause a dry cough or white phlegm. Bacterial infections of the lower respiratory tract will produce brown phlegm. While TB, usually will cause a cough for more than 3 weeks accompanied by bloody sputum.
- Are you sneezing? TB does not cause sneezing. These symptoms usually accompany the flu.
- Do you have a fever? TB can cause low or high fever, but people with the flu generally have a fever of more than 38 degrees C.
- Do your eyes appear watery or itchy? These symptoms generally accompany the flu, but do not accompany TB.
- Are you having a headache? The flu is usually accompanied by a headache.
- Do you have joint pain or body aches? Flu and colds can cause these symptoms.
- Does your throat hurt? Pay attention to the inside of your throat, is it red, looks swollen, and hurts when you swallow? These symptoms generally accompany a cold, but can also accompany the flu.
Part 3 of 3: Undergoing a TB Screening
Step 1. Know when to see a doctor
Certain signs and symptoms must be treated immediately. Even after testing you don't have TB, these symptoms may indicate another serious illness. Chest pain can be caused by a variety of conditions, both harmful and not. However, you should always tell your doctor about these symptoms and have an EKG done, because:
- may signal malnutrition or cancer if accompanied by weight loss.
- may indicate lung cancer if accompanied by coughing up blood and weight loss.
- High fever and chills can also be caused by a blood infection or sepsis, although they usually also cause a drop in blood pressure, dizziness, delirium, and an increased heart rate. If left untreated, this disease can lead to death, or organ failure.
- the doctor will prescribe intravenous antibiotics and ask for blood tests to determine the number of white blood cells (blood cells that fight infection).
Step 2. Schedule screening for latent TB infection if necessary
Even if you are not suspected of having TB, you may still be asked to undergo a latent TB test. Health workers must undergo this examination every year. You should also be checked after traveling or returning from a high-risk country, having a weakened immune system, or working/living in a crowded room with poor airflow. You only need to schedule a TB examination with a general practitioner.
Latent TB infection will not cause any symptoms of the disease and cannot be transmitted to other people. However, this latent infection will eventually become active in 5-10% of sufferers
Step 3. Request a purified protein derivative (PPD) test
This test is also known as the tuberculin skin test (TST) or the Mantoux test. The doctor will clean the surface of the skin with cotton and water, then inject the PPD near the surface of the skin. Small bumps will appear as a result of the injection. Do not cover the raised bump with a bandage as this can change its shape. So, just allow the liquid to be completely absorbed for a few hours.
- If your body has antibodies against TB, the part that is injected with PPD will thicken or swell (form an induration).
- Note that what is measured in this test is not redness of the skin, but the size of induration. After 48-72 hours, return to the clinic and let the doctor measure the induration formed.
Step 4. Understand how to interpret the results of the examination
There is a maximum induration measure that indicates a negative result. Induration exceeding this size indicates the patient has TB. If you do not have TB risk factors, a maximum induration size of 15 mm is still considered a negative result. However, if there are risk factors as described previously, the maximum negative induration size is 10 mm. If you experience any of these conditions, the maximum negative induration size is 5 mm:
- Using immune system-suppressing drugs such as chemotherapy
- Long term use of steroids
- HIV infected
- Close contact with TB patients
- Is an organ transplant patient
- Shows fibrotic changes on chest X-ray
Step 5. Request an IGRA examination in lieu of PPD
IGRA is an interferon gamma release assay, which is more accurate and faster than PPD. However, the costs required are more expensive. If your doctor recommends this test, a sample of your blood will be taken and examined in a laboratory. The results should be available within 24 hours, and follow-up examinations may be required afterward. A positive result for TB is characterized by high levels of interferon (determined by comparison with the normal range in the laboratory).
Step 6. Follow up on the results of the inspection
Positive results on skin and blood examinations at least indicate the presence of latent TB infection. To determine if you have active TB, your doctor will need a chest X-ray. Patients with normal radiographs will be diagnosed with latent TB, and given preventive care. Abnormal radiographs accompanied by positive results on blood or skin tests indicate active TB.
- The doctor will also ask for a sputum culture. A negative result indicates latent TB, while a positive result indicates active TB.
- Note that sputum may be difficult to collect from infants and children, and the diagnosis of TB is made without examination of sputum in children.
Step 7. Follow your doctor's advice once you are diagnosed
If the X-ray and sputum culture confirm active TB, the doctor will prescribe several medications to treat it. However, if the X-ray results are negative, the patient is considered to have latent TB. Follow your doctor's advice carefully to prevent latent TB from developing into active TB. TB is a dangerous infection and its treatment is monitored by a drug monitor, who will make sure the patient takes every dose of the drug.
Step 8. Consider getting the Bacillus Calmette–Guérin (BCG) vaccination
The BCG vaccine can reduce the risk of infection, but that doesn't mean it's completely eliminated. BCG vaccination can give false positive results on PPD, so people who have been vaccinated with BCG should be tested with an IGRA test.
The BCG vaccine is not recommended in the US, due to the low incidence of TB there and it can interfere with the results of the PPD test. However, in other areas such as developing countries, this vaccine is widely used
Tips
- Miliary TB has the same symptoms as pulmonary TB, but is accompanied by specific signs and symptoms in certain organs.
- Not everyone infected with TB will appear sick. Some people have latent TB, which, even if it is not contagious, can cause disease if the immune system is weakened. You may have latent TB that does not progress to being active for life.
- TB is spread through coughing and sneezing.
- TB may recur, and the CDC (US center for disease control) has changed guidelines for who should receive treatment. The upper age limit for patients to be treated with isoniazid, which previously was 34 years, has been changed. All those who test positive will be prescribed this drug as a precaution both for themselves and for others. For the health of you and those around you, use the medicine as prescribed.
- The BCG (bacille calmette-guerin) vaccine can give false positive results on PPD. This false positive result must be confirmed by X-ray examination.
- While this is debatable, you need to be aware that people with latent TB who have been on treatment may still test positive for TB. The results of this examination should be discussed further and reaffirmed by the doctor.
- Patients with Miliary TB should be examined further, including through MRI scans and biopsies of suspected infected organs.
- The IGRA test is recommended for people who have been vaccinated against BCG and get a false positive result on the PPD examination. However, doctors may still opt for the PPD test because of its cost and availability.
- PPD is more recommended for children under 5 years of age than IGRA due to the lack of supporting research evidence.
