What is your experience of surviving tuberculosis?

tuberculosis

tuberculosis(TBC, Tb, consumption): Chronic infectious disease due to the slow growing but extremely resilient Tuberculosis bacteria (Mycobacterium tuberculosis, TBC bacteria, "tubercle bacteria").

Tuberculosis is the infectious disease with the highest number of fatalities worldwide. She is v. a. Very common in poor countries, a third of the world population is considered infected. According to the WHO, in 2015 there were 10.4 million new cases and 1.8 million deaths from tuberculosis worldwide. In Germany, almost 6,000 tuberculoses were registered in 2016, which corresponds to an incidence of 7.2 new cases per 100,000 inhabitants. In 85% of cases, tuberculosis is confined to the lungs, but it can spread to any organ through spread of bacteria. With consistent antibiotic therapy for at least 6 months, 95% of those affected can be cured.

Leading complaints

Depending on which organ the tuberculosis bacteria have migrated to, there are very different complaints. However, the lungs are most commonly affected.

  • Moderate fever with night sweats
  • Weight loss, weakness
  • Cough, shortness of breath
  • Sputum (possibly slightly bloody).

When to the doctor

The same day if

  • there is bloody sputum.

In the next few days if

  • Cough lasts for more than 3 weeks and develop fever and night sweats.

The illness

Disease emergence

Tuberculosis bacteria are transmitted from person to person through droplet infection when coughing, speaking or sneezing. The bacteria can survive for 1–2 days in a poorly ventilated room, but compared to other diseases, the infectiousness of tuberculosis pathogens is low. Bad social and hygienic conditions play a major role in the spread of tuberculosis. Malnutrition and the close coexistence of many people in a small area favor the spread. The disease therefore almost only affects the homeless and undernourished in this country, people with reduced immune defenses, alcoholics, drug addicts, the elderly and migrants from countries with many tuberculosis sufferers.

On average, an untreated patient with open tuberculosis has close contact with 100 people within a year and infects around ten of them. In which of these 10 people a disease breaks out, depends on the amount of invading bacteria and the immune defense of the infected person. In people with an intact immune system, the white blood cells limit the tuberculosis bacteria with a cell wall; they make one Pulmonary focus (Granuloma). The tuberculosis bacteria that have entered the lymphatic system are also encircled by immune cells in the lymph nodes. The lung focus and lymph nodes together form the tubercular primary complex. This can scar and calcify and remains visible in the X-ray image for life.

In over 90% of cases, the disease ends with the primary complex; the infected person has no complaints.

Open tuberculosis. The tuberculosis bacteria only overcome their "walls" in 5–10% of infected people, multiply and spread through the body via the lymphatic system or the blood. However, the primary complex can also soften and break into the airways. This is how the tuberculosis bacteria get into the exhaled air: it is a open tuberculosisthat scatters into the environment; the sick person is contagious.

Causes and Risk Factors

Bad social and hygienic conditions play a major role in the spread of tuberculosis. Malnutrition and the close coexistence of many people in a small area favor the spread. The disease therefore almost only affects the homeless and undernourished in this country, people with reduced immune defenses, alcoholics, drug addicts, the elderly and migrants from countries with many tuberculosis sufferers.

clinic

The symptoms are uncharacteristic:

  • to cough
  • Pronounced tendency to perspire
  • V. a. Temperatures up to 38 ° C at night
  • Weakness, constant fatigue, low resilience
  • Sputum with blood deposits.

Sometimes loss of appetite and nausea lead to massive weight loss, hence the German name "consumption".

course

The symptoms of the disease appear either immediately after the initial infection (progressive primary tuberculosis) or many years later. Tuberculosis bacteria can survive in the lung for decades and become active again if the immune system of those affected is weakened, e.g. B. by a chronic general illness, a tumor or an immunosuppressive therapy (e.g. with cortisone).

The spread of tuberculosis bacteria in the blood can affect many organs:

  • The meninges in the Tubercular meningitis (tuberculous meningitis): It typically occurs within the first 3 months after the initial infection. Fever, loss of appetite, headache, and impaired consciousness are possible complaints.
  • Lungs, brain, liver, spleen, kidneys and adrenal glands in the Miliary tuberculosis. Small to millet-sized (milium = millet-grain) herds form in these organs.
  • The urinary and genital organs in the Urogenital tuberculosis, which can occur decades after a primary infection: Tuberculous nodules along the mucous membrane and in the kidney tissue lead to narrowing of the ureter, shrinkage of the bladder and changes in the calyxes and ultimately to destruction of the kidney.

Diagnostic assurance

Pneumonia that does not cure, unexplained fever, cough that has persisted for weeks, a corresponding history of the patient (contact with infected people, stay in countries with high numbers of infections) suggest the suspicion of tuberculosis. The doctor will clarify whether the patient has previously had tuberculosis, which may now flare up again. He also asks about cases of tuberculosis in the family or among friends.

X-rays of the lungs are the most reliable way to detect tuberculosis. The doctor looks primarily for small and very small tuberculosis herds. The picture shows the lungs of a patient with open tuberculosis. In the left upper lobe of the lung there is a tangerine-sized area. This focus, which is dark in the X-ray image, corresponds to a cave called a cavern. In it the tuberculosis bacteria multiply largely unmolested by the immune system; they are also difficult to reach there with medication.
Georg Thieme Verlag, Stuttgart

In adults and children from 6 years of age, the immunological Interferon gamma test (IGRA = Interferon-Gamma-Release Assay) recommended. This test is carried out using a blood sample in the laboratory. If the patient's immune system has had contact with tuberculosis bacteria, his immune cells in the blood sample release interferon gamma after the addition of tuberculosis antigens. Compared to the previously used Mendel-Mantoux tuberculin skin test (Tuberculin test), the interferon gamma test is more reliable and is also independent of a previous tuberculosis vaccination (BCG vaccination). However, due to the still inadequate data situation, the tuberculin test is still used initially in small children.

The final pathogen detection is made from sputum or bronchial secretions, or, depending on the organ involvement, e.g. B. also from gastric juice or urine. The fast one microscopic evidence of the tuberculosis bacteria as so-called acid-fast rods has a bacterial count of 103-104 Germs / ml possible. The cultural cultivation on the other hand, takes at least 2 weeks even on special media.

treatment

In the case of miliary tuberculosis, it is important to start therapy as soon as possible.

Pharmacotherapy

Every active tuberculosis must consistently with it for months Tuberculostatics be treated. These are antibiotics that are especially effective against tuberculosis bacteria. So-called first-line or standard drugs are available for the treatment of tuberculosis. These are isoniazid, rifampicin, pyrazinamide, ethambutol. Based on the resistance situation known in Germany, an initial quadruple therapy with isoniazid, rifampicin, pyrazinamide and ethambutol is recommended, which usually lasts 2 months. So far, patients have received the 4 active ingredients individually as tablets. There is now a tablet that combines all 4 active ingredients and works just as well. If sensitivity to the first-line medication can be demonstrated, ethambutol can be dispensed with in individual cases during the further course of the two-month initial phase. In the subsequent stabilization phase, isoniazid and rifampicin are used until the end of the 6-month total therapy period.

Therapy for resistance. If standard therapy does not work, resistance can be assumed. An attempt is made to cultivate pathogens isolated from sputum or a tissue sample and to check which reserve drugs they are sensitive to. These so-called "secondary drugs" are injectable aminoglycosides such as streptomycin (downgraded by the WHO from primary to secondary drug) or amikacin, fluoroquinolones such as ofloxacin, thioamides such as protionamide, serine derivatives such as cycloserine and para-aminosalicylic acid. Most of these medications have to be taken in a combination of 5–6 preparations, and this for up to 2 years.

Therapy of various forms of tuberculosis

  • Pulmonary tuberculosis: Standard therapy in adults is 2-month initial therapy with isoniazid, rifampicin, pyrazinamide and ethambutol, followed by 4-month continuity therapy with isoniazid and rifampicin.
  • Urogenital and abdominal tuberculosis: If a clinically clear therapeutic success can be demonstrated, a 6-month standard therapy is sufficient.
  • Bone and joint tuberculosis: The concentrations reached in the bone and articular cartilage of isoniazid, rifampicin and pyrazinamide are high enough to allow the patient to be treated with standard 6 months of therapy.
  • Central nervous system tuberculosis: The penetration behavior of the drugs through the blood-brain barrier is important here. While isoniazid, pyrazinamide and protionamide always show a sufficiently good penetration rate, this is not the case with rifampicin. Ethambutol and streptomycin only penetrate the blood-brain barrier in sufficient quantities if the meninges are inflamed and are therefore only effective at the start of therapy. In Germany, the standard therapy is treatment with isoniazid, rifampicin, pyrazinamide and streptomycin for 2 months, followed by 10 months only with isoniazid and rifampicin. If the brain is also affected, a cortisone such as z. B. Prednisolone used.
  • MDR and XDR tuberculosis: Are tuberculosis bacteria insensitive, i. H. resistant to the standard therapeutic agents isoniazid and rifampicin, one speaks of MDR tuberculosis (MDR = Multi Drug Resistance). If no medication from the fluoroquinolone group and at least one from the aminoglycoside group does not work, an infection with extreme resistance to therapy is present with XDR tuberculosis (XDR = Extreme Drug Resistance). For the treatment of these resistant forms of tuberculosis see above under "Therapy for resistance".

Controls. Since side effects from tuberculostatics are common, the blood count as well as liver and kidney values ​​must be checked regularly every 2 to 4 weeks. When taking ethambutol, an ophthalmological check-up is recommended, and for streptomycin, an ear check-up is recommended. The doctor can prescribe a vitamin B supplement to improve tolerability. The pathogen excretion is also checked regularly. If there are 3 negative sputum samples, a patient with formerly overt tuberculosis is allowed to go public again. X-ray controls are initially carried out every 4 and then every 8 weeks.

Note: If the patient needs anticoagulant therapy in addition to treating his tuberculosis infection, the doctor must monitor this closely: Tuberculostatics change the effectiveness of anticoagulants and many other drugs. They can also weaken the contraceptive effect of the pill.

forecast

Uncomplicated tuberculosis can be cured with adequate drug treatment. The earlier the diagnosis is made and therapy is started, the better the chances of recovery. However, the chances of success are poorer in patients with pathogens that show complicated resistance patterns.

Hygiene, prevention and early detection

General control of tuberculosis. The fight against tuberculosis in Germany rests on 3 pillars:

  • Recognize sick people, d. H. search for infected people among contact persons of sick people and in risk groups such as the homeless, migrants from countries with a high incidence of tuberculosis or drug users
  • Isolate infectious people
  • Treat effectively early on.

Hygiene in the hospital. In the clinic, infectious patients are usually accommodated in a single room with good ventilation and a separate wet room. The patient should not cough at anyone, hold a paper towel over his mouth and nose when coughing and dispose of this in special containers. When visiting or leaving the room for diagnostic or therapeutic measures, the patient must wear a face mask. Visitors and staff wear respirators.

Hygiene in the home environment. The doctor, health department and patient decide together whether a tuberculosis patient who is considered to be infectious may be treated at home. To do this, the patient must be cooperative and ensure that the medication is reliably taken. In the infectious stage, the patient must not be allowed to use public spaces such as B. go to a supermarket or events. He needs his own, well ventilated bedroom; a separate toilet is not necessary even with urogenital tuberculosis. Cough hygiene and nasal and mouth masks are to be observed as in the hospital, infectious sputum may be disposed of via the toilet. The risk of infection from potentially contaminated surfaces is estimated to be very low. In very rare cases, a disinfectant wipe disinfection may be necessary. Immunosuppressed and children under 5 years of age should not live in the same household. Otherwise, the same rules apply to contact persons during the infectious stage as in the hospital.

Duration of isolation. The duration of isolation of an infectious patient is an individual decision made by the attending physician. Primarily, the microscopically detectable decrease in pathogen excretion in the sputum (3 negative samples, if initially positive) is used. In addition, the clinical and radiological response to the therapy are relevant. As a rule, the duration of the necessary isolation under adequate therapy is around 3 weeks. In order to participate in public life such as attending school or community facilities, the sick person needs a written certificate from the doctor.

Vaccinations. The so-called BCG vaccination is available as an active protective vaccination against tuberculosis. However, its effect is considered uncertain, which is why the Standing Vaccination Commission (STIKO) no longer recommends it. New inhalative vaccinations are currently in clinical development.

Chemoprophylaxis. The aim of chemoprophylaxis after contact with infectious tuberculosis patients is both to prevent a possible infection and to effectively treat an infection that has not yet been detected. This is v. a. recommended for immunocompromised people. If the interferon gamma test is negative, prophylaxis with isoniazid is carried out for 8 weeks. Then it is tested again. If the test remains negative and the person is symptom-free, isoniazid therapy is ended. If the test result is positive, the therapy is continued as preventive chemotherapy for 9 months.

Reporting requirement. Illness and death from tuberculosis requiring treatment must be reported, as are people suffering from tuberculosis who refuse or discontinue treatment.

Your pharmacy recommends

What you and your loved ones can do

Therapy adherence.

In order to fight the disease as safely as possible, you will be treated with several drugs at the same time. It is imperative that you take all medication regularly, even if you are feeling better again. If you don't fight the disease properly, resistance will develop: in such cases, the bacteria learn to survive despite the pills, and the drugs lose their effectiveness.

Hygiene.

Strictly observe all hygiene rules, this also applies in particular to relatives and contact persons. If you are being treated at home, make sure you have adequate nasal and mouth masks and respirators.

Refraining from alcohol and nicotine.

Alcohol and nicotine promote the disease. Try that To reduce smoking and alcohol consumption to a minimum and adjust if possible.

See a doctor early.

Pay attention to family members, friends and other contacts. If they experience a cough, fever, night sweats, or other symptoms of a possible tuberculosis infection, encourage them to see a doctor.

Contraception.

Tuberculostatics change the effectiveness of the pill.Use other contraceptives to ensure safe contraception.

Note: Tuberculostatics can turn urine and other body fluids orange.

Further information

  • www.kbv.de - Information for patients on tuberculosis in 6 languages ​​is provided by the National Association of Statutory Health Insurance Physicians (KBV)
  • www.aerzte-ohne-grenzen.de - The online presence of the organization "Doctors Without Borders" provides useful information with a view to the global significance of tuberculosis. Enter "tuberculosis" in the search.

Authors

Kristine Raether-Buscham; Dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update of the introduction and the sections "Symptoms and key complaints", "When to see a doctor", "The disease", "Confirmation of diagnosis", "Treatment", "Prognosis", "Prevention and early detection", "Your pharmacy recommends", " Further information ": Dr. med. Sonja Kempinski | last changed on at 16:46


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.