How to get your TB diagnosed and treated better

With all the media attention currently on tuberculosis, and with the disease being reasonably simple to understand and treat in the first instance, we thought it appropriate to address certain important issues in tuberculosis

05

Feb

2012

These are issues which a patient and his/her relatives/friends must understand. They are also important issues/questions of public health relevance.

Ask your doctor whether your diagnosis of tuberculosis has been confirmed. The gold standard for the diagnosis of TB is growing the organism in a culture medium, not a chest x-ray or blood report. Chest x-rays and blood tests may help, but never CONFIRM tuberculosis. So too, skin prick tests. If your treatment has been started without confirmation (which can be done in certain situations), let your doctor inform you about this.
Tuberculosis can involve almost any organ of the body, the common one being the lungs. Symptoms are usually a cough which takes time to resolve, low-grade fever and/or weight loss, and sometimes very few symptoms at all. You are potentially most infectious to others when your lungs have TB bacteria, and they are being coughed out in the sputum (phlegm/spit).
Possibly one-third or more of our population is exposed to the TB bacilli, but those with reasonable immunity levels often dont contract disease. Crash-dieting, extreme physical exertion, frequent fasts, skipping meals frequently, unhealthy diets, inadequate sleep, smoking, regular alcohol consumption, diabetes and/or regular steroid tablet use can all compromise immunity, and predispose to development of disease.
Ask your doctor (if he hasn't already suggested in lung TB) whether to send your sputum for testing. There are different tests on sputum for TB. Your doctor will decide which one you need. If you are unable to bring out sputum for testing, your doctor may use nebulised saline to bring it out, or refer you for a procedure called a bronchoscopy.
You are potentially infectious to others around you if your sputum contains TB bacteria. Everyone around you will not get infected. The less the immunity of the surrounding people, and the more you are coughing/talking loudly close to somebody (especially in a poorly-ventilated room), the more likelihood that person could contract tuberculosis.
The drugs used for the treatment of tuberculosis are the same, whichever the organ involved. The doses will vary depending on your body weight. Always ask your doctor whether the drugs have been given according to your body weight. This is one of the common reasons we see patients developing a relapse of TB or resistant TB.
Drugs for TB should ideally be taken at one time of the day, unless you are unable to tolerate it that way, or your doctor (for some reason) has advised otherwise. Do ask him why, if he has. Also, ask him (if he hasn't already done) the common side effects of the regular medication prescribed.
The only reason to change the drug/s is if you are allergic to one or more of them, or you have developed side effects to any of them. If not, the just changing one drug in a regimen is one of the commonest reasons to developing, or promoting resistant TB.
The duration of treatment in tuberculosis of most organs is 6 to 9 months. In brain, spinal and bone tuberculosis, the duration often needs to be extended to 1 year. If your doctor prescribes you less than 6 months, or more than 1 year of treatment (without giving you reasons), please ask him why.
Always ask your doctor whether you are harbouring TB bacteria that respond to the standard medication or not. This question itself will ensure your doctor reassures you (or investigates you appropriately) on the likelihood of you having resistant TB.
Multi-drug resistant TB (MDR-TB) is TB resistant to both Isoniazid and Rifampicin at least. This would be tested on a culture medium after growing the bacteria (ideally at an accredited laboratory).
People at increased risk to develop MDR-TB are those who have relapse of TB, a family history or contact with an MDR-TB patient, are healthcare workers, are immunocompromised, or have extensive disseminated disease.
MDR-TB should only be treated by a respiratory (chest) physician, or a physician experienced in treating this disease. The duration of treatment in MDR-TB is at least 20 months, with durations sometimes lasting to over 2 and a half years, depending on response. At least 120 injections may also often be necessary, but your doctor (specialist) may adjust this according to your response and side effects.
When treating MDR-TB, at least 3 to 4 new drugs should be prescribed. Ask your doctor about this, and be aware. Ask your doctor about common side effects of the new medication, so that you are prepared to face them in advance. Also, ask your doctor about the role of lung surgery . Sometimes, (in appropriate patients) it can be curative for MDR-TB.
If you are pregnant or breast-feeding with tuberculosis, then its usually safe to continue all the anti-TB drugs. If you have MDR-TB, please check with your doctor on the safety of the drugs during pregnancy and breast-feeding.
Never stop/alter treatment on your own. First check with your doctor. Feeling very well is the commonest reason patients prematurely stop the treatment, only to relapse with a more aggressive form of the disease in the future.
Do not go to work with infectious TB (children with infectious TB should not attend school), and do not board a flight or travel in crowded public transport as far as possible. You are potentially infecting many other people. Use a handkerchief or appropriate mask to cover your cough. This is in the interests of your family, close friends/contacts, and public health. Your doctor will tell you so. It may take up to 3 to 6 weeks of treatment (if you are infectious to others) for you to become less infectious, or non-infectious. Be responsible to society.
Remember - tuberculosis in the first instance is a simple disease to diagnose and treat. Mistakes made early on, create MDR-TB. Mistakes made in MDR-TB treatment, create XDR TB, and so on and so on. Be wise early in your disease.