Tuberculosis (TB)

Fahrettin Boztepe July 22, 2018

28 9 dakika okuma süresi

One third of the world's population, that is, 2 billion people, are infected with tubercle bacilli.

SITUATION IN TURKEY

In Turkey, 20,000 new cases of tuberculosis occur each year. One fourth of the population of Turkey is infected with tuberculosis, but there is no increase in the numbers. On the contrary, there is a decrease in the number of patients. The prevalence of the disease, which was very common in Turkey in the 1950s and was the leading cause of death in those years, decreased rapidly with intensive studies initiated in 1952. The death rate due to tuberculosis, which was 262 per hundred thousand in 1945, has decreased to 2.5 per hundred thousand today, and the rate of contracting the disease has decreased from 172 per hundred thousand in 1965 to 30 per hundred thousand today.

DOES TUBERCULOSIS HAVE ANOTHER NAME?

In medicine, it is called tuberculosis. Also, when people say that they have a thin disease and there is smoke in their lungs, they usually mean tuberculosis.

WHAT KIND OF DISEASE IS TUBERCULOSIS?

Tuberculosis is a microbial, contagious, chronic disease that mainly settles in the lungs, but can spread throughout the body.

IS TUBERCULOSIS STILL A DISEASE TO BE FEARED?

Despite being one of the oldest known diseases, its cause being known for sure, its treatment being possible for 50 years, and it being a preventable disease, it still remains one of the most common and deadly infectious diseases in the world. More than three million people die from tuberculosis each year.

WHAT IS THE STATUS OF TUBERCULOSIS IN THE WORLD?

One in three people living on Earth has encountered and met the tuberculosis microbe. Currently, three million people die from tuberculosis each year, and 8 million new tuberculosis patients are diagnosed each year. It is especially common in Asia and Africa. In the past, developed European and North American countries never talked about this disease. However, parallel to the AIDS epidemic and the globalization process, the number of tuberculosis patients in these countries has begun to increase.

HOW IS IT TRANSMITTED?

The microbe that causes the disease spreads from a tuberculosis patient to a healthy person. Much less commonly, it can also be transmitted through milk from sick cattle and dairy products made from this milk.

HOW DOES IT TRANSMIT FROM A SICK PERSON TO A HEALTHY PERSON?

Tuberculosis is transmitted through the air. The microbes that are released into the air when a sick person coughs, sneezes, speaks and breathes can remain alive in the air for days. When healthy people who have been in contact with a sick person, that is, who have breathed the same air for a long time in a closed environment, breathe, these microbes in the air reach their lungs and settle there, starting the disease. This is the main form of transmission responsible for the spread of the disease. Apart from this, it can also be transmitted very rarely through the skin and mucous membranes, the birth canal and breast milk, but in practice, such transmissions are insignificant.

DOES EVERY TUBERCULOSIS PATIENT TRANSMIT THE GERMS?

Patients with widespread disease and coughing and having microbes in their sputum are more responsible for the infection. Those with extrapulmonary tuberculosis and those who have been receiving treatment for 15 days are practically not contagious.

DOES EVERY HEALTHY PERSON WHO HAS CONTACT WITH THE PATIENT GET THE DISEASE?

Fortunately, only a small number of people who come into contact with a tuberculosis patient and encounter the microbe or even inhale the microbe develop the disease.

WHY DO SOME PEOPLE WHO GET THE MICROBE DEVELOP THE DISEASE, BUT NOT OTHERS?

This varies from person to person depending on the number of microbes inhaled, their disease-causing power (some microbes are dead or weak and cannot cause disease), the resistance of the healthy person, and the strength of the immune system. People who smoke, drink alcohol, have poor nutrition and poor living conditions, and those with chronic diseases such as other lung diseases, diabetes, some blood diseases, AIDS and kidney diseases are more likely to develop TB.

HOW LONG DOES IT TAKE FOR THE DISEASE TO APPEAR AFTER THE CONTAMINATION OF THE MICROBE?

This period varies greatly. Sometimes a person who has contracted the microbe may develop the disease after 1-2 months, sometimes after a few years, sometimes after decades. Or it may not develop at all.

HOW DOES TUBERCULOSIS MICROBE REACH OTHER ORGANS AND TISSUES?

The microbe's entry point into the body is the lungs in almost all patients. However, from there, it can spread to all tissues and organs in our body through the lymphatic system and blood.

WHICH ORGANS AND TISSUES, OTHER THAN THE LUNGS, ARE MOST INFECTED BY TUBERCULOSIS?

It is frequently found in bones and joints, kidneys and reproductive system, meninges, membranes surrounding the chest and abdominal cavities, skin and lymph nodes.

WHAT ARE THE SYMPTOMS OF TUBERCULOSIS?

The disease does not appear suddenly and loudly. It progresses insidiously and slowly. Patients usually consult a physician with complaints such as fatigue, loss of appetite, weight loss, mild fever, and night sweats that have been ongoing for months. Over time, coughing and expectoration are added to these. Blood may also be present in the sputum. Pain is rarely seen. In extrapulmonary tuberculosis, there may be complaints related to the affected organ. For example, complaints related to urine (red urine, burning during urination, etc.), enlargement of the lymph nodes in the neck, etc.

IS TUBERCULOSIS DIAGNOSIS DEFINITE WHEN THESE SYMPTOMS ARE OBSERVED?

None of these complaints are specific to tuberculosis and can be seen in many other diseases. Therefore, patients with such complaints should be evaluated by a specialist physician and a chest X-ray should be taken and investigated.

HOW IS TUBERCULOSIS DIAGNOSED?

It can be said that a person has tuberculosis only by seeing and growing tuberculosis microbes in body samples (sputum, urine, gastric fasting fluid, cerebrospinal fluid, pleural-peritoneal fluid, lymph node aspiration, etc.). Sometimes, diagnosis can also be made by observing tuberculosis-specific changes in tissue biopsies.

CAN TUBERCULOSIS TREATMENT BE STARTED BASED ON COMPLAINTS AND EXAMINATION FINDINGS WITHOUT INVESTIGATION OF THE MICROBE OR WITHOUT FINDING IT EVEN IF INVESTIGATION IS MADE?

Unfortunately, such treatments are frequently initiated but should not be. However, tuberculosis treatment is a long-term treatment in which many drugs are used, and when the side effects and costs of the drugs are taken into account, there is a high probability that an unnecessarily incorrect tuberculosis treatment will be applied, so such blind (empirical) treatments are not correct. Moreover, wrong treatment also delays the diagnosis and treatment of the actual disease. Tuberculosis often gives similar symptoms to tumors. Accordingly, tumor diagnosis can be delayed and a significant loss of time can occur for the patient. A treatable tumor can be mistaken for tuberculosis and spread throughout the body during blind treatment.

WHAT SHOULD BE DONE IF NECESSARY EXAMINATIONS TO INVESTIGATE THE MICROBE CANNOT BE PERFORMED?

The patient should be referred to the nearest center where such examinations can be performed, or sputum etc. samples taken from the patient should be sent to the relevant laboratories in accordance with the procedure.

WHAT IS THE PURPOSE OF ESTABLISHING TUBERCULOSIS DISPENSARIES?

In our country, the Ministry of Health has developed an organization under the Tuberculosis Control Department to combat tuberculosis. Tuberculosis Control Group Presidencies, inpatient institutions, and dispensaries are available in almost every region, province, and district. Tuberculosis diagnosis, treatment, follow-up, and vaccinations are provided free of charge here. Microbe research is also performed in some dispensaries.

WHAT PURPOSE WAS IT FOUNDED FOR THE FIGHT AGAINST TUBERCULOSIS ASSOCIATIONS?

They provide services to finance the services needed to fight tuberculosis and to provide financial assistance to patients and their families.

IS IT POSSIBLE TO TREAT TUBERCULOSIS?

Elimizdeki tedavi imkanlarıyla uygun şekilde tedavi edilmek koşuluyla artık tüberküloz %100’e yakın tedavi edilebilir bir hastalık haline geldi. Ancak bu pratikte tüberküloz tedavisinde sorun olmadığı anlamına gelmez. Günlük uygulamalarda maalesef bir çok hastanın tedavisi yetersiz kalıp ve hastalık müzminleşmekte. Bunun nedeni de yanlış veya eksik tedaviler.

HOW SHOULD CORRECT TUBERCULOSIS TREATMENT BE?

First of all, the diagnosis should be confirmed by growing the microbe from the patient and drug resistance tests should be performed to show which drugs the microbe is sensitive to and which drugs it is resistant to. Because primary resistance rates to tuberculosis drugs are very high in our country. A treatment should be started by using at least four different drugs at the same time. Treatment that starts with fewer drugs is wrong for our country. The drugs to be used together should be selected according to the patient's age and medical condition. During the treatment, the drugs should definitely be used in appropriate doses and for appropriate periods without interruption or interruption. Today, the shortest tuberculosis treatment must continue for 6 months. There is no tuberculosis treatment shorter than 6 months. However, depending on the patient's condition, this period can be extended by the physician to 9 months, 12 months, or 24 months.

WHAT HAPPENS IF THESE ARE NOT TAKEN INTO CONSIDERATION?

If even one of the principles described above is not heeded, the tuberculosis microbe will eventually become resistant to treatment and after a while, the treatable disease will become incurable. For this reason, the World Health Organization has announced that "treating tuberculosis incorrectly is worse than not treating it at all."

DO WRONG OR INCOMPLETE TREATMENTS NOT PROVIDE RESULTS?

Unfortunately, it does. In other words, after starting such inappropriate treatments, the patient's complaints completely improve within 15-20 days and the patient thinks that they are fine and everything is going well. However, within 3-6 months, the drug resistance develops and the disease returns. In this case, treatment becomes very difficult and sometimes impossible.

WHAT CAN BE DONE IN PATIENTS WITH DRUG RESISTANCE?

The treatment of such patients has become difficult and the probability of successful treatment has decreased considerably. Moreover, since these patients spread drug-resistant microbes to their surroundings, the treatment of new people who contract microbes from them and become ill also becomes difficult. In this way, the treatment and control of tuberculosis in society becomes increasingly difficult. This situation worries the relevant people all over the world, and close monitoring and recommendations are being sent to countries by the World Health Organization and relevant organizations to take the necessary measures to prevent the increase in drug resistance. Despite everything, patients who are drug resistant or whose initial treatments are inadequate must be sent to special centers where such patients can be treated by hospitalization, alternative drugs can be used, and where there are experienced specialists in the treatment of resistant tuberculosis, and they must be treated only there. Treating these patients randomly here and there and using different drugs not only wastes time, but can also make the disease completely incurable.

HOW ARE TUBERCULOSIS DRUGS USED?

Except for streptomycin, other tuberculosis drugs can be taken orally as pills or syrups, all at once every day. If necessary, they can be given in divided doses over two or three meals. It is recommended that the drug called rifampin be taken on an empty stomach.

IS IT POSSIBLE TO TREAT BY TAKING MEDICATION TWO DAYS A WEEK?

In theory yes, but in our country's conditions no. Because in such intermittent treatment regimens, the drugs must be visited by a health care personnel and administered under supervision. Otherwise, as in daily treatment, the drugs cannot be administered to the patient by giving them. Because if a dose is forgotten or skipped, there is a high probability of resistance developing.

WHAT KIND OF SIDE EFFECTS DO TUBERCULOSIS MEDICINES HAVE?

The most important side effect is on the liver. It is more common in people over the age of 35, those who have consumed alcohol, or those with hepatitis or other liver diseases. Negative effects on vision, hearing and balance, and red-green color blindness may occur. It may have harmful effects on the kidneys and digestive system. Allergic reactions may also be observed.

WHAT SHOULD BE DONE IF UNDESIRABLE EFFECTS DUE TO MEDICATIONS OCCUR?

In this case, the patient should not stop the treatment on their own, and should not treat it as unimportant and as if nothing is happening, but should immediately contact their physician and report their problem. Any health problem that occurs in any patient under tuberculosis treatment, whether related to medication or not, should be reported to their physician and investigated in terms of drug side effects. If the complaints are related to medications, first of all, which medication is related to it and the severity of the side effect should be determined and then action should be taken accordingly. In cases of minor problems, the medication should be continued, while in cases of serious reactions, the medication can be paused for a while, or the medication can be completely removed from the treatment.

IS CHECK-UP NECESSARY DURING TREATMENT?

The patient should be called for monthly check-ups to see if the treatment is effective and to avoid overlooking possible side effects of the medication.

IS IT NECESSARY FOR A TUBERCULOSIS PATIENT TO BE FOLLOWED UP AND TREATMENT AT A TUBERCULOSIS DISPENSARY?

A specialist doctor can also treat tuberculosis from the outside. However, in order for the patient to be monitored regularly, to receive their medicines free of charge and to be able to document the tuberculosis problem in our country, they need to be registered with the dispensary. In any case, it is a legal obligation to report a patient diagnosed with tuberculosis.

HOW CAN WE PROTECT OURSELVES FROM TUBERCULOSIS?

First of all, sick people need to be diagnosed and treated. Because they are the source. A patient transmits the disease to an average of 10 healthy people per year. Secondly, the transmission from a sick person to a healthy person needs to be prevented. For this, the patient's living space should be ventilated, the air should be cleaned with negative aspirators, ultraviolet irradiation should be applied, and the patient should be prevented from shedding bacilli by using a mask. The isolation of patients with microbes in their sputum is no longer used much. Thirdly, vaccination should be done to increase the resistance of healthy people. If someone in the house has caught tuberculosis, the household should be screened and preventive treatment should be applied to the necessary people.

WHO SHOULD BE VACCINATED?

Doğumu takiben ikinci ay sonunda ve ilk okula başlayan her çocuğa BCG aşısı denen tüberküloz aşısı yapılması gerekir. Aşı konusunda bazı çevrelerin akıl karıştırıcı yaklaşımları varsa da ülkemizin durumu göz önüne alındığında bu aşının mutlaka yapılması gerekir. Aşı hastalığı %100 önlemese de sıklığını azaltır ve ağır türlerinin ortaya çıkmasını önler.

TO WHOM SHOULD PREVENTIVE MEDICATION TREATMENT BE APPLIED?

Every person who has close contact with a tuberculosis patient who sheds microbes in their sputum should be evaluated by a specialist physician in terms of preventive drug treatment. In addition, patients who have previously contracted the tuberculosis microbe, who have not had active disease, but who have suitable conditions for tuberculosis to reactivate, that is, who have another disease that lowers the body's resistance (AIDS, lymphoma, etc.), or who are receiving another treatment that lowers resistance (using cortisone) may require preventive drug treatment.

HOW IS PREVENTIVE MEDICATION TREATMENT APPLIED?

In this case, the person is not sick. They have only taken the microbe. The treatment is not to cure the disease but to prevent it. Therefore, it is usually applied with a single drug for 6 months. However, depending on the person's condition and the microbe characteristics of the patient they are in contact with, different regimens may be required.

IF A TUBERCULOSIS TEST IS PERFORMED ON A CHILD’S ARM AT SCHOOL AND IT COMES OUT POSITIVE, IS TREATMENT NECESSARY?

The application we call PPD or tuberculin skin test is done to reveal whether or not the tuberculosis microbe has been encountered. It does not show whether or not the disease is present. A positive test shows that the person has previously received the tuberculosis microbe from a patient and that a reaction has occurred in their body against tuberculosis. However, the person in question may or may not have tuberculosis. Therefore, positivity alone does not require treatment.

1. recipe

Nettle, lemon balm, quince leaf, mallow, St. John's wort, sorrel, thyme, sage, sagebrush, licorice root, lemon balm, buckthorn, rosemary, mint and parsley.

All or some of the herbs are mixed in equal amounts and boiled, and consumed on an empty stomach or full stomach.

Drink 1-2 glasses of water plain or with honey on an empty stomach.

2. recipe

Celery, cabbage, carrots, red beets, sugar beets, grapes, quinces, almonds and figs are eaten in abundance.

3. recipe

50 gr. quince seeds

50 gr. coriander

100 gr. nettle seeds

Mix it with 1 kg of honey and drink it with warm milk on an empty stomach for 3 meals.

4. recipe

50 gr. henna henna

100 gr. pollen