Tuberculosis

Overview

Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis.
Not everyone exposed to you will be infected, as their immune systems may be able to fight the bacteria.

Among those who do get infected, most will feel well because the body's defences are able to build a wall around the bacteria, preventing them from causing diseases.

This is the latent stage of TB. At this stage:

TB bacteria is asleep (dormant) in the body.
These persons will not feel unwell.
TB bacteria will not be passed to others.
The bacteria is still alive and can become active later, especially in diabetics, persons with weakened immunity or kidney failure and smokers. Medication is available to kill the bacteria before they become active.

Some people may also already have the active form of TB at the time of screening. These patients need to start on TB medication immediately.

In the active stage of TB:

TB bacteria is active and multiply quickly
These persons may exhibit TB symptoms (cough, loss of appetite and weight, fever, night sweats)
TB bacteria can be spread to others in close contact with these persons.

Causes

TB bacteria is spread in the air when you cough, sneeze or talk. Anyone in recent close contact with you before you were started on TB medication can be infected with TB bacteria. TB is not spread through sharing of utensils, food or towels.

The best way you can help to minimise the spread of TB is by being adherent to your TB treatment under Directly Observed Therapy. This decreases the amount of TB bacteria in your body so that less bacteria is present to spread disease.

Signs & Symptoms

Pulmonary TB: Common symptoms are prolonged cough (> 3 weeks), chest pain and haemoptysis. Patients with miliary TB may have minimal respiratory symptoms and present with systemic complaints.
Extrapulmonary TB: Lymphadenitis (especially cervical), pleural effusion, osteomyelitis, meningitis or gastrointestinal involvement.
Patients often have associated fever, night sweats, loss of appetite, loss of weight and fatigue.
Risk factors for HIV and examination for physical signs of HIV (e.g. oral candidiasis) should be sought.

Prevention

In an endemic area, BCG vaccination at birth helps to reduce the incidence of miliary TB and TB meningitis in childhood.

Detection & Treatment

Investigations

Chest X-Ray. All persons with chest X-ray findings suggestive of TB should have sputum specimens submitted for microbiological examination.
Acid fast bacilli (AFB) smear and TB culture of sputum and other pathological specimens such as pleural fluid, CSF, urine and pus. All patients suspected of having pulmonary TB should have at least two, preferably three, sputum specimens obtained for microscopic examination and TB culture (with drug susceptibility testing), with at least one early morning specimen where possible.
Nucleic acid amplification tests (NAATs) do not obviate the need for TB culture as these tests do not provide information on the drug susceptibility pattern of the organism. The NAATs are not sufficiently sensitive for a negative result to exclude TB in smear-negative sputum samples
HIV testing should be performed for all patients.
Screening for diabetes mellitus is strongly recommended.

Treatment

Initial drug therapy for new cases should consist of 4 first-line drugs: isoniazid (INH), rifampicin, pyrazinamide and ethambutol or streptomycin. Initiating treatment using a quinolone as a first-line drug is not a standard practice. In uncomplicated, drug-susceptible TB cases, 6 months of drug therapy is sufficient. Monotherapy should never be given as this will generate drug- resistant TB. A single drug should never be added to a failing regimen.
Directly observed therapy (DOT) is recommended for all TB patients, as it allows for closer monitoring, thus ensuring adherence to treatment, preventing the development of drug resistance. DOT is available at the National Tuberculosis Care Centre (NTBCC) and polyclinics.

Care Management

Do I Need to Complete the Full Course of Tuberculosis Treatment?

It is very important to complete the full course of TB treatment as prescribed.
Although you will start to feel better after the first few weeks of treatment, TB bacteria would still exist in your body at this time.
To completely recover from TB, you must complete the full course of medications, even when you no longer experience any symptoms.

What Else Should I Note When Undergoing Tuberculosis Treatment?

Undergoing Directly Observed Therapy (DOT), during which you would need to take your TB medications under supervision at the polyclinic, is the best way to ensure a full recovery from TB.
If you take your medicines as prescribed, you will no longer be infectious after a few weeks and will not spread TB to your family and friends.
TB cannot be spread by sharing cups and utensils, so you can still have meals with your family during your treatment.
You can continue to work while you are on treatment.

If you need more information, talk to your family doctor or contact the National Tuberculosis Care Centre (NTBCC).

Additional Resources

TTSH_Treating_Tuberculosis_Chi.pdf TTSH_Treating_Tuberculosis_Eng.pdf TTSH_Treating_Tuberculosis_Mal.pdf TTSH_Treating_Tuberculosis_Tam.pdf

Specialties & Services

Infectious Diseases

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