Tuberculosis (TB)

TB has an active (contagious) and an inactive form (not contagious). TB often becomes active
when the immune system is weakened by another disease, malnutrition, or HIV. Currently, TB is
the leading cause of death for HIV-positive people.
As part of the bodys defence, cells release hormone like compounds which cause fever and
suppress the appetite.
Transmission:
- An infected person coughs or sneezes, releasing tiny droplets of liquid which are carried in
the air.
- TB spreads rapidly in overcrowded conditions, places with substandard housing, among
population with low immunity.
- M. bovis occurs in cattle and can be transmitted to humans through contaminated meat and
milk.

Recently there has been an increase in the prevalence of TB because of drug resistant strains,
the HIV/AIDS pandemic, poor housing in inner cities and homelessness, and breakdown of TB
control programmes.
Treatment:
- In the 1940s the antibiotic, streptomycin, was used to treat it.
- Now, once TB is diagnosed the person is isolated for the most infectious stage (2-4 weeks)
- If the person has a drug-resistant form for TB they have to use several drugs to insure that the
bacteria will all die.
- Treatment is long (6-9 months) because the bacteria are slow frowning and not very sensitive
to the drugs (rifampicin and isoniazid).
- The WHO promotes a scheme called DOTS (direct observation treatment, short course) to
ensure that patients complete their course of drugs. This involves health workers or family
members monitoring the patient and making sure they take their medication for 6-8 months.
Drug resistance:
- Antibiotics act as selective killing agents which kill the susceptible bacteria, leaving behind the
resistant ones.
- The more drugs are used, the less likely it is that a bacterium resistant to all the used
antibiotics will form and survive.
- If the treatment is stopped too early, not regularly (no constant concentration of drug in
system), or not taken the bacteria will spread throughout the body and increase the risk of a
drug resistant strain forming and being transmitted to others ( 10-15 infected per carrier)
- Multiple-drug-resistant (MDR) tuberculosis is resistant to at lease two of the first-line drugs
used to treat TB (isoniazid and rifampicin).

- Extensively-drug-resistant (XDR) TB is resistant to the first-line drugs and the drugs used to
treat MDR-TB.
- Drug resistant forms of TB must be treated with other less potent drugs and treatment can last
more than two years.
Prevention

- Contact tracing is important, although it can take up to two weeks for diagnosis.
- The BCG vaccine, derived from M. bovis is 70-80% efficient.