A general practitioner at the Federal Medical Centre, Ebute Metta, Lagos, Dr Bilikisu Odusanya, speaks on the causes and management of tuberculosis in this interview with GODFREY GEORGE
How best can we define tuberculosis?
Tuberculosis is a chronic disease (i.e. duration of disease usually long) that affects different organs of the body but primarily the lungs, resulting from infection by Mycobacterium tuberculosis, Mycobacterium bovis, the proliferation of these organisms in the body, and the body immune response. It is an airborne disease, transmitted as aerosols through the respiratory tract.
When one contracts the infection, what parts of the body are most affected and why?
Tuberculosis, primarily, affects the lungs; however, it can spread through blood or lymphatics to other organs of the body. It can cause TB Meningitis. This means it can affect the meninges (the brain covering). It can also present as abdominal TB, Tuberculosis salpingitis (fallopian tube) in which the patient may be infertile. Patients may also present with back pain (non-responsive to pain relievers), lymphatics (scrofula) seen as neck swelling. I would also like to add that tuberculosis is not a death sentence, although some forms of TB may be life-threatening, it is important the individual starts treatment immediately after diagnosis.
In what ways can a person contract the infection?
It is transmitted by breathing in the air that contains the droplet nuclei of M. tuberculosis of the person that has the active TB (i.e. the individual has the organism in their body and the organism is proliferating) and this can be done through coughing, sneezing, singing and speaking. You cannot contract TB by sharing toiletries, handshakes or sharing the same glasses with an infected person. This droplet – M. bovis – is usually transmitted by ingesting contaminated cattle products, like fura da nono.
How close should one get to a tuberculosis patient?
It is not advisable to stay around someone who has active pulmonary tuberculosis, as this individual can easily spread the organism through speaking, coughing (most common), sneezing, especially, if you are immune-compromised (i.e. have low immunity). However, if it is unavoidable to come in contact with an individual with the disease, both the diseased and the individual must put on a face mask appropriately.
What are the types of tuberculosis and how do they present themselves in their hosts?
There is pulmonary TB. This is the most contagious type. It affects the lungs of the host. The patient would present with cough, weight loss, hemoptysis (coughing of blood), drenching night sweat, amongst others. There is meningeal TB. In this type, the affected individual may present with features of meningitis, such as headache, fever, neck pain, neck stiffness, skin rashes and others. We also have abdominal TB. Here, it affects the peritoneum (the lining of the abdominal cavity), the intestine, abdominal lymph nodes, and hardly, the liver, spleen or pancreas. Patients may present with abdominal swelling, loss of weight, pain in the abdomen, cough, etc. We also have what we call spinal TB. This can be life-threatening, and if not discovered in time, it may cause paralysis which may take years to be cured. Patients here present with lower back pain, stiffness, spasm of muscle, gibbus, and others. There is also TB of the salpinx. This may present with infertility scrofula. This is when there is inflammation of the lymph nodes, especially the cervical lymph nodes.
How do the symptoms start?
Tuberculosis usually starts with a chronic cough (usually more than three weeks), weight loss, drenching night sweat, haemotypsis (coughing blood) and a difficult breathing.
What signs should one look out for to suspect one may have TB?
The signs to look out for depend on the part of the body affected. It is also noteworthy that someone may have TB without coughing.
Are there stages to the condition?
Yes, there are three stages of tuberculosis. We have Stage One called the Infective Stage. Here, one is exposed to the organism which now resides in their body. In Stage Two, known as Active Stage, the organism multiplies in the host. In Stage Three, called the Reactivation, the individual’s immunity is compromised (i.e. .the ability to fight infection is attacked). The TB in the body is then reactivated. In the infective stage, the patient is asymptomatic. In the active stage, the individual may have cough, weight loss, anorexia (loss of appetite) and easy fatigability.
Is TB curable at any of these stages?
Yes, TB can be cured in all stages of the disease.
Is it possible to have the lungs recover completely after TB is cured?
Yes, it is possible. Most patients do recover fully. But it is always good to present to the medical facility on time.
What is the diagnosis like when someone with TB presents at the hospital?
When the individual presents at a clinic, they are required by the health professional to come along with their first sputum which is collected in a sterile bottle provided at the hospital. This may not be the same in children. In children, a gastric lavage (i.e taking sputum directly from the stomach) is usually done as they tend to swallow their sputum. A gene expert or culture test is then carried out on the sputum sample collected. After that, a chest x-ray may be requested and fibrotic lesions are seen on x-ray. This is usually obvious at the upper lobe of the lungs as the organism is an aerobic organism and would proliferate in an aerated environment. When these are done, the health care professional goes on to do a mantoux test – this is a purified protein derivative given intra-dermally and a reaction is expected. The result is determined based on the size of the reaction.
Can one use local herbs to manage the condition?
As a doctor, we do not advise anyone to treat any ailment using local herbs when they can simply just walk into any facility and get help. Like most other diseases, tuberculosis cannot be managed with local herbs, and should never be managed with herbs as this may cause further deterioration of the disease.
How do we differentiate TB from whooping cough or any other cough?
The cough in TB is usually chronic (i.e. has a very long duration), associated with weight loss, night sweats, however, whooping cough is not chronic and associated with post-tussive vomiting.
What are the risk factors for contracting the condition?
Generally, factors that predispose an individual to TB are those that suppresses the immunity, this include diabetes mellitus, HIV/AIDS, radiotherapy, chemotherapy for people on cancer treatment, poor nutrition, cancer, etc.
Is it hereditary?
There is no known proof to say tuberculosis is hereditary, as it cannot be transmitted from generation to generation. However, more studies are ongoing.
What is the prognosis like?
The prognosis depends on the timing of treatment, comorbidities, early treatment and absence of comorbid conditions has good prognosis.
How cheap can one get the treatment for the infection?
The drugs for tuberculosis are available in government hospitals all over Nigeria for free. Once you are diagnosed with the condition and prescriptions are given, approach any government facility nationwide and get the drugs and begin treatment.
Are there nutritional requirements that can aid quick recovery from the condition?
Vitamins are required to strengthen the immunity. It is imperative to know that Vitamin B6 is required especially by the person taking isoniazid as it causes peripheral neuropathy (loss of sensation). An individual with tuberculosis can eat any food provided they are not contaminated, and balanced.
Is it safe to kiss someone who has tuberculosis?
Yes, it is safe to kiss someone with tuberculosis, as the organism is transmitted through air and not by direct contact or saliva.