By Dr Udaya S

Mangaluru, Mar 26: Tuberculosis is a communicable disease that we have been fighting worldwide since times unknown. We have come from Tuberculosis sanatoriums to give missed calls to nikshay tele support while taking medicines at the ease of our home. Yet despite all these efforts, it remains to hound us.

Therefore, what is tuberculosis and how does it affect us?

This is an infectious disease quite prevalent in our society, commonly seen to affect crowded townships with poor socioeconomic structure due to cramped homes with poor ventilation, inadequate protein diet and poor hygiene measures. However, having said that it can affect anyone who has a slightly suppressed immunity, reason being cancer treatment, HIV patients, Patients on immunomodulators and even patients undergoing any stressful life event, crash diets.

The symptoms and signs depend on the organ affected and the route of entry.
The most common being droplets of cough, patients present with prolonged fever which might be daily evening rise not high grade, typically described as slight warmth of body, associated with cough which is persistent since more than 2 weeks with or without sputum, weight loss more than 10 kg or significant without any other cause, loss of appetite. While most of the symptoms are systemic labelled as constitutional symptoms, which are common irrespective of organ affected. Pulmonary tuberculosis presents with an unremitting cough, which is a red flag as it is infectious. Patients may also present with blood in the sputum which might be a few spoons or even a large bout of 500 to 1000 ml. Patients with Lymph node tuberculosis present with lymph node swelling in various areas most peculiar being cervical neck, near the ear and in armpits . These r painless cold to touch swelling on worsening lead to break down to sterile pus, which may cause it to be boggy to touch. When it breaks open, it leads to discharge and chronic non-healing sinus formation. This type is a non-infectious variety unless discharging fluids. Pleural tuberculosis which is the TB, affecting the lining of the lung leads to chest pain on breathing , dry cough and breathlessness, these symptoms are due to filling up of fluid in this layer causing compression of the lungs and difficulty in breathing. These patients need immediate attention and drainage of the fluid, failure to do so might lead to respiratory failure and conversion to empyema or pus filled outside lungs needing surgical intervention.

Patients with nervous system involvement may present initially with fits, headache, even paralysis; some may have vision problems depending on the region of brain and spine involved. TB can manifest in bones and spine as abscesses or pus filled collections leading to poor healing and local symptoms or pain and joint swelling and immobility. In the heart the usual involvement is again the lining covering it and may fill up with fluid, this is a medical emergency as compression of the heart like lead to cardiac arrest and also needs urgent expert drainage by interventional cardiologist. In the abdomen most common presentations are abdominal pain, lymph node swelling, some may present with diarrhea and ulcers on biopsy proven as Tuberculosis, fluid can again fill up in the abdomen known as ascites, which again requires drainage. TB of the genitourinary tract also is common but difficult to identify hence are delayed in diagnosis, recurrent urine infection with sterile culture should raise a suspicion. Skin manifestations are plenty in number any unhealing skin lesion should be immediately consulted to a dermatologist for evaluation and the usual go to steroids medicines makes the condition worse. One has to remember that although the list of symptoms seem extensive, on correct diagnosis it is easily and completely curable with oral medicines if one adheres to the regimen thoroughly. Therefore, in case of suspicion it is best to visit a specialist and confirm.

Dr Udaya S, consultant pulmonologist, KMC Hospital, Mangaluru.