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Empyema Thoracis Tips

Boerhaave Syndrome

Dr. Mirza Nimmat Baig 90% (144 ratings)
md general phisician
General Physician, Hyderabad
Boerhaave Syndrome

Boerhaave first described the spontaneous rupture of the esophagus in 1724. It typically occurs after forceful emesis. Boerhaave syndrome is a transmural perforation of the esophagus to be distinguished from mallory-weiss syndrome, a nontransmural esophageal tear also associated with vomiting. Because it often is associated with emesis, boerhaave syndrome usually is not truly spontaneous. However, the term is useful for distinguishing it from iatrogenic perforation, which accounts for 85-90% of cases of esophageal rupture.
Diagnosis of boerhaave syndrome can be difficult because often no classic symptoms are present and delays in presentation for medical care are common. Approximately one third of all cases of boerhaave syndrome are clinically atypical. Prompt recognition of this potentially lethal condition is vital to ensure appropriate treatment. Mediastinitis, sepsis, and shock frequently are seen late in the course of illness, which further confuses the diagnostic picture.
See can't-miss gastrointestinal diagnoses, a critical images slideshow, to help diagnose the potentially life-threatening conditions that present with gastrointestinal symptoms.
A reported mortality estimate is approximately 35%, making it the most lethal perforation of the gi tract. The best outcomes are associated with early diagnosis and definitive surgical management within 12 hours of rupture. If intervention is delayed longer than 24 hours, the mortality rate (even with surgical intervention) rises to higher than 50% and to nearly 90% after 48 hours. Left untreated, the mortality rate is close to 100%.
 

Pathophysiology
Esophageal rupture in boerhaave syndrome is postulated to be the result of a sudden rise in intraluminal esophageal pressure produced during vomiting, as a result of neuromuscular incoordination causing failure of the cricopharyngeus muscle to relax. The syndrome commonly is associated with overindulgence in food and/or alcohol. The most common anatomical location of the tear in boerhaave syndrome is at the left posterolateral wall of the lower third of the esophagus, 2-3 cm proximal to the gastroesophageal junction, along the longitudinal wall of the esophagus. The second most common site of rupture is in the subdiaphragmatic or upper thoracic area. [1, 2]

Although likely underreported, the incidence of boerhaave syndrome is relatively rare. A 1980 review by kish cited 300 cases in the literature worldwide. [3] a 1986 summary by bladergroen et al described 127 cases. [4] of these, 114 were diagnosed antemortem; the others were diagnosed at autopsy. Overall, boerhaave syndrome accounts for 15% of all cases of traumatic rupture or perforation of the esophagus.

Race-, sex-, and age-related demographics
Cases have been reported in all races and on virtually every continent, affecting males more commonly than females, with ratios ranging from 2: 1 to 5: 1.
Boerhaave syndrome is seen most frequently among patients aged 50-70 years. Reports suggest that 80% of all patients are middle-aged men. However, this condiction has also been described in neonates and in persons older than 90 years. Although no clear explanation exists for this, the least susceptible age group appears to be children aged 1-17 years.
Mortality/morbidity

Prognosis
Prognosis is directly contingent on early recognition and appropriate intervention. Early diagnosis of boerhaave syndrome allows prompt surgical repair. Diagnosis and surgery within 24 hours carry a 75% survival rate. This drops to approximately 50% after a 24-hour delay and approximately 10% after 48 hours.
 

Morbidity/mortality
The mortality rate is high. Esophageal perforation is the most lethal perforation of the gi tract. Survival is contingent largely upon early recognition and appropriate surgical intervention.
Overall, the mortality rate is approximately 30%. Mortality is usually due to subsequent infection, including mediastinitis, pneumonitis, pericarditis, or empyema.
Patients who undergo surgical repair within 24 hours of injury have a 70-75% chance of survival. This falls to 35-50% if surgery is delayed longer than 24 hours and to approximately 10% if delayed longer than 48 hours.
Cases of patients surviving without surgery exist but are rare enough to warrant case reports in the medical literature.
 

Complications
Esophageal rupture may lead to the development of septicemia, pneumomediastinum, mediastinitis, massive pleural effusion, empyema, pneumomediastinum, or subcutaneous emphysema.
If the esophageal rupture extends directly into the pleura, hydropneumothorax is expected. In adults, this occurs more commonly on the left side of the pleura. In neonates, esophageal rupture usually occurs on the right side.
After esophageal rupture, free air enters the mediastinum and also may spread to the adjacent structures, resulting in mediastinal abscess or superimposed secondary infection.
Other complications include acute respiratory distress syndrome, pneumomediastinum, pneumothorax, and hydrothorax.

1 person found this helpful

Can a Sinus Infection (Rhinosinusitis) Cause Spinal Meningitis?

Dr. Anurag 90% (215 ratings)
MBBS, MS - ENT
ENT Specialist, Delhi

The answer is unfortunately. Yes!
Meningitis, sometimes referred as spinal meningitis, is an inflammation of the membranes surrounding the brain and spinal cord. Usually caused by a viral infection, but it can also be caused by a bacterial or fungal infection.
 
Among pediatric patients admitted for treatment of sinusitis, 3.2% were found to have an intracranial complication. Infection of the sphenoid sinuses, however, merits concern. These thin-walled sinuses develop late in childhood, and their deep location places them adjacent to the dura mater and other critical structures.
 
Sphenoid sinusitis is identified in approximately 3% of cases of acute sinusitis, typically in the context of pansinusitis. Significant development of the sphenoid sinuses does not begin until age 4 to 6 years, thus, sphenoid sinusitis is restricted.
 
Viral infection causes most cases of spinal meningitis. Viral meningitis is usually mild and heals without treatment. Bacterial meningitis is more severe and requires treatment with antibiotics. Streptococcus pneumoniae and neisseria meningitidis are strains of bacteria that cause pneumococcus and meningococcus meningitis respectively.
It can be life threatening condition owing to its proximity to brain and spinal cord and infective media is the fluid surrounding them.
 
Diagnostic tools:
• Lumbur puncture – csf examination (cell count, glucose, proteins) and culture

Blood culture
• Chest x ray
• CT scan of head and nose – pns
MRI brain
 
Symptom checker in meningitis secondary to sinusitis:
Fever (92%)
• Headache (85%)
Nausea, vomiting (62%)
• Altered consciousness (31%)
• Seizure (31%)
• Hemiparesis (23%)
• Visual disturbance (23%)
• Meningismus (23%)
 
Conclusion and quick pearls:
• Complications that are less common with antibiotics
• Orbital (cellulitis, abscess)
• Intracranial (subdural empyema, thrombosis of cavernous sinus)
Bony osteomyelitis.
• Can result in drastic sequelae
• Drain abscess and open involved sinuses
Ent surgical involvement – functional endoscopic sinus surgery
- Usually amenable with medical treatment
- Drain sinuses if no improvement after 48 hours
• Ophthalmology check up
• Neurosurgery intervention
 
A low index of suspicion is necessary for early diagnosis and treatment of sphenoid sinusitis, orbital complications and prevention of intracranial complications including meningitis.

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Thoracotomy - When It Is Performed?

Dr. Prashanth Hegde 85% (10 ratings)
MBBS, MS - General Surgery, Fellowship in Gastroenterology
General Surgeon, Hyderabad
Thoracotomy - When It Is Performed?

The chest cavity within the ribs is a very vital area of your body. There are multiple vital organs within this area and if there are any problems with any of these, then one of the ways to perform surgery in this area is with the help of thoracotomy.

What is thoracotomy?
Thoracotomy is the opening up of the chest cavity for the doctors to allow access to the vital organs within the region such as:

  • Heart
  • Lungs
  • Throat
  • Aorta
  • Diaphragm

In this procedure, the doctors make a medium to large incision on the side of the chest which may extend much further up the back depending on how far the doctor needs access too. However, in certain cases, the doctors may extend the incision to the front of the chest and even remove ribs to allow access. Thoracotomy is a major and invasive surgery. It is a fairly common surgery but carries risks because of it being such an invasive surgery.

When is thoracotomy performed?
Some of the indications where thoracotomy is performed would be –

  1. To check for lung diseases
  2. To remove non-cancerous or benign tumors
  3. To treat infections of the chest cavity also known as empyema
  4. To remove blood from the lungs in a condition known as Hemothorax
  5. Thoracotomy is also performed as an emergency procedure to remove fluid from the chest cavity
  6. One of the most common cases wherein this procedure is performed is during pulmonary embolism or a blood clot within the lungs
  7. Treatment of wounds sustained from knife stabbings or gunshot wounds
  8. As a part of treatment for lung cancer

Risks of Thoracotomy

  1. Since thoracotomy is more invasive than other procedures, it tends to carry more risks as well. Some of the risks are mentioned as follows -
  2. Infection of the wound, as is the case with any surgery
  3. Excessive bleeding during the surgery
  4. Development of Pneumonia due to the lungs becoming inflamed after the surgery
  5. If the heart surgery isn’t successful, then it might lead to further worsening of the problems.
  6. Further chances of blood clots; especially deep vein thrombosis, wherein a clot in the leg moves up to the lungs causing serious health problems.
  7. Leakage of air through the walls of the lungs that results in longer healing time and thus warrants longer hospital stay.

Aftercare
Aftercare is fairly complicated with this procedure and will take some time to heal completely.

  1. In most cases, tubes to carry out fluids, as well as IV Drips, may also be connected to you.
  2. You will also be given anti-pain and anti-inflammatory medications in order to deal with post-surgery recovery.
  3. You will also be recommended breathing and movement exercises to slowly improve your tolerance and bring back normalcy in movement.
  4. You will also need to be careful while touching the area so as not to infect it.
  5. Ensure your hands are thoroughly washed and clean when you touch them. Also, ensure that dressings are changed regularly with the appropriate precautions as prescribed by the doctors.

In case you have a concern or query you can always consult an expert & get answers to your questions!

3439 people found this helpful

TB Symptoms - What Are The Signs Of Tuberculosis?

Dr. Mool Chand Gupta 91% (35709 ratings)
MD - Pulmonary, DTCD
Pulmonologist, Faridabad
TB Symptoms - What Are The Signs Of Tuberculosis?

Tuberculosis (TB) is one of most deadly diseases know globally. It is an infectious disease occurring in many developing and developed countries as well. However, more patients can be seen coming from developing nations. According to WHO (World Health Organisation), 9 million people suffer from TB in a year. Tuberculosis is one of the diseases leading to deaths among women aged between 15 to 40 years.

The main cause of TB is a bacterium called Mycobacterium tuberculosis. It is an infectious disease that is also contagious. However, tuberculosis can be of two varying types:

  1. Latent TB- In this case, the bacteria causing TB remains inactive in a person’s body and does not show any signs and symptoms of TB. However, it may become active. An estimated 2 million people have latent TB and need to be treated.
  2. Active TB- The bacteria causing TB is active and results in various symptoms which can be transmitted from one person to another.

Some of the signs and symptoms of active TB are:

  1. Severe Cough
  2. Coughing up Blood (Hemoptysis)
  3. Chest Pain
  4. Loss of Weight
  5. Fatigue
  6. Fever
  7. Night Sweats
  8. Decreased Appetite
  9. Feeling Cold
  10. Having Difficulty in Breathing
  11. Swollen Lymph Nodes

There are other types of TB occurring among people that have many more symptoms:

  1. Skeletal TB (Pott’s Disease)
  2. TB Meningitis- headaches, mental changes and coma
  3. TB Arthritis- usually pain in knees and joints
  4. Genitourinary TB- dysuria, flank pain, increased frequency, masses or lumps
  5. Gastrointestinal TB- problem in swallowing, ulcers, mal-absorption and diarrhoea
  6. Military TB- It is basically small nodules that occur in organs
  7. Pleural TB- This basically refers to the respiratory problems of empyema and pleural effusions
  8. Multidrug-resistant Tuberculosis (MDR TB)- People suffering from TB and having medications for it may develop a resistant to certain drugs over time.
  9. XDR TB- Patients being drug resistant to tuberculosis drugs. XDR stands for extensively drug-resistant.
  10. Caseous TB- Necrotic (dead and dying) tissue infected with TB has a dry and cheesy appearance.

These were some of the symptoms associated with various types of Tuberculosis. However, its diagnosis may range of doing a skin test to blood tests to x-rays to sputum tests. Along with this doctors use a stethoscope to listen to the sounds of lungs.

What you need to keep in mind is that TB affects other parts of the body as well. If you are having tuberculosis in your kidneys, then it results in loss of blood through urine. So you need to observant and report to your doctor accordingly.

As TB is a contagious disease, its treatments require certain medications which have to be consumed for a period of 6 months. For effective results and better recovery, doctors advise patients to complete the full course of medications.

4496 people found this helpful

Gall Bladder Stone

Fellowship in Minimal Access Surgery, FACRSI (Colo-Rectal Surgery), Ph. D - Gastrointestinal Surgery, FAIS, DNB (General Surgery), MNAMS (Membership of the National Academy) (General Surgery) , MBBS
Gastroenterologist, Bangalore
Gall Bladder Stone

Gall Bladder Stone

Courtesy -Dr.Kumar Parth (MBBS; MNAMS; FMAS; FAIS; FACRSI (Colo-Rectal Surgery) DNB; FSGE (Surgical Gastroenterology)

(Consultant Surgical Gastroenterologist), drkparth9@gmail.com, www.drparthgastro.com

Definition:   Presence of stones in the gallbladder is referred to as cholelithiasis.               

PredisposingFactors:

  • Genetics , Gender (more in women)
  • Body weight (Obesity), or rapid loss in weight , Fasting
  • Decreased motility (movement) of the gallbladder
  • Diet
  • Drugs : Cholesterol / Lipid lowering drugs , Estrogen
  • Diseases: Diabetes, blood disorder (Hemolytic anemia etc.)

Composition of Gall Bladder Stone:

Cholesterol Stone: Found in western world, causes accounted to diet rich in cholesterol.

Pigmented stone: generally found in diseases related to blood disorder

Mixed stone: Contains Calcium, magnesium, sodium phosphate ( most common type found in Asian population (India).

Symptoms :

  • (70–85%) are asymptomatic or "Silent Gall Stone"
  • Pain in right upper and central part of abdomen (may radiate to inter-scapular region) mostly after half an hour of food (seen more symptomatic after a fatty diet.)
  • post meal fullness, belching, upper abdominal discomfort
  • Jaundice (yellowing of the skin or eyes)
  • Clay colored stools or dark urine

Investigations required:

  • Blood - Liver Function test , Complete Blood Count,
  • Imaging -Ultrasound Of abdomen and if required MRI (MRCP) abdomen.
  • Complications of Gall Stone
  • Infection of gall bladder {Empyema(pus) / Mucocele of Gall bladder}
  • Perforation of gall bladder
  • Stone slipped in Common Bile Duct resulting in obstruction in the passage of bile leading to Jaundice
  • Stone from gall bladder slipped to common bile duct and entering into pancreatic duct through common channel of opening in Duodenum (small bowel) leading to Pancreatitis.

Indications for Surgery:

  • Symptomatic Gall stone with typical history of pain as mentioned above and proven with Imaging (ultrasound)
  • Asymptomatic or Silent gall stone (Found Incidentally during Ultrasound abdomen) - "DOES NOT REQUIRE SURGERY".

Asymptomatic or Silent gall stone requiring surgery in special circumstances are:

  • Pregnant lady diagnosed with gall stone during first trimester (incidental finding)
  • Any blood disorder and patient is going for any abdominal surgery for any reason.
  • Diabetes mellitus - as chances of infection are high on by ground of diabetes
  • Gall bladder polyp (a soft tissue growth in lumen of gall bladder) size > 1 cm or single stone measuring > 3 cms, as risk of Gall Bladder cancer increase by 10 fold in these cases.

Treatment: Surgery - Laparoscopic Cholecystectomy (Key Hole Surgery) is Gold standard worldwide.

  • Safe surgery, there are no side effects of removing of gall bladder as one has to weigh the complication arising from a "symptomatic" gall stone disease.
  • Can be done as a day care surgery
  • Post surgery patients are advised to refrain from fatty meal for a week so as to acclimatize the body to a diluted bile. Normal activity is allowed from day 1 of post surgery.
1 person found this helpful

Laparoscopic Cholecystectomy - Laparoscopic Gallbladder Removal Surgery!

Dr. Nimisha S Kantharia 85% (10 ratings)
MBBS, MS - General Surgery, DNB, FNB - Minimal Access Surgery, MRCS, FIAGES, FMAS.Laparoscopy, FALS Bariatric Surgery
Laparoscopic Surgeon, Mumbai
Laparoscopic Cholecystectomy - Laparoscopic Gallbladder Removal Surgery!

What is Laparoscopic Gallbladder Removal Surgery (Laparoscopic Cholecystectomy)?

Gallbladder removal is one of the most commonly performed surgical procedures. Gallbladder removal surgery is usually performed with minimally invasive techniques and the medical name for this procedure is Laparoscopic Cholecystectomy or Laparoscopic Gallbladder Removal.

The gallbladder is a pear-shaped organ that rests beneath the right side of the liver. Its main purpose is to collect and concentrate a digestive liquid (bile) produced by the liver. Bile is released from the gallbladder after eating, aiding digestion. Bile travels through narrow tubular channels (bile ducts) into the small intestine. Removal of the gallbladder is not associated with any impairment of digestion in most people.

What Causes Gallbladder Problems?

Gallbladder problems are usually caused by the presence of gallstones which are usually small and hard, and are made up of cholesterol, calcium and bile salts in the gallbladder or in the bile duct.

It is uncertain why some people form gallstones but risk factors include being female, prior pregnancy, age over 40 years and being overweight. Gallstones are also more common as you get older and some people may have a family history of gallstones. There is no known means to prevent gallstones.

These stones may block the flow of bile out of the gallbladder, causing it to swell and resulting in sharp abdominal pain, vomiting, indigestion and, occasionally, fever. If the gallstone blocks the common bile duct, jaundice (a yellowing of the skin) can occur.

Diagnosis

  1. Ultrasound is most commonly used to find gallstones.
  2. In a few more complex cases, other X-ray test such as a CT scan or a gallbladder nuclear medicine scan may be used to evaluate gallbladder disease.

Gallstones do not go away on their own. Some can be temporarily managed by making dietary adjustments, such as reducing fat intake. This treatment has a low, short-term success rate. Symptoms will eventually continue unless the gallbladder is removed. Treatments to break up or dissolve gallstones are largely unsuccessful.

Surgical removal of the gallbladder is the time-honored and safest treatment of gallbladder disease.

Complications of Gallstones

  • Infection and inflammation of gall bladder called Acute Cholecystitis.
  • Collection of pus within the gallbladder due to blockage of its opening by the stone "empyema".
  • Infected gall bladder is fragile, and may rupture or perforate, resulting in spread of infection.
  • The stone may slip into bile ducts causing a blockage and jaundice.
  • Stones in bile duct can further result in irritation of the pancreas and pancreatic duct, resulting in inflammation of pancreas called pancreatitis which is a dangerous condition and can be life threatening.

Solution if any complication occures:

In case the gallstones slip into bile duct, the doctor will opt an additional procedures called Endoscopic Retrograde Cholangiopancreatography (ERCP). In this procedure, the doctors perform endoscopic removal of the stones with or without placement of a stent.

The doctors may also opt for a surgery such as bile duct exploration (which can be done laparoscopically) to remove the stones.

What are the Advantages of Performing Laparoscopic Gallbladder Removal?

  1. Rather than a five to seven inch incision, the operation requires only four small openings in the abdomen.
  2. Patients usually have minimal post-operative pain.
  3. Patients usually experience faster recovery than open gallbladder surgery patients.
  4. Most patients are discharged on next day after surgery and enjoy a quicker return to normal activities.

Are you the right Candidate?

Although there are many advantages to laparoscopic gallbladder removal (cholecystectomy), the procedure may not be appropriate for some patients who have severe complicated gallbladder disease or previous upper abdominal surgery. A thorough medical evaluation by your personal physician, in consultation with a surgeon trained in laparoscopy, can determine if laparoscopic gallbladder removal (cholecystectomy) is an appropriate procedure for you.

Know About Tuberculosis

Dr. Srikanth Md 92% (943 ratings)
MD
General Physician, Secunderabad

Definition

Tb is a disease which in humans is usually caused by bacteria called mycobacterium tuberculosis (m. Tuberculosis). Tb is an abbreviation of the word tuberculosis and is how people often refer to the disease.

Bovine tb is a disease caused by similar bacteria called mycobacterium bovis (m. Bovis). Bovine tb mainly affects cattle but can also affect humans.

Just a few years ago it was believed that tb was an old disease, and that it was no longer a problem in humans. But now because of such issues as drug resistance and hiv, it has become a major problem again.

History

  • On march 24, 1882, Dr. Robert koch announced the discovery of mycobacterium tuberculosis, the bacteria that cause tuberculosis (tb). During this time, tb killed one out of every seven people living in the united states and europe. Dr. Koch’s discovery was the most important step taken toward the control and elimination of this deadly disease.
  • In 1982, a century after Dr. Koch’s announcement, the first world tb day was sponsored by the world health organization (who) and the international union against tuberculosis and lung disease (iuatld). The event was intended to educate the public about the devastating health and economic consequences of tb, its effect on developing countries, and its continued tragic impact on global health.
  • Today, world tb day is commemorated across the globe with activities as diverse as the locations in which they are held. But more can be done to raise awareness about the effects of tb. Among infectious diseases, tb is now the leading killer of adults in the world, with 1.8 million tb-related deaths in 2015. In the united states, the overall number of tb cases increased over the previous year in 2015 after having declined yearly during 1993–2014.
  • Until tb is eliminated, world tb day won’t be a celebration. But it is a valuable opportunity to educate the public about the devastation tb can spread and how it can be stopped.

Epidemiology

Globally, more than 1 in 3 individuals is infected with tb. According to the who, there were 8.8 million incident cases of tb worldwide in 2010, with 1.1 million deaths from tb among hiv-negative persons and an additional 0.35 million deaths from hiv-associated tb. In 2009, almost 10 million children were orphaned as a result of parental deaths caused by tb.

Overall, the who noted the following:

  • The absolute number of tb cases has been falling since 2006 (rather than rising slowly, as indicated in previous global reports)
  • Tb incidence rates have been falling since 2002 (2 years earlier than previously suggested)
  • Estimates of the number of deaths from tb each year have been revised downwards
  • The 5 countries with the highest number of incident cases in 2010 were india, china, south africa, indonesia, and pakistan. India alone accounted for an estimated 26% of all tb cases worldwide, and china and india together accounted for 38%.

Types

1. Active tb

Active tb is an illness in which the tb bacteria are rapidly multiplying and invading different organs of the body. The typical symptoms of active tb variably include cough, phlegm, chest pain, weakness, weight loss, fever, chills and sweating at night. A person with active pulmonary tb disease may spread tb to others by airborne transmission of infectious particles coughed into the air.

If you are diagnosed with an active tb disease, be prepared to give a careful, detailed history of every person with whom you have had contact. Since the active form may be contagious, these people will need to be tested, as well.

Multi-drug treatment is employed to treat active tb disease. Depending on state or local public health regulations, you may be asked to take your antibiotics under the supervision of your physician or other healthcare professional. This program is called “directly observed therapy” and is designed to prevent abandonment or erratic treatment, which may result in “failure” with continued risk of transmission or acquired resistance of the bacteria to the medications, including the infamous multi-drug resistant tb (mdr-tb).

2. Miliary tb

Miliary tb is a rare form of active disease that occurs when tb bacteria find their way into the bloodstream. In this form, the bacteria quickly spread all over the body in tiny nodules and affect multiple organs at once. This form of tb can be rapidly fatal.

Types of tb

1. Cavitary tb

Cavitary tb involves the upper lobes of the lung. The bacteria cause progressive lung destruction by forming cavities, or enlarged air spaces. This type of tb occurs in reactivation disease. The upper lobes of the lung are affected because they are highly oxygenated (an environment in which m. Tuberculosis thrives). Cavitary tb can, rarely, occur soon after primary infection.

Symptoms include productive cough, night sweats, fever, weight loss, and weakness. There may be hemoptysis (coughing up blood). Patients with cavitary tb are highly contagious. Occasionally, disease spreads into the pleural space and causes tb empyema (pus in the pleural fluid).

2. Latent tb infection

Latent tb occurs when a person has the tb bacteria within their body, but the bacteria are present in very small numbers. They are kept under control by the body’s immune system and do not cause any symptoms.

People with latent tb do not feel sick and are not infectious. They cannot pass the bacteria on to other people. In addition they will usually have a normal chest x-ray and a negative sputum test. It is often only known that someone has latent tb because they have had a test, such as the tb skin test.

Risk factors

You are at risk of tb infection if you are around people with active tb disease who are coughing, which releases bacteria into the air. The risk of infection increases for intravenous drug users, healthcare workers, and people who live or work in a homeless shelter, migrant farm camp, prison or jail, or nursing home.

Most people who are infected with the bacteria that cause tb do not develop active disease. The following factors increase the risk that latent disease will develop into active disease:

  • Infection with hiv, the virus that causes aids and weakens the immune system
  • Diabetes mellitus
  • Low body weight
  • Head or neck cancer, leukemia, or hodgkin’s disease
  • Some medical treatments, including corticosteroids or certain medications used for autoimmune or vasculitic diseases such as rheumatoid arthritis or lupus, which suppress the immune system.
  • Silicosis, a respiratory condition caused by inhaling silica dust.

Causes

The mycobacterium tuberculosis bacterium causes tb. It is spread through the air when a person with tb (whose lungs are affected) coughs, sneezes, spits, laughs, or talks.

Causes of tuberculosis

  • Tb is contagious, but it is not easy to catch. The chances of catching tb from someone you live or work with are much higher than from a stranger. Most people with active tb who have received appropriate treatment for at least 2 weeks are no longer contagious.
  • Since antibiotics began to be used to fight tb, some strains have become resistant to drugs. Multidrug-resistant tb (mdr-tb) arises when an antibiotic fails to kill all of the bacteria, with the surviving bacteria developing resistance to that antibiotic and often others at the same time.
  • Mdr-tb is treatable and curable only with the use of very specific anti-tb drugs, which are often limited or not readily available. In 2012, around 450, 000 people developed mdr-tb.

Symptoms

Although tuberculosis (tb) is most frequently associated with symptoms involving the lungs—because the disease most often affects the lungs—it can affect any organ of the body. The disease can cause a variety of symptoms. If you have symptoms, your doctor will want to know when they began.

People with latent tb infection (an infection without active disease) have no symptoms.

The usual symptoms of tb include:

  • Fever
  • Chills
  • Night sweats
  • Cough
  • Loss of appetite
  • Weight loss
  • Blood in the sputum (phlegm)
  • Loss of energy

The symptoms may be mild and may not seem particularly worrisome to the patient. In other people, the symptoms become chronic and severe.

Other symptoms of active tb disease depend on where in the body the bacteria are growing. If active tb disease is in the lungs (pulmonary tb), the symptoms may include a bad cough, pain in the chest, and coughing up blood. If active tb is outside the lungs (for example, the kidney, spine, brain, or lymph nodes), it is called extrapulmonary tb and has other symptoms, depending on which organs are affected. For example, tuberculosis in the spine may cause back pain or stiffness.

Diagnosis and test

  • During the physical exam, your doctor will check your lymph nodes for swelling and use a stethoscope to listen carefully to the sounds your lungs make while you breathe.
  • The most commonly used diagnostic tool for tuberculosis is a simple skin test, though blood tests are becoming more commonplace. A small amount of a substance called ppd tuberculin is injected just below the skin of your inside forearm. You should feel only a slight needle prick.
  • Within 48 to 72 hours, a health care professional will check your arm for swelling at the injection site. A hard, raised red bump means you’re likely to have tb infection. The size of the bump determines whether the test results are significant.
  • If your gp suspects you may have tb, they will send you for testing. If you do have tb, it’s best to know as soon as possible. Delaying treatment makes it more likely you may develop long-term health problems and could put people close to you at risk.

Types of tb test

There are a range of tests to show if you have tb, such as a sputum test, a culture test and x-rays.

Chest x-ray

A chest x-ray can show damage in your lungs, but you might need further tests to prove you have tb, such as sputum and culture tests or scans.

Testing sputum

A lab will use a microscope to look at any sputum (phlegm) that you cough up. If there are tb germs in your sputum, you have tuberculosis of the lungs or throat (pulmonary tb). This test also helps doctors to understand how infectious you may be.

Biopsy

If it is thought that you have tb, but not in your lungs or throat, the doctor may take a biopsy to test for tb. This is a small sample of tissue or fluid taken from the area where the tb is thought to be.

Culture test

This test uses your sputum or tissue sample to grow any tb bacteria that may be there. It tells doctors how infectious you are and also whether your tb is resistant to any antibiotics. This helps ensure they put you on a combination of drugs that will cure you. As tb culture grows slowly, it may take up to eight weeks to get some of the results.

Treatment and medications

Treatment for active tb

If you have this form of the disease, you’ll need to take a number of antibiotics for 6 to 9 months. These four medications are most commonly used to treat it:

Your doctor may order a test that shows which antibiotics will kill the tb strain. Based on the results, you’ll take three or four medications for 2 months. Afterward, you’ll take two medications for 4 to 7 months.

You’ll probably start to feel better after a few weeks of treatment. But only a doctor can tell you if you’re still contagious. If you’re not, you may be able to go back to your daily routine.

Treatment of latent tb

The treatment of latent tb is considered by many people to be an important part of tb prevention.

It is not recommended that everyone with latent tb infection (ltbi) should have tb treatment. Rather it is recommended that certain “target” groups should receive treatment. The main “target” groups considered by the world health organisation (who) to be most at risk from progressing from latent to active tb include people in low tb burden countries:

  • Who have had recent contact with an infectious patient;
  • With silicosis (there is more about tb & mining);
  • Infected with both tb and hiv;
  • Who have been or who are in prison;
  • Who are immigrants to a low burden country from a high burden country;
  • Who are homeless;
  • Who are an illicit drug user;

Who have certain clinical conditions, or conditions which compromise their immune system, such as people with diabetes, and people with chronic renal failure.

In high tb burden countries the populations that are most strongly recommended for the treatment of latent tb infection are people living with hiv, and children under five who are household contacts of pulmonary tb cases.

Treatment for miliary tb

  • Antibiotics
  • Corticosteroids
  • Sometimes surgery
  • Generally, treatment of miliary tuberculosis is similar to thetreatment of pulmonary tuberculosis.
  • Antibiotics are given usually given for 6 to 9 months, unless the meninges are affected. Then antibiotics are given for 9 to 12 months.
  • Corticosteroids may help if the pericardium or meninges are affected.
  • Tuberculosis bacteria can easily develop resistance to antibiotics, particularly when people do not take the drugs regularly or for as long as they are supposed to.
  • Surgery is needed for some complications of military tuberculosis.

Prevention

If you test positive for latent tb infection, your doctor may advise you to take medications to reduce your risk of developing active tuberculosis. The only type of tuberculosis that is contagious is the active variety, when it affects the lungs. So if you can prevent your latent tuberculosis from becoming active, you won’t transmit tuberculosis to anyone else.

Protect your family and friends

  • If you have active tb, keep your germs to yourself. It generally takes a few weeks of treatment with tb medications before you’re not contagious anymore. Follow these tips to help keep your friends and family from getting sick:
  • Stay home. Don’t go to work or school or sleep in a room with other people during the first few weeks of treatment for active tuberculosis.
  • Ventilate the room. Tuberculosis germs spread more easily in small closed spaces where air doesn’t move. If it’s not too cold outdoors, open the windows and use a fan to blow indoor air outside.
  • Cover your mouth. Use a tissue to cover your mouth anytime you laugh, sneeze or cough. Put the dirty tissue in a bag, seal it and throw it away.
  • Wear a mask. Wearing a surgical mask when you’re around other people during the first three weeks of treatment may help lessen the risk of transmission.
  • Finish your entire course of medication
  • This is the most important step you can take to protect yourself and others from tuberculosis. When you stop treatment early or skip doses, tb bacteria have a chance to develop mutations that allow them to survive the most potent tb drugs. The resulting drug-resistant strains are much more deadly and difficult to treat.

Vaccinations

In countries where tuberculosis is more common, infants often are vaccinated with bacillus calmette-guerin (bcg) vaccine because it can prevent severe tuberculosis in children. The bcg vaccine isn’t recommended for general use in the united states because it isn’t very effective in adults. Dozens of new tb vaccines are in various stages of development and testing.

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