Tuberculosis (Ft. MTB)

In my previous post, I talked about antibiotic resistance, a problem that is making the war on disease even more problematic. Now, I move on to tuberculosis, a disease whose causative organism has been emerging resistant to medications.

Tuberculin skin test

Ranked one in deaths caused by a single infectious agent, it is also one of the leading causes of death.

And now, I'll hand the mic (keyboard, whatever) to MTB who’s gonna continue with the topic.

"Hi! I am Mycobacterium tuberculosis, you can call me Myco; I personally think MTB is terrible.

"Stel has just told you about my achievements. I dream every night of being the one organism to kill off all you stupid humans but guess its gonna take time.

"I have infected a vast amount of people (over a quarter of the world population; you heard that right) although very few show any actual symptoms. Let's call this latent tuberculosis. Only a minor percentage of them show symptoms of active disease, although the chances of progression to active state increase with compromised immune systems such as HIV infection or malnutrition cases.

"Right now, I’m chilling with my clan inside a human’s lungs. Ah...the air here is intoxicating. You see, I'm an aerobe, which means I need oxygen to survive, just like you and where better to get oxygen than human lungs? Some of my mates from our previous target went ahead and targetted their next victim's spine. You'd call it Pott's disease. We can target just about any tissue, be it your kidney, intestine, bone or meninges; its just that we prefer your lungs.

"Unlike certain other bacterial conditions such as botulism, we take a long time (ranging upto months) to show ourselves. Which means while we organize ourselves to destroy you, we also use you to spread ourselves to your fellow human beings. We travel by air, when an infected person exhales us (by coughing, sneezing, laughing, etc.) although we find it hard to colonize new bodies. I admit it, we are contagious but do not spread very fast."

Alright, that’s it for today. I'll take over from this terrible bore of a bacteria. So how are people diagnosed? The classical symptoms of pulmonary tuberculosis include chronic cough (accompanied by blood), weight loss, fever and night sweats. The old fashioned method of confirming the diagnosis involved sputum smear examination, which meant that the sputum would be collected and examined under a microscope after staining. Culturing the bacteria is much slower as they tend to grow slowly and takes days to give a result. Chest X rays are also used.

Molecular methods are increasingly more popular and one such automated method, Gene Xpert MTB/RIF has been endorsed by the WHO. This test gives results in about 2 hours from a sputum sample. Apart from detecting the bacteria, it also tests for resistance to the antituberculous drug Rifampicin.

And lastly we come to the treatment stage. Being the hardy bacteria that it is, it takes a combination of drugs for months to cure tuberculosis. The commonly used combination is rifampicin, isoniazid, pyrazinamide and ethambutol for 6-7 months.

"Ha! Thought I would take this lying down? Many of us have learnt to arm ourselves better. Your treatments are being less effective every passing day and the day is not far off when -"

Sorry, my bad! But yea, he has a point. Drug resistance is becoming a problem as more and more cases of Multidrug Resistant TB are being reported. Although we have second line drugs to deal with this situation, resistance has been developing to them too apart from the fact that MDR-TB is much harder to cure with more chemotherapy and related side effects.

What can be done to check this?

Symptoms may decrease within a few weeks of treatment. This is when a lot of people think "Chemo is so harmful and my disease is gone. I think I'll stop this." That, ladies and gentlemen, is the worst mistake you can possibly make. While your symptoms may have subsided, it is not because ALL bacteria have been killed. It is because MOST have been destroyed, leaving behind the more resistant ones. Thus by stopping treatment prematurely, you contribute to MDR-TB.

Directly Observed Treatment, where a trained healthcare professional administers the treatment to the patient to ensure therapy is completed, is recommended in order to check the menace.

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A few notes...

XDR-TB or Extensively Drug Resistant TB is another highly resistant strain on the rise.
And I forgot! Prophylaxis! How to prevent new cases? The BCG vaccine is administered to children as soon after birth as possible in endemic regions. Isolating diagnosed cases can help limit the spread.

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Sources
https://en.m.wikipedia.org/wiki/Tuberculosis
https://www.cdc.gov/features/tbsymptoms/index.html
http://www.who.int/mediacentre/factsheets/fs104/en/ [Check this out for some interesting quick facts!]

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Pics
https://pixabay.com/en/vaccination-tuberculin-test-syringe-67477/
https://pixabay.com/en/anatomy-man-human-face-body-lips-254129/ (Captioned by me)
Sketches by me

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I may have missed out on some points, or inadvertently made a mistake somewhere. Constructive feedback is always welcome. Follow me @stelmar for more, upvotes and resteems would be nice too :P

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GIF by @rocking-dave

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