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Tuberculosis - Symptoms, Infection, and Treatment

In the 19th Century, tuberculosis was still in Germany a widespread public health problem, which usually ended fatally. Today, the once infamous "white plague" in this country lost its terror, because through early and consistent treatment sufferers can be cured completely.

By AIDS and the infectious tuberculosis among the world but to infectious diseases, the most common cause of death. Statistically, one in three is infected with the pathogen. Still die every year nearly two million people.

Tuberculosis on the rise worldwide

Tuberculosis is most common in poorer countries. There, the necessary drugs are unaffordable and not partially available. In addition, for patients with HIV infection are at high risk of developing tuberculosis. Especially in Africa, both diseases potentiate each other. Where tuberculosis is on the rise. A significant increase in new infections reported by the World Health Organization (WHO) also in the CIS countries, where in recent decades, the states involvement in the public health waned considerably. The proliferation of new infections, the WHO not only due to the lack of nutrition, unhygienic conditions and poor medical care, but also the fact that more and more spread antibiotic-resistant strains. The treatment of tuberculosis is therefore simultaneously with multiple medications. In the western industrialized countries even severe cases of tuberculosis are good to get a grip. Ill in Germany, according to statistics from the Robert Koch Institute, currently around 4,000 people every year of tuberculosis. The disease mainly in immunocompromised patients, in extreme underweight, malnutrition and alcoholism. Even homeless people have been affected due to poor living conditions.

Tuberculosis: a decline in Germany complicates diagnosis

The tiny number in a global comparison of infections in Germany, however, has tuberculosis that can not always be diagnosed, especially since not every infected patients, the disease has actually erupt. Healthy and young people can live symptom-free for years and with the pathogen. The disease is highly contagious and is transmitted by droplet infection. Onset of the disease, the first symptoms are not always clear. Malaise, fever, cough: The winter can also be a common cold disease. For this reason, many doctors do not even think of the possibility that they are dealing with a tuberculosis patient.

The excitation - the Mycobacterium tuberculosis complex

Causative agent of tuberculosis are rod-shaped bacteria, which in contrast to other bacteria (every 10 to 20 minutes) on average only divide every 20 hours. The people concerned bacteria called Mycobacterium tuberculosis complex. Including the species

Mycobacterium tuberculosis,
Mycobacterium bovis,
Mycobacterium africanum,
Mycobacterium microti,
Mycobacterium canetti
and Mycobacterium pinepedii.

The most frequent pathogen is Mycobacterium tuberculosis. Mycobacterium tuberculosis and Mycobacterium africanum people are the only relevant hosts. For Mycobacterium bovis form humans, cattle and some wildlife reservoir.

Mycobacterium tuberculosis resistant to disinfectants and is called weak because of its dyeing, after treatment with an acidic solution as an acid-resistant rods. The proof is usually on the "Ziehl-Neelsen stain," which contrasts with the red-colored bacteria from the blue background. Further detection methods are the fluorescence microscopy, the auramine-rhodamine stain.

Modes of transmission of tuberculosis

The bacteria are transmitted mainly by airborne droplets. The pathogens are inhaled or enter through open wounds and mucous membranes in the bloodstream.

»Transmission through food

A dietary intake is possible. This is for example the case with infected cattle, whose milk contains concentrated mycobacteria. In Europe, such cases are very rare, as there is hardly infected cattle and cows milk is pasteurized in principle before it goes on sale.

»Transmission during operations

The bacteria can also be transmitted via smear infection, blood transfusions or surgery (transplant infected tissue or organs). Another option is the transmission during birth to the child when the mother is suffering from urogenital tuberculosis.

The most common Mycobacterium tuberculosis located mainly in the lungs, because the pathogens are inhaled through the respiratory droplets. Normally goes to infection from an adult because of the small amount of children bacteria coughed not sufficient for infection.

Immunity in tuberculosis

The defense mechanism of the immune system is in the alveoli. Here take the phagocytes to the mycobacteria in itself, but without killing them. Therefore, the foci of infection are isolated by additional, consecutive in several layers arranged immune cells. This cell structure in inflammation lead to the death of the tissue, thus the typical tuberculosis "caseous necrosis" - also called granuloma - arises. The trapped pathogen slow their metabolism, divide more slowly and can survive years without the tuberculosis outbreak ever. Statistics show that only about one in ten infected ill man.

»Open Tuberculosis

Of the granulomas are frequently larger caverns. These cavities are formed by melting of the dead tissue. Granulomas and caverns can be seen on the radiograph. As the number of cavities that can also ignite, however, increases the risk of suffering from further infection and ultimately to the tuberculosis. An open connection between the caverns and airways, it is called the "open tuberculosis." Patients are highly infectious and must be treated in isolation in hospital.

Even in healthy people previously infected, the bacteria can from a passive primary infection out about by weakening the immune system after years of re-activated and leads to an outbreak of tuberculosis. It may equally be a new infection with a different strain of agent. This shows that man after an infection by the tuberculosis-causing mycobacteria is not immune to such a chickenpox disease. Therefore, vaccinations make far less sense. The usual until 1998, vaccination with an attenuated mycobacterial vaccine was discontinued due to lack of efficiency.

Tuberculosis infection and incubation

Between infection and a significantly measurable immune response takes about six to eight weeks. Only about 10 percent of those infected suffer from a serious tuberculosis, because normally a healthy organism can successfully combat the pathogen. In the first two years after infection, the risk of disease is greatest. Particularly immunocompromised patients and young children fall ill immediately after infection.

Located in Germany, and the Western industrialized countries most common Mycobacterium tuberculosis is in most cases the causative agent of tuberculosis.

Of patients with open pulmonary tuberculosis is the greatest risk of infection. The pathogen can be found mainly in the bronchial secretions coughed and sucked. Younger children and ten years have a weaker cough, and the prospects pathogens can be detected. Patients are treated with drugs after infection by a non-resistant strain of bacteria is usually not infectious after three weeks. With more pronounced forms of tuberculosis and complications caused by antibiotic-resistant pathogens can infect others last longer.

Tuberculosis symptoms and disease progression

Fundamentally affected the agents to the lungs. It also may organs (organ disease), and the bone marrow (especially the spine) to be affected. Regarding the clinical course of pulmonary tuberculosis is divided into the following stages:

Primary tuberculosis or tuberculosis closed

After infection within the next six weeks is the immune system. In the lung form the typical granulomas (tubercles = Latin for "small tumor"). The isolated cause of inflammation so long no symptoms until the bacteria are activated by disease or immunodeficiency. If the inflammation is not openly connected with the respiratory tract, it is called the "closed tuberculosis". The bacteria can not get outside, which is why this form of TB is not contagious.

Manages the organism not to encase the mycobacteria permanently, or an isolated pathogen be reactivated wide., The bacteria continue to send out and take on the typical symptoms These are:

Fatigue and weakness
Anorexia
Loss in weight
Swollen lymph nodes
Fever
Night sweats
Constant cough, usually without even ejection
Hoarseness

Come increasingly in immunocompromised patients pathogens into the bloodstream, while both lungs and multiple organs are affected, it is the so-called military tuberculosis. In this way, the tuberculous meningitis (meningitis) caused.

The meningitis is initially characterized by behavioral changes. Usually followed by symptoms such as

Headache
Neck stiffness
Loss of consciousness and hallucinations
Seizures
Fever
Sepsis in extreme immunodeficiency
Coma

If left untreated, leads to death of tuberculous meningitis.

Post Primary or secondary tuberculosis

In about ten percent of those infected with tuberculosis breaks far from after infection. The disease is accompanied by typical symptoms:

Fatigue
Fatigue
Night sweats
Inflammation-related high temperatures and fever
Prolonged cough with yellowish-green sputum
When coughing chest pain
Difficulty in breathing
Bloody sputum

With bloody sputum must immediately consult a doctor, as this is the reference to an open tuberculosis.
In advanced stages, the pathogens increasingly enter the bloodstream and infect organs. Not infrequently, the course is characterized by a bone tuberculosis, which is reflected in joint swelling.

Less common are cutaneous tuberculosis. Symptoms are

Non-healing small wounds
Skin cracks
Pus
Ulceration

Tuberculosis: Diagnosis

The symptoms of TB disease show up in the late stage, namely when the fight refused by the immune system. Since the typical signs which resemble a flu infection, tuberculosis is often not recognized. This is particularly the exact diagnosis from the fact that tuberculosis in Germany and hardly occurs with about 4,000 reported cases per year clearly declining. An undiagnosed and therefore inadequately treated TB in severe cases can lead to death, however. Therefore, should at the slightest indication - the latest when bloody sputum - the urgent personal physician or a pulmonary specialist should be consulted. About the Internetnetportal lung specialists in the network (http://www.lungenaerzte-im-netz.de/aerzte/) Affected find several specialists in their area.

If tuberculosis is suspected, by interviewing an infection history and the pathogens are using

Tuberculin skin testing,
microscopic evidence
Interferon gamma-Test
Gewebsuntersuchungen

detected. An advanced pulmonary tuberculosis is also visible on the radiograph. If the diagnosis of the doctor is required by law to report to the appropriate health department undertakes. This is addressed to the contact person in order to exclude possible infection and prevent further infections.

Therapy for tuberculosis

By the slow pitch, the pathogens develop a more effective resistance to antibiotics. For this reason, the tuberculosis is treated with several specially designed against Mycobacterium tuberculosis-tuberculosis drug. To prevent relapses, the treatment must be routed over the prescribed period. Regular intake is essential. If there are doubts about the reliability of the patient, must be taking medical supervision. For the combined treatment are currently (as of 2012) the following drugs are available:

Isoniazid
Rifampicin
Ethambutol
Pyrazinamide
Streptomycin

When resistance or intolerance will make use of second-line drugs.

As part of the standard short-term therapy, the treatment is carried out as a six-month chemotherapy. During the 2-month initial phase of isoniazid, rifampicin, pyrazinamide and ethambutol (or streptomycin) are administered. During the subsequent 4-month stabilization phase, patients are treated only with isoniazid and rifampicin. The therapy is provided for both adults and children. The drugs are taken orally as a single daily dose.

Complications occur (in organ or tuberculosis in immunocompromised patients eg HIV infection), we recommend prolonged therapy. Since the prescribed drugs cause few serious side effects, regular checks by a doctor is necessary.

Tuberculosis Prevention

Since 1998, the BCG vaccination against tuberculosis by the Standing Committee on Vaccination (STIKO) is no longer recommended. Firstly, ensure the vaccine only limited efficacy, on the other hand, there was in the past quite often to vaccine complications.

In addition, cases of tuberculosis in Germany are currently declining. Also X-ray screening is not recommended due to the radiation.

More important rapid discovery and isolation is infectious disease patients in order to avoid an expansion of tuberculosis. The good medical care, a high standard of living, modern hygiene and the statutory obligation in connection with the investigation of contacts held in Germany to the fact that the number of sufferers from tuberculosis is declining.

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