In the past, tuberculosis pulmonary was known as “the disease of poverty”, since it mainly affected people living in precarious conditions and with limited access to health services. It was during the 19th century that the disease became a public health problem in Europe and North America, and campaigns to control its spread began.
Tuberculosis Pulmonary in children: Challenges and solutions
When the child is in good health, the disease can cause local changes in the lungs and lymph nodes. But if the infant is malnourished or suffers from other infections, such as HIV, serious complications appear, among which are bronchial obstruction, pleural effusion or fluid accumulation in the space between the membranes that cover the lung.
If tuberculosis pulmonary appears at least two years after contracting the infection, it is called post-primary disease or adult tuberculosis. This indicates that the infection remained latent, which is why it is more aggressive than the primary infection, causes severe lung lesions, and spreads more easily throughout the rest of the body.
Throughout history, tuberculosis pulmonary has been a disease that has challenged humanity and has required collective action to be faced. In this sense, it is important to know its history and evolution in order, to understand its current situation and the path that must be followed for its control and eradication.
1. Causes of tuberculosis pulmonary
The bacterium Mycobacterium tuberculosis is responsible for this infection, which, in honor of its discoverer, Robert Koch, is also called Koch’s bacillus.
Among humans, it is transmitted through the air, by tiny droplets that contain the causative bacilli and that people with active infection eliminate by coughing, sneezing or speaking.
Unlike what happens with other more contagious pathogens, such as the coronavirus that causes Covid-19, the transmission of the tuberculosis bacillus requires very close and prolonged contact. It is estimated that a sick person can infect about 15 people a year.
2. Incidence
According to WHO estimates, in 2019 10 million people worldwide fell ill with tuberculosis: 5.6 million men, 3.2 million women and 1.2 million children.
The numerology associated with pulmonary tuberculosis includes an impressive fact: around 2,000 million people in the world (close to a quarter of the world population) are infected by the tubercle bacillus. This means that the term “infection” does not always imply “disease” (the number of patients with TB is close to 14 million) and, furthermore, that the immune system of at least 90% of individuals manages to “control” the causal agent, indefinitely or temporarily
3. Tuberculosis pulmonary on global public health
For many years, tuberculosis pulmonary was an incurable and highly fatal disease. However, in the 20th century, it was possible to develop effective treatments that significantly reduced their mortality. Despite medical advances, pulmonary tuberculosis remains a disease that affects millions of people worldwide, especially in low- and middle-income countries.
Although the disease can influence different human tissues, the lungs represent the infected organs in approximately 90% of cases, since the causative remedy is mainly airborne; The bacillus reaches the lung parenchymal and is composed of alveolar macrophages, where it develops slowly but effectively. In the case of immunosuppressed people, the invader is neutralized 2–8 weeks later by intracellularly prevented and captured in the granuloma: activated macrophages surrounded by huge TH1 cells and lymphocytes; The latter gives the stability of the granuloma and ensures that cytokines such as SO inhibition factor of macrophage migration are called. In this case, there is talk of a cousin infection (but not TB), which has no further tissue damage and is generally clinically and radiologically undetected.
4. Risk factor’s
- Birth in an endemic country.
- Living in places with a clear hygiene and sanitation deficit or with overcrowding of people. It is a disease closely linked to poverty.
- Active smoking doubles the chances of tuberculosis pulmonary.
- Alcoholism because it is usually linked to social deterioration, homelessness…
- Poorly controlled diabetes also multiplies between 2 and 4 times the chances of tuberculosis.
- People with weakened immune systems, such as those with HIV/AIDS, are also more at risk. Likewise, those who follow aggressive treatments such as chemotherapy or biological therapies that are used for hematological, dermatological and hematological diseases.
- Malnutrition
- Transmission through food is not frequent, although unpasteurized milk can be a source of contagion in countries where the incidence of tuberculosis is higher. In fact, cattle can also get tuberculosis and transmit the bacteria to humans.
5. Symptoms of tuberculosis pulmonary
- Intense tiredness
- General discomfort.
- Profuse sweating, especially at daylight.
- Weight loss.
- Blood in the sputum.
- Dry, persistent cough.
- Body temperature ranging between 37 and 37.5 degrees. However, sometimes no symptoms appear.
However, sometimes no symptoms appear.
When should I see a doctor?
One of the most important factors to take into account when, detecting whether it is a case of tuberculosis pulmonary, is the duration of the symptoms. If the symptoms last 15 days or more, it’s necessary to see a doctor. There are a good deal of tuberculosis pulmonary that debut with hemoptoic expectoration (expulsion of blood in the cough), which can scare the patient; It must be taken into account that, this symptom can also be caused by a cold, tobacco or other serious diseases such as cancer. Therefore, it is important to control the duration of the symptoms and go to an expert to obtain a diagnosis.
6. How to make the diagnosis?
When the bacilli enter the body, they spread, triggering the host’s immune response, which can be demonstrated by the tuberculin or Mantoux test. This test consists of the intradermal administration, on the front face of the arm, of a protein derivative of the bacillus. 72 hours after its administration, the local reaction generated is assessed.
Pregnant women routinely undergo a skin test to detect the presence of tuberculosis pulmonary (tuberculin skin test). If a positive reaction is observed, a chest x-ray should be performed. Blood tests are also performed to detect the tubercle bacillus.
Children whose mothers have tested positive for tuberculin are also tested for this test. However, some children have false negative results. If tuberculosis pulmonary is suspected, samples of cerebrospinal fluid and fluid from the respiratory tract and stomach are sent to the laboratory for culture.
A chest x-ray usually shows if the lungs are infected. In certain cases it may also be necessary to perform a biopsy of the liver, lymph nodes or lungs and the membrane that surrounds them (pleura) to confirm the diagnosis.
When the diagnosis is positive, it is best to follow the treatment prescribed by the specialist correctly. It is also convenient to recommend to the people in the environment that diagnostic tests be carried out to find out if they have the disease, in a latent or active form.
7. Treatments to consider:
The treatment of tuberculosis is based on the administration for six months (in the future, depending on how you respond to treatment and your ability to resist, it is likely that it can be shortened to three or four months) of a combination of antibiotics:
- Rifampicin.
- Ethambutol.
- Pyrazinamide.
- Isoniazid.
It’s a very effective therapy, but it’s important to do it well, and complete the administration period. Many times, when a patient has symptoms of tuberculosis pulmonary, we start treating him and, in 15 or 20 days, he feels better. If we don’t do an awareness exercise and explain to him that, there are many dormant bacilli, he ends up leaving him.
In patients whose disease is caused by resistant strains of bacteria, second-line antibiotics are administered, such as fluoroquinolones, which are very active against tuberculosis, but resistance to them is also appearing. So, in these patients, the duration of treatment is considerably longer.
In certain cases -mainly when there is a very high risk of developing the disease- a combination of rifampicin and isoniazid is administered for several months to treat latent infection.
8. Tuberculosis pulmonary prevention: A shared responsibility
Prevention involves early detection of the disease, so that transmission can be stopped. It is also important to take action against the most important risk factors.
The WHO recommends vaccination with the BCG vaccine for all newborns in countries with a high incidence of tuberculosis, including it in the infant calendar on a systematic basis. It should be administered only once, since the efficacy of re-vaccination has not been proven. Likewise, it is not recommended for adults who are going to move to high-risk areas, since its efficacy in this field has not been demonstrated either.
Advice for patients
Another of the factors to guarantee healing has to do with the habits that are followed. A tuberculosis pulmonary patient has to eat well (having a varied and balanced diet that provides enough nutrients and energy and that serves to strengthen the immune system), sleep enough and avoid bad habits such as alcoholism, smoking and consumption of drugs, especially heroin.
Tobacco consumption is very harmful for tuberculosis, since if you smoke when you have this disease, the cure is much more complicated, you continue expectorating for much longer and, as it lasts longer, the risk of contagion increases. others.
If the patient is addicted to heroin, complications can make it difficult to cure tuberculosis and worsen the disease. The effects caused by the substance (anemia, weight loss, insomnia), and the habits of the consumers, as well as the development of infections linked to the hygienic conditions of consumption, will make healing more complicated.
To recap:
Tuberculosis pulmonary is a disease that has affected humanity since time immemorial. Its presence has been recorded in the literature and history of various cultures, and its impact on public health has been significant throughout the world. Currently, the fight against tuberculosis pulmonary is a global challenge that requires the cooperation and commitment of governments, civil society organizations, health professionals and the community in general. Prevention and effective treatment of pulmonary tuberculosis are essential to reduce its impact on public health and improve the quality of life of people affected by this disease. If pulmonary tuberculosis (TB) is suspected, the patient should be isolated, a chest X-ray obtained, and three sputum specimens collected for smear and culture of acid-fast bacilli; a nucleic acid amplification test should be performed on at least one respiratory specimen.
