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TYPHOID:
History, Causes, Treatment and Prevention

Definition:
Typhoid fever is caused by Salmonella typhi bacteria. Typhoid fever is rare in industrialized countries. However, it remains a serious health threat in the developing world, especially for children.

Typhoid fever spreads through contaminated food and water or through close contact with someone who’s infected. Signs and symptoms usually include high fever, headache, abdominal pain, and either constipation or diarrhea.

Most people with typhoid fever feel better within a few days of starting antibiotic treatment, although a small number of them may die of complications. Vaccines against typhoid fever are available, but they’re only partially effective. Vaccines usually are reserved for those who may be exposed to the disease or are traveling to areas where typhoid fever is common.

HOW IS TYPHOID FEVER SPREAD?

Salmonella Typhi lives only in humans. Persons with typhoid fever carry the bacteria in their bloodstream and intestinal tract. In addition, a small number of persons, called carriers, recover from typhoid fever but continue to carry the bacteria. Both ill persons and carriers shed Salmonella Typhi in their f***s (stool).
You can get typhoid fever if you eat food or drink beverages that have been handled by a person who is shedding Salmonella Typhi or if sewage contaminated with Salmonella Typhi bacteria gets into the water you use for drinking or washing food. Therefore, typhoid fever is more common in areas of the world where handwashing is less frequent and water is likely to be contaminated with sewage.
Once Salmonella Typhi bacteria are eaten or drunk, they multiply and spread into the bloodstream. The body reacts with fever and other signs and symptoms.

HISTORY

A physician in Paris first described typhoid fever in 1829. The first vaccine to prevent typhoid fever was introduced in 1896. However, availability and widespread use of vaccines against typhoid fever have failed to materialize. As a consequence, especially in developing countries, the disease continues be a significant problem. Before adequate antibiotic therapy was developed, untreated mortality from typhoid fever was 10%-30%. With the advent of modern medicine and antibiotic therapy, mortality has dropped to approximately 1%-4%.

EPIDEMIOLOGY

Typhoid fever occurs worldwide, primarily in developing nations whose sanitary conditions are poor. Typhoid fever is endemic in Asia, Africa, Latin America, the Caribbean, and Oceania, but 80% of cases come from Bangladesh, China, India, Indonesia, Laos, Nepal, Pakistan, or Vietnam. Within those countries, typhoid fever is most common in underdeveloped areas. Typhoid fever infects roughly 21.6 million people (incidence of 3.6 per 1,000 population) and kills an estimated 200,000 people every year.

In the United States, most cases of typhoid fever arise in international travelers.
With prompt and appropriate antibiotic therapy, typhoid fever is typically a short-term febrile illness requiring a median of 6 days of hospitalization. Treated, it has few long-term sequelae and a 0.2% risk of mortality. Untreated typhoid fever is a life-threatening illness of several weeks’ duration with long-term morbidity often involving the central nervous system. The case fatality rate in the United States in the pre-antibiotic era was 9%-13%.

TYPES

Typhoid fever Is caused by a Gram-negative organism Salmonella enterica subspecies enterica serovar Typhi (Salmonella typhi).

1. Paratyphoid fever

Is divided into three subtypes (A, B and C). Paratyphoid fever is caused by any of three serovars of Salmonella enterica subspecies enterica:

* paratyphi A.
schottmuelleri (also called S. paratyphi B).
hirschfeldii (also called S. paratyphi C).
Type A is the most common worldwide, although B predominates in Europe. Type C is rare, and is seen only in the Far East.

The overall ratio of disease caused by S. typhi to that caused by S. paratyphi is about 10 to 1.

RISK FACTORS

Typhoid fever remains a serious worldwide threat especially in the developing world affecting an estimated 26 million or more people each year. The disease is endemic in India, Southeast Asia, Africa, South America and many other areas.

Worldwide, children are at greatest risk of getting the disease, although they generally have milder symptoms than adults do.

If you live in a country where typhoid fever is rare, you’re at increased risk if you:

1. Work in or travel to areas where 2.typhoid fever is endemic
3. Work as a clinical microbiologist 4. handling Salmonella typhi bacteria
5. Have close contact with someone who is infected or has recently been infected with typhoid fever
6. Drinking water contaminated by sewage that contains typhi
Causes.
Typhoid fever is caused by infection with Salmonella typhi. Salmonella typhi is similar to, but not the same as, the Salmonella bacteria that causes food poisoning in the US. Unlike most types of Salmonella, Salmonella typhi only live and reproduce inside humans.

ROUTE OF TRANSMISSION

Salmonella typhi is transmitted via the fecal-oral route. This means that it is spread from person to person when you eat, drink or even touch your mouth with anything contaminated with infected f***s. Because the Salmonella typhi multiply in human intestines, the bacteria is shed in the f***s (solid material passed during a bowel movement).

MODES OF TRANSMISSION

Anything that becomes contaminated with f***s that contain Salmonella typhi has the potential to spread the virus. The following are several ways you can get yellow fever:

Drinking contaminated water
Eating fresh fruits or vegetables that have been washed with contaminated water
Eating food prepared by someone who has not washed their hands thoroughly
Touching your mouth after going to the bathroom, before you wash your hands
Eating seafood harvested from a contaminated body of water (lake, ocean, river)
Having oral or a**l s*x with someone who is infected with the bacteria
High-risk Destinations

Typhoid fever is most common in countries where there is poor sanitation and lack of access to clean drinking water. In these countries it is more likely that infected human f***s contaminate the water supply. In addition, handwashing may not be practiced as frequently as in developed countries (where food establishments require employees to wash hands).

CARRIERS

In some people the bacteria survives in the body even after treatment has effectively relieved their symptoms. These people are considered carriers, because the bacteria continues to be shed through their f***s, so contact with their f***s carries the disease to other people. Carriers don’t realize they are still infected because they don’t have symptoms.

SYMPTOMS

Symptoms usually appear 1 or 2 weeks after infection but may take as long as 3 weeks to appear. Typhoid usually causes a high, sustained fever, often as high as 40°C (104°F), and extreme exhaustion.

Other common symptoms include:

1. Constipation
2. Cough
3. Headache
4. Loss of appetite
5. Stomach pains
6. Sore throat
7. Rarer symptoms include:

Bleeding from the re**um

1. Delirium
2. Diarrhea
3. Temporary pink spots on the chest and abdomen
In some people, signs and symptoms may return up to two weeks after the fever has subsided.

COMPLICATIONS

Serious complications of typhoid fever usually occur only in people who have not been treated or are treated late in the illness. Complications tend to develop during the third week of infection. The two most serious complications of typhoid fever are INTESTINAL BLEEDING AND INTESTINAL PERFORATION.

INTESTINAL BLEEDING

Without treatment the bacteria continue to multiply in the intestines. Intestinal bleeding as a potential complication. The seriousness of the complication depends on the severity of the bleeding– how much blood is lost and how quickly. The first sign of intestinal bleeding can be a sudden drop in blood pressure. The following are symptoms of intestinal bleeding:

Fatigue
Shortness of breath
Pale skin
Irregular heartbeat
Vomiting blood
Blood in stools (stools appear dark and tar-like)
Intestinal bleeding may require a blood transfusion to replace blood loss.

INTESTINAL PERFORATION

Intestinal perforation is always a life-threatening complication. A perforation occurs when a hole develops in the walls of the intestines. The contents of the intestines then leak out through the hole and collect in the abdominal cavity. Perforation essentially lets the bacteria loose inside the body. The peritoneum is the lining of the abdominal cavity. Intestinal perforation can cause inflammation or infection of the peritoneum, a condition known as peritonitis. The following are signs and symptoms of intestinal perforation:

Severe abdominal pain
Nausea
Vomiting
Sepsis (infection in the bloodstream)
Intestinal perforation is a medical emergency and requires immediate medical attention.
Diagnosis and test
Diagnosis includes questions about travel, examining blood, stool or bone marrow for evidence of infection, and additional testing to determine the particular strain of Salmonella typhi that is causing the illness.

PREVENTION

Preventing typhoid is all about avoiding contaminated food and water. The same healthy practices will also help protect you from diseases such as cholera and hepatitis A, which are transmitted in the same way. Follow these guidelines to minimize your risk:

1* Boil or disinfect all water before drinking it – use disinfectant tablets or liquid available in pharmacies or drink commercially bottled (preferably carbonated) beverages.

2* Peel all fruit and vegetable skins before eating.

3* Keep flies away from food.

4* Watch out for ice cubes, ice cream, and unpasteurized milk, which can easily be contaminated.
Cook all food thoroughly and eat it while it’s hot.

5* Be aware of the “danger foods” shellfish, salads, and raw fruit and vegetables.

6* Do not eat food or drink beverages from street vendors.

At present, vaccinations against typhoid provide about 50% protection for 3 to 7 years – the duration of protection depends on the vaccine used. The vaccine is available as an oral capsule and as an injection. Your doctor will determine what form is best for you or your children.

NOTE:....... Even vaccinated people must follow the food safety tips listed above. It is best to be immunized at least 7 to 14 days before possible exposure (depending on the vaccine used).

And the outreach was a success!

CERVICITIS - Definition, Types, Causes, and Treatment.

DEFINITION

The cervix is placed at the closure of the uterus, arriving at into the va**na. The point when the exterior tissues of the cervix get inflamed, more often than not through infection, this is called cervicitis. About 50% of all ladies will experience one session or a greater amount of cervicitis in their lifetimes. Cervicitis has several causes.

Cervicitis is an irritation of the cervix the easier part of the uterus expanding about an inch into the va**nal waterway. Most ordinarily, cervicitis is the infection, despite the fact that it can additionally be initiated by harm or irritation (a response to the chemicals in douches and contraceptives, for instance, or a disregarded tampon).

The foremost symptom of cervicitis is prone to be a va**nal discharge that comes to be more declared quickly emulating your menstrual period. Different signs include bleeding, itching, or irritation of the external ge****ls; pain throughout in*******se; a burning sensation throughout urination; and lower back pain. In its mildest form, you may not perceive any side effects whatsoever, yet a more intense instance of cervicitis can make a bountiful, practically discharge like, and discharge with an upsetting smell, joined by compelling va**nal irritation or stomach pain. Provided that the spoiling gets into your framework, you might additionally have fever and nausea.

TYPES
Cervicitis is classified according to the following types:

1. ACUTE CERVICITIS

Manifestations of the acute form of the disease are expressed significantly. The patient is concerned with purulent or abundant mucosal leucorrhoea, va**nal itching and burning, which are intensified by urination. Also may be painful in cervicitis. Usually, it is a dull or aching pain in the lower abdomen, a painful in*******se. Other symptoms of the disease are due to concomitant pathology. If the inflammatory process of the cervix has arisen against the background of cystitis, worries about frequent and painful urination. With adnexitis and inflammatory process in the cervix, there is an increase in temperature from subfebrile (above 37) to febrile digits (38 and above). With the combination of pseudo-erosion and cervicitis, spotting after coition may appear. A distinctive feature of the disease is the aggravation of all clinical symptoms after menstruation.

2. CHRONIC CERVICITIS

The disease, which was not adequately treated on time in an acute stage, is chronic. Symptoms of chronic cervicitis are less or less pronounced. The discharge acquires a turbid-mucous character, the flat epithelium of the va**nal part of the cervix is replaced by a cylindrical cervical channel, and pseudo-erosion of the cervix is formed. Inflammatory phenomena (redness and swelling) are poorly expressed. When the inflammation spreads to the surrounding tissues and into the interior, the cervix becomes denser, it is possible again to replace the cylindrical epithelium with the ectopia, which is accompanied by the formation of the set cysts and infiltrates.

RISK FACTORS

You may be at higher risk for cervicitis if you:

1. Had recent s*xual in*******se without a condom
2. Recently had multiple s*xual partners
3. Have had cervicitis before
Studies show that cervicitis will recur in 8% to 25% of women who get it.

CAUSES

There are quite a few reasons for the emergence of cervicitis.
1. The most common are a variety of infections of the ge****ls, which include both venereal diseases
Gonorrhea
Chlamydia Etc.
and
Ge***al
Herpes
Candidiasis
Human Papillomavirus.

2. The next cause of cervicitis is TRAUMA CERVIX - this is caused as a result of frequent s*xual acts or the use of tampons during menstruation. Because of minor damage, the cervix becomes exposed to infectious processes.
Often cervicitis is diagnosed in women who started s*xually early or often change partners. Thus, these factors can also be called the causes of the appearance of the disease.

3. The last cause of cervicitis is MECHANICAL DAMAGES of the cervix, which may result from an abortion, a diagnostic curettage, or the installation of a contraceptive spiral.

SYMPTOMS

Some cases of cervicitis in women can be symptomless. However, in most cases, symptoms are present, and they include:

1. Persistence of gray or white va**nal discharge that may or may not smell
2. Vaginal bleeding under certain conditions e.g. in between periods or after s*x
3. Pain during in*******se
4. A backache
5. Difficulty or pain during urination
In rare cases, fever or pain in the abdomen

COMPLICATIONS

Untreated cervicitis can give rise to a host of other problems, particularly if the underlying cause is an infection. Some potential complications are listed below:

1. Having cervicitis is associated with a higher risk of contracting HIV infection.
2. If the patient is already HIV positive, having cervicitis can increase the probability of transmitting the virus to their partners.
3. This is the inflammation of the endometrium or inner lining of the uterus.
4. Inflammation of the fallopian tubes. This is known as salpingitis.
Pelvic Inflammatory Disease (PID), a severe condition that could leave the reproductive system permanently damaged.
5. Infertility.
6. Neonatal infections and other problems due to exposure of the fetus to infection while passing through the birth ca**l.
7. Cervicitis may also be implicated in giving rise to cervical cancer.

NOTE.........

Avoiding s*xual in*******se is important until the completion of treatment and until the chronic cervicitis is completely resolved. It is also important to treat the patient’s partner if the cause of chronic cervicitis is a s*xually transmitted infection.

PREVENTION

Things you can do to reduce your risk of developing cervicitis include:


1* Avoid irritants such as douches and deodorant tampons.

2* Make sure that any foreign objects you insert into your va**na (such as tampons) are properly placed. Be sure to follow instructions on how long to leave it inside, how often to change it, or how often to clean it.

3* Abstain casual s*x. Abstinence is key to avoiding any STI

4* Make sure your partner is free of any STI. You and your partner should not have s*x with any other people.

5* Use a condom every time you have s*x to lower your risk of getting an STI. Condoms are available for both men and women but are most commonly worn by the man. A condom must be used properly every time.

Epilepsy: Definition, Complications and Treatment.

DEFINITION

Epilepsy is defined as the repeated occurrence of sudden, excessive and/or synchronous discharges in cerebral cortical neurons resulting in disruption of consciousness, disturbance of sensation, movements, impairment of mental function, or some combination of these signs. Because of their sudden nature, seizures are called ictal events, from the Latin ictus meaning ‘to strike’. The terms epilepsy, seizure and convulsion are not synonymous.

TYPES OF EPILEPTIC SEIZURES

There are three diagnoses a doctor might make when treating a patient with epileptic seizures:

* Idiopathic – this means there is no apparent cause.
* Cryptogenic – this means the doctor thinks there is most probably a cause, but cannot pinpoint it.
* Symptomatic – this means that the doctor knows what the cause is.

There are three descriptions of seizures, dependant on what part of the brain the epileptic activity started:

1. Partial seizure

A partial seizure means the epileptic activity took place in just part of the patient’s brain. There are two types of partial seizure:

2. Simple partial seizure – the patient is conscious during the seizure. In most cases, the patient is also aware of their surroundings, even though the seizure is in progress.

3. Complex partial seizure – the patient’s consciousness is impaired. The patient will generally not remember the seizure, and if they do, their memory will be vague.
Generalized seizure

4. A generalized seizure occurs when both halves of the brain have epileptic activity. The patient’s consciousness is lost while the seizure is in progress.

5. Tonic-clonic seizures (previously known as grand mal seizures) – these are perhaps the best known type of generalized seizure. They cause a loss of consciousness, body stiffness, and shaking.

6. Absence seizures (previously called petit mal seizures) – these involve short lapses in consciousness where the individual appears to be staring off into space. Absence seizures often respond well to treatment.

7. Tonic seizures – muscles become stiff. They may cause a fall.
Atonic seizures – loss of muscle control, causing the individual to drop suddenly.

Clonic seizures – associated with rhythmic, jerking movements.
Secondary generalized seizure

A secondary generalized seizure occurs when the epileptic activity starts as a partial seizure, but then spreads to both halves of the brain. As this development happens, tancient descriptions and concepts

ANCIENT DESCRIPTIONS AND CONCEPT

Srliest detailed account of epilepsy is in the British Museum, London. It is part of a Babylonian text on medicine, Sakikku [All diseases], which was written over 3000 years ago, i.e. before 1000 BC. I have had the privilege of working with a Babylonian scholar, James Kinnier Wilson, on the translation of this text.

The Babylonians were keen observers of clinical phenomena and provide remarkable descriptions of many of the seizure types (miqtu) that we recognize today, including what we would call tonic clonic seizures, absences, drop attacks, simple and complex partial seizures and even focal motor (Jacksonian) or gelastic attacks. They also understood some aspects of prognosis, including death in status as well as post-ictal phenomena. The Babylonians had no concept of pathology, however, and each seizure type was associated with invasion of the body by a particular named evil spirit. Thus treatment was not medical but spiritual.

Interestingly, Hippocrates also had some notion that epilepsy could become chronic and intractable if not treated early and effectively, although it is not clear exactly what treatments he had in mind: “Moreover it can be cured no less than other diseases so long as it has not become inveterate and too powerful for the drugs which are given. When the malady becomes chronic, it becomes incurable.” Unfortunately the Hippocratic concept of a treatable brain disorder had little influence on the prevailing supernatural view, as is well described in the scholarly history of epilepsy from the Greeks to the late 19th century by Temkin.

Incidence and prevalence
The incidence (the number of new cases per year) of epilepsy is 24–53 per 100 000 population in developed countries. There are few incidence studies in developing countries, none of which is prospective: they show rates from 49.3 to 190 per 100 000 population. Higher incidence rates in developing countries, thought to be attributable to parasitosis particularly neurocysticercosis, HIV, trauma, perinatal morbidity and consanguinity, are difficult to interpret because of methodological issues, particularly the lack of age adjustment, which is important because epilepsy has a bimodal peak with age. Incidence rates worldwide are greater in men than women. In developed countries, incidence among the elderly is rising and among children it is falling. This is relevant to developing countries as longevity rises and risk of cerebrovascular disease increases. Conversely, better obstetric care and infection control can diminish incidence in children.

The prevalence (the total number of cases at a particular point in time) of active epilepsy in a large number of studies has been shown to be fairly uniform at 4–10 per 1000 population. Higher prevalences in sub-Saharan Africa and Central and South America have been reported, possibly due to methodological differences, consanguinity or environmental factors and particularly so in rural areas. It is difficult to tease out racial and socioeconomic factors. Prevalence data are primarily used by health planners and for generating aetiological hypotheses.

SOME CAUSES OF EPILEPSY

In the majority of cases, no cause for epilepsy can be found and it is described as idiopathic. There are, however, a number of recognized factors that increase a person’s risk of developing epilepsy. These include:

Brain scarring or brain damage, e.g. due to birth injuries, accidents, physical assaults, excessive use of alcohol/drugs
Infections and fevers, e.g. meningitis, rubella, encephalitis, AIDS.

Benign and malignant tumours
Genetic factors, e.g. tuberous sclerosis
Dementia and neurodegenerative disorders, e.g. Alzheimer’s disease
Stroke, which can occur at any age
Parasitic infections, e.g. malaria
Developmental disorders – for instance, autism or neurofibromatosis
Genetics

RISK FACTORS

Sometimes a risk factor can cause scarring of the brain or lead to areas of the brain not developing or working right. Risk factors include:

1. Babies who are born small for their age

2. Babies who have seizures in the first month of life

3. Babies who are born with abnormal areas in the brain
Bleeding into the brain

4. Abnormal blood vessels in the brain

5. Serious brain injury or lack of oxygen to the brain

6. Brain tumors

7. Infections of the brain: abscess, meningitis, or encephalitis

8. Stroke resulting from blockage of arteries

9. Cerebral palsy

10. Conditions with intellectual and developmental disabilities

11. Seizures occurring within days after head injury (“early posttraumatic seizures”)

12. Family history of epilepsy or fever-related seizures
Alzheimer’s disease (late in the illness)

13. Autism spectrum disorder
Fever-related (febrile) seizures that are unusually long

14. Long episodes of seizures or repeated seizures called status epilepticus

15. Use of illegal drugs such as co***ne

16. Mild head injuries, such as a concussion with just a very brief loss of consciousness, do not cause epilepsy. Yet the effects of repeated mild head injuries and epilepsy is unknown.

EPILEPSY SYMPTOMS

The main symptom of epilepsy is repeated seizures. If one or more of the following symptoms are present, the individual should see a doctor, especially if they recur:

* A convulsion with no temperature (no fever)

* Short spells of blackout, or confused memory
Intermittent fainting spells, during which bowel or bladder control is lost, which is frequently followed by extreme tiredness

* For a short period, the person is unresponsive to instructions or questions

* The person becomes stiff, suddenly, for no apparent reason

* The person suddenly falls for no clear reason

* Sudden bouts of blinking without apparent stimuli

* Sudden bouts of chewing, without any apparent reason

* For a short time the person seems dazed and unable to communicate

* Repetitive movements that seem inappropriate

* The person becomes fearful for no apparent reason; they may even panic or become angry

* Peculiar changes in senses, such as smell, touch, and sound

* The arms, legs, or body jerk, in babies these will appear as a cluster of rapid jerking movements

COMPLICATIONS OF EPILEPSY

1. If you fall during a seizure, you can injure your head or break a bone.

2. If you have epilepsy, you’re 15 to 19 times more likely to drown while swimming or bathing than the rest of the population because of the possibility of having a seizure while in the water.

3. Car accidents. A seizure that causes either loss of awareness or control can be dangerous if you’re driving a car or operating other equipment.

4. Pregnancy complications. Seizures during pregnancy pose dangers to both mother and baby, and certain anti-epileptic medications increase the risk of birth defects. If you have epilepsy and you’re considering becoming pregnant, talk to your doctor as you plan your pregnancy.

5. Emotional health issues. People with epilepsy are more likely to have psychological problems, especially depression, anxiety and, in extreme cases, su***de. Problems may be a result of difficulties dealing with the condition itself as well as medication side effects.

6.Sudden unexplained death in epilepsy (SUDEP).People with epilepsy also have a small risk of sudden unexplained death. The cause is unknown, but some research shows it may occur due to heart or respiratory conditions.

PREVENTION AND CONTROL OF EPILEPSY

Here are some tips that may help reduce your risk of having an epilepsy seizure:

1* Get plenty of sleep each night — set a regular sleep schedule, and stick to it.

2* Learn stress management and relaxation techniques.

3* Avoid drugs and alcohol.

4* Take all of your medications as prescribed by your doctor.

5* Avoid bright, flashing lights and other visual stimuli.

6* Skip TV and computer time whenever possible.

7* Avoid playing video games.
Eat a healthy diet.

TUBERCULOSIS (TB) – CAUSES, SYMPTOMS, TREATMENT AND PREVENTION

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.

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:

1. Fever

2. Chills

3. Night sweats

4. Cough

5. Loss of appetite

6. Weight loss

7. Blood in the sputum (phlegm)

8. 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.

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.

1* 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.

2* 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.

3* 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.

4* 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.

5* 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.