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With appropriate
antibiotic treatment,
tuberculosis can be
cured in more than nine out of ten
tuberculosis patients.
Successful tuberculosis
treatment depends on close
cooperation between the patient and doctor
and other health care workers.
Tuberculosis treatment usually combines several different
antibiotic drugs which are given for at
least six months, sometimes for as long as
12 months.
Tuberculosis
patients must take their medicine on time
every day for the 6 to 12 months.
Some tuberculosis patients stop
taking their prescribed medicines because
they may feel better after only a couple of
weeks of treatment. Another reason they may
stop taking their medicine is because
tuberculosis drugs can have unpleasant
side effects.
Why is it so important to finish all of the tuberculosis medicine?
If
tuberculosis patients
don't take all their medicine the way their
doctor tells them, they can become sick
again and spread tuberculosis to their
friends and family. Additionally,
when
tuberculosis patients do not take all the drugs the
doctor has prescribed or skip times when
they are supposed to take them, the tuberculosis bacteria learn to outwit the
tuberculosis antibiotics, and soon those
medications no longer work against the
disease. If this happens, the person now has resistant tuberculosis infection. Some
patients have disease that is resistant to
two or more drugs. This is called multidrug-resistant
tuberculosis or MDR-tuberculosis because the
tuberculosis germ,
M.
tuberculosis
resists eradication with more than drug.
This form of tuberculosis is much more
difficult to cure.
Tuberculosis
Treatments
Treatment for MDR-tuberculosis often requires the use of
special drugs, all of which can
produce serious side effects. To cure MDR-tuberculosis,
patients may have to take several
antibiotics, at least three to which the
bacteria still respond, every day for up to
two years. However, even with this treatment, between four and six out of ten
patients with MDR-tuberculosis will die,
which is the same as for patients with
normal tuberculosis who do not receive
treatment.
How is tuberculosis prevented?
Tuberculosis
is largely a preventable disease. In the
United States, doctors try to identify
persons infected with
M.
tuberculosis
as early as possible, before they have
developed
active tuberculosis. They will
give a drug called isoniazid (INH) to
prevent the active disease. This drug is
given every day for 6 to 12 months. INH can
cause hepatitis in a small percentage of
patients, especially those older than 35
years. A nurse may watch the patients take
their medicine to make sure all pills are
taken.
Hospitals and
clinics can take precautions to prevent the
spread of tuberculosis. Precautions include
using ultraviolet light to sterilize the
air, special filters, and special
respirators and masks. Until they can no
longer spread the tuberculosis germs,
the patients in hospitals should be
isolated in special rooms with controlled
ventilation and airflow.
Is there a vaccine for Tuberculosis?
In those
parts of the world where tuberculosis is
common, the World Health Organization (WHO)
recommends that infants receive a vaccine
called BCG made from a live weakened
bacterium related to
M.
tuberculosis. BCG vaccine prevents
M.
tuberculosis
from spreading within the body, thus
preventing the desease from developing.
However, the
vaccine has its drawbacks. It does not
protect adults very well against
tuberculosis. In addition, BCG interferes
with the tuberculosis skin test, showing a
positive skin test reaction in people who
have received BCG vaccine. In countries
where BCG vaccine is used, the ability of
the skin test to identify persons that are
infected with
M.
tuberculosis is
limited. Because of these limitations, more
effective vaccines are needed and BCG is not
recommended for general use in the United
States.
How is M.
tuberculosis infection
different in people with
HIV infection?
The World
Health Organization (WHO) estimates that
10
million people worldwide are infected with
the M.
tuberculosis bacterium and
HIV virus at the same time. The primary
cause of death in these patients is from
tuberculosis, not
AIDS. In the United
States, it is estimated that about
2 out of
ten persons who have tuberculosis are also
infected with
HIV.
One of the
first indications that a person is infected
with HIV may be that he or she suddenly
develops tuberculosis. This form of
tuberculosis often occurs in areas outside
the lungs, particularly when the patient is
in the later stages of
AIDS.
In the United
States, it is much more likely for persons
infected with
M.
tuberculosis and
HIV to develop
active tuberculosis than it
is for someone that is only infected with
M.
tuberculosis. However,
the disease can be prevented and
cured, even in people with
HIV infection.
People with MDR-tuberculosis that are also infected with
HIV appear to have a more rapid and deadly
disease course than do those patients with MDR-tuberculosis who are otherwise healthy.
If no medicines are available for these
patients as many as eight out of ten may
die, often within months of diagnosis.
Diagnosing
tuberculosis in
HIV-infected people is often
difficult.
HIV infected patients frequently
have disease symptoms similar to those of
tuberculosis, and may not react to the
standard tuberculosis skin test because
their immune system does not work properly.
X-rays, sputum tests, and physical exams may
also fail to provide evidence of infection
with M.
tuberculosis in
HIV-infected individuals.
How is research helping the fight against
Tuberculosis?
Tuberculosis research supports not only studies to better
understand how
M.
tuberculosis
infects and causes the disease in humans but
also how the human immune system responds to
it. This research will help to develop new
tools to diagnose tuberculosis, find better
vaccines, and new medicines against it. Below are some important
advances that have been made in its
research:
Tuberculosis
Diagnosis:
Potential new tests to speed the diagnosis
of tuberculosis from four weeks to two days;
differences found in the DNA of
M.
tuberculosis and the bacterium used in
the BCG vaccine may lead to a test to tell
the difference between people who really
have tuberculosis and those who only react
to previous BCG vaccination.
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