Content

• To step
• Part 1 of 3: Knowing the risk factors
• Part 2 of 3: Recognizing the signs and symptoms of TB
• Part 3 of 3: Getting tested for TB
• Tips

Tuberculosis (TB) is a disease caused by a bacterium (Mycobacterium tuberculosis) that can be transmitted from person to person via the air. TB usually affects the lungs (the place where the bacteria often first settle), but can in principle spread to any organ. In the latent form, the bacteria dormant without signs or symptoms, while in the active form, signs and symptoms are experienced. Most TB infections remain dormant. If you don't treat TB or treat it properly, it can be deadly, so it's important to learn to recognize its signs.

To step

Part 1 of 3: Knowing the risk factors

1. Know the areas in which you can contract TB. If you live or travel in these areas, or even if you only come into contact with people who live or have traveled there, you are at risk for TB. In many parts of the world, preventing, diagnosing, and treating TB is difficult because of poor health care, financial constraints, or overcrowding. As a result, TB can go unnoticed and untreated for a long time, allowing it to spread. Even when traveling by plane to and from these areas, you can contract the bacteria due to poor ventilation.
   • Countries in Africa south of the Sahara
   • India
   • China
   • Russia
   • Pakistan
   • South East Asia
   • South America
2. Assess your working and living conditions. In places where many people congregate, and in places with poor ventilation, bacteria can be more easily transferred from person to person. A bad situation can get worse when those around you don't have access to good healthcare. Places to be careful include:
   • Prisons
   • Immigration offices
   • Nursing homes
   • Hospitals / clinics
   • Refugee camps
   • Homeless shelter
3. Think about your own immune system. If you have a disease that has weakened your immune system, it can be problematic. If your immune system isn't working properly, you are susceptible to all kinds of infections, including TB. These types of conditions include:
   • HIV / AIDS
   • Diabetes
   • End stage of kidney disease
   • Cancer
   • Malnutrition
   • Age (young children have a less developed immune system, just like the elderly).
4. Consider whether you are taking any medications or drugs that can affect your immune system. Drug abuse, including alcohol, tobacco, and other substances, can affect your body's defense system. And in addition to putting you at a higher risk of TB due to certain types of cancer, chemotherapy can also weaken your immune system. Long-term use of steroids and medications to keep you from rejecting a transplanted organ can have the same effect. Medicines for autoimmune diseases such as rheumatoid arthritis, Lupus disease, intestinal diseases (Crohn's and ulcerative colitis) and psoriasis can also affect the immune system.

Part 2 of 3: Recognizing the signs and symptoms of TB

1. Watch for unusual coughing. TB usually infects the lungs and breaks down the tissue there. The body's natural response is to cough to get rid of irritants. Think about how long you've been coughing; TB usually lasts longer than 3 weeks and can be accompanied by worrying signs such as coughing up blood.
   • Think about how long you've been taking over-the-counter cough remedies or antibiotics without helping. For TB, you need very specific antibacterial agents, and in order to get started, you must first establish that you actually have TB.
2. Watch for phlegm when you cough. Do you notice that you are coughing up phlegm? If it stinks and is dark in color, it could be a bacterial infection. If the mucus is clear and odorless, it could be a viral infection. Also check for blood in the mucus when you cough into your hand or tissue. If cavities and nodules form in your lungs due to TB, nearby blood vessels can become damaged, causing you to cough up blood.
   • Always go to the doctor if you are coughing up blood. He / she can then tell you what the next steps are.
3. Feel if you have chest pain. Chest pain can indicate a variety of conditions, but if you have it along with other symptoms, it could be TB. If you feel sharp pain, it can be traced to a specific place. Notice if it hurts especially when you push the area, or when you breathe or cough.
   • In TB, hard cavities and nodules form on the wall of the lungs or chest. When you breathe, they can damage the environment, causing inflammation. The pain is usually sharp, the spot where it hurts can be pinpointed and it hurts more when you push it.
4. Pay attention to whether you lose weight or have no appetite. The body reacts very complexly to the Mycobacterium tuberculosis bacteria, resulting in poor absorption of nutrients and altered protein digestion. These changes can have been going on for months without you realizing.
   • Look in the mirror for changes in your body. If you see your bones, it could mean that you do not have enough muscle mass due to a shortage of proteins and fats.
   • Weigh yourself. Compare your weight to a recent weight when you were still feeling healthy. Your weight may fluctuate, but if you have suddenly lost a lot of weight, you should see a doctor.
   • Notice if your clothes are getting too loose.
   • Keep track of how often you eat, and compare that to how much you ate when you recently felt healthy.
5. Don't ignore fever, chills, and night sweats. Bacteria reproduce at a normal body temperature (37ºC). The brain and immune system respond to this by raising the body temperature so that the bacteria can no longer reproduce. The rest of the body notices the change and tries to lower the temperature again by contracting the muscles (chills), making you feel feverish. TB also causes specific inflammatory proteins to be produced that help in the development of fever.
6. Be aware of latent TB infection. A latent TB infection is dormant and does not cause infections. The bacteria is then in the body without causing any harm. The disease can become active in people with a weakened immune system, as described above. It can also occur as a person gets older, making the immune system weaker. Reactivation can also occur for other, unknown causes.
7. Be able to distinguish TB from other respiratory infections. There are many other conditions that can be confused with TB. It is not good to wait for a simple cold to pass when actually something serious is going on. To know the difference between TB and other diseases, ask yourself the following questions:
   • Is clear mucus dripping from my nose? With a cold, the nose and lungs can become inflamed or blocked, causing mucus to come out of the nose. TB does not cause a runny nose.
   • What am I coughing up? A viral infection or the flu often includes a dry cough or a cough with white mucus. A bacterial infection of the lower respiratory tract often has brown mucus. If you have TB, you often cough for more than 3 weeks, and you may also cough up blood.
   • Do I sneeze? You don't have to sneeze from TB. This is usually a sign of a cold or flu.
   • Do I have a fever? TB can cause both high and low fevers, but when you have the flu, your temperature is usually above 38ºC.
   • Are my eyes watery / itchy? These symptoms are associated with a cold, but not with TB.
   • Do I have a headache? The flu usually comes with a headache.
   • Do I have pain in my joints and / or muscles? Colds and flu can cause this.
   • Do I have a sore throat? Look down your throat and see if it is red and swollen. This symptom mainly occurs with a cold, but also with the flu.

Part 3 of 3: Getting tested for TB

1. Know when to seek immediate medical attention. Certain signs and symptoms require immediate medical attention. Even if these symptoms do not result in a diagnosis of TB, they may indicate another serious condition. Many illnesses, both harmless and dangerous, can cause chest pain, but you should always take them to the doctor so they can get an ECG.
   • Persistent weight loss can indicate malnutrition or cancer.
   • In combination with coughing up blood, weight loss can also indicate lung cancer.
   • A high fever and chills can also be caused by septicemia, although this usually also causes a rapid drop in blood pressure, dizziness, delirium and a high heart rate. If left untreated, it can be fatal or lead to serious disorders.
   • Doctors will give antibiotics through an IV and draw blood to determine the number of white blood cells (immune cells that fight infection).
   • Knowing how to care for someone with delirium can be difficult, but understanding the condition better can help you avoid common mistakes.
2. Get tested for latent TB. Even if you don't suspect you have TB, there are instances when you should get tested for it. For example, if you are going to work in healthcare, you have to get tested annually. If you are traveling to a country where you are at high risk, or if you are from there, you should also get tested. Even if you work or live with a lot of people in poorly ventilated areas, or if you have a weakened immune system, it is good to have an examination. Make an appointment with your doctor and request a TB test.
   • Latent TB infection does not cause symptoms or disease and cannot be passed on to others. Five to ten percent of people with a latent TB infection will eventually develop TB.
3. Ask for a Mantoux test. This test is also referred to as a PPD or skin reaction test. The doctor cleans a piece of skin with a cotton ball, and then injects a small amount of tuberculin (a protein mixture obtained from the bacteria Mycobacterium bovis and Mycobacterium avium) under the skin. A small bubble will form due to the injected liquid. The area should not be covered with a band-aid as this could displace the liquid. Let the liquid absorb in a few hours.
   • If you have antibodies against TB, they will respond to the tuberculin and cause swelling or thickening.
   • Know that the redness is not being watched, but the size of the bulge. After 48 to 72 hours, go back to the doctor to have the swelling measured.
4. Understand how to interpret the results. There are a maximum size for the swelling to be considered negative for different categories of people. Any swelling greater than that indicates the patient has TB. If you have no risk factors for TB, a swelling of up to 1.5 cm is considered a negative result. However, if risk factors apply, as described earlier in this article, a swelling of up to 1 cm is considered negative. If any of the following applies to you, a swelling of up to 0.5 cm will result in a negative result:
   • Medicines that suppress the immune system, such as chemotherapy
   • Chronic steroid use
   • HIV infection
   • Close contact with someone who has TB
   • Patients who have had an organ transplant
   • People in whom scar tissue is visible on an X-ray
5. Ask for an IGRA blood test, instead of the Mantoux test. IGRA stands for "interferon gamma release assay", and this blood test is more accurate and faster than the Mantoux test. However, it is more expensive. If your doctor wants to do this test, he will draw blood and send it to the lab. The results will be there within 24 hours. If there are a lot of interferons in your blood, it indicates that you have TB.
6. Have additional tests performed if the test result is positive. If the result of the Mantoux test or the blood test is positive, this indicates in any case a latent TB infection. To determine if you have active TB, the doctor will order an X-ray and initiate preventive treatment. An abnormal X-ray in addition to a positive skin or blood test indicates active TB.
   • The doctor may also take a culture of your mucus. A negative result indicates latent TB infection and a positive result for TB.
   • Note that collecting mucus from babies and young children can be difficult, so the diagnosis in children is usually made without this test.
7. Follow your doctor's advice after diagnosis. If the X-ray and mucus culture confirm that you have active TB, your doctor will prescribe multiple medications. However, if the X-ray is negative, the diagnosis is latent TB. Follow your doctor's directions to prevent latent TB from turning into active TB. Tuberculosis is a notifiable disease. Laboratory and attending physician report to the GGD within 1 working day
8. Consider getting the Bacillus Calmette-Guérin (BCG) vaccine. The BCG vaccine can reduce the risk of getting TB, but it cannot completely prevent it. The BCG vaccination will cause a false positive on the Mantoux test, so if you have been vaccinated and you suspect you have TB, you should get an IGRA test.
   • In the Netherlands, not everyone is vaccinated with BCG, only risk groups.

Tips

• TB can be spread by coughing and sneezing.
• Not everyone infected with TB gets sick. Some people have latent TB; although these individuals are not contagious, they can become ill much later in life when their immune systems are weakened. It's also possible to have latent TB and never get sick.
• Due to the increased immigration in the last two decades, the downward trend of tuberculosis in the Netherlands came to a halt around 1987. Since then, there has been a gradual increase until 1994 (1811 patients), after which the trend fell again to 867 patients in 2015 (= 5.1 / 100,000).
• Miliary TB can have the same symptoms as normal TB, as well as specific signs and symptoms in other organs.
• It is important to note that, although it is uncommon, even people who have latent TB and have been treated can test positive for TB. This result should be evaluated by your doctor.
• BCG (bacillus calmette-guerin) vaccines may give a false positive in the Mantoux test. An X-ray is then required.
• People with miliary TB must undergo multiple examinations, including an MRI scan of the organ suspected of being infected and a biopsy.
• People who have been vaccinated with BCG and have had a false positive Mantoux test are recommended to take an IGRA test.
• In children under the age of 5, the Mantoux test is preferable to the IGRA test, because not enough research has been done on this.