Symptoms and treatment of tuberculosis

Tuberculosis, which in layman's language is called the "lung spots" is a multisystemic disease with clinical forms are manifold. Tuberculosis is the most common cause of death worldwide related to infectious diseases. The disease is becoming more increasingly around the world, especially in developing countries. In addition, the prevalence of TB resistant (impervious) to drugs is also increasing worldwide. Ketidakmempanan antibiotics against tuberculosis caused by their co-infected with human immunodeficiency virus (HIV) which is now increasingly widespread. Thus, the regimen early detection of HIV and tuberculosis cross each other, ie, patients suffering from tuberculosis shall be checked for HIV, and patients affected by HIV are required to be checked for TB. For a discussion of HIV itself is discussed separately.

Cause

The cause lung plek are Mycobacterium tuberculosis, rod-shaped (bacillus) acid-resistant. These bacteria spelled "recalcitrant" for not just lodged in the lungs, but also in organs other than the lungs, ranging from the lining of the brain to the bone.

Signs and symptoms

It should be emphasized that the signs and symptoms of tuberculosis in children and adults are very different.
In children, there should be no cough, but if seumah or no history of exposure to tuberculosis people, and the child is impaired growth, decreased appetite, fever nglemeng for 2 weeks, then you should test Mantoux test at the nearest health center.

Whereas in adults, the classic clinical features associated with active pulmonary TB are as follows:

• Cough
• Weight loss / anorexia
• Fever
• night sweats
• Hemoptysis / coughing up blood
• Chest pain (also can result from acute pericarditis tuberculosis)
• Fatigue

Besides the lungs, TB can "stroll" to other organs such as the lining of the brain, is called TB meningitis, bone called Pott's disease, organ into the urinary tract, to the joints, and so on. It relies on the durability and speed of diagnosis among patients.

Symptoms of TB meningitis may include the following:

• Headache intermittent or continuously for 2-3 weeks
• Mild mental status changes that may progress to coma over a period of days to a matter of weeks
• Fever is not too high

Symptoms of TB of bone, called Pott's disease:

• Back pain or stiffness backs
• Paralysis of the lower limbs down, as many as half of patients with the disease undiagnosed Pott
• Arthritis tuberculosis, usually involve only one joint (most commonly the hip or knee, followed by ankle, elbow, wrist, and shoulder)

Genitourinary tuberculosis symptoms may include the following:

• Low back pain
• dysuria
• Frequent urination
• In men, the mass of scrotal pain, prostatitis, orchitis, epididymitis or
• In women, symptoms such as pelvic inflammatory disease

Gastrointestinal symptoms of TB which refers to infected sites and may include the following:

• Nonhealing ulcers in the mouth or anus
• Difficulty swallowing (with esophageal disease)
• Abdominal pain mimicking peptic ulcer disease (infection of the stomach or duodenum)
• Malabsorption (infection of the small intestine)
• Pain, diarrhea, or hematochezia (infection of the colon)

If it found any of these symptoms, immediately consult a doctor. Later, the doctor will examine a series of anamnesis (interview) and physical examination. Physical examination findings associated with TB depends on the organ involved. Patients with pulmonary TB may have the following:

• Abnormal breath sounds, especially the upper lobes or the regions involved
• Rales or bronchial breath signs, indicating pulmonary consolidation

Signs of pulmonary TB differs according to the tissue involved and may include the following:

• Loss of consciousness and coma
• neurological deficit
• Chorioretinitis (inflammation of the retina of the eye)
• lymphadenopathy
• skin lesions

The absence of any significant physical findings do not necessarily rule out the existence of an active TB. The better immunity or immunity, even signs and symptoms tend to be more visible. However, the bad or weak immune system, even signs and symptoms may not appear. This is actually harmful, because often TB has appeared in more severe degree. Patients tend to have weaker immune are HIV patients, patients undergoing chemotherapy, patients with diabetes.

Enforcement Diagnosis

Screening methods for TB are as follows:

• Mantoux tuberculin skin test with purified protein derivative (PPD) for active or latent infection (primary method)
• Checking the patient's sputum in patients with symptoms of cough. Painting Basil acid resistant (BTA) and bacterial culture: painting negative results do not necessarily rule out a diagnosis of TB; BTA culture is the most specific test for TB
• HIV serology in all patients with TB and HIV status is not known: Individuals infected with HIV are at increased risk for TB
• Chest X-rays to see the picture of the lungs in patients with TB.

If the results of bacterial culture was positive there are TB bacteria, it must be followed by trials of antibiotics are suitable for tuberculosis that affects the patient. However, this test is usually done if the first-line TB treatment does not work so patients categorized into patients who have failed first-line treatment.
Meanwhile, if the lesions outside the lungs, then a more complex examination which includes:

• A bone marrow biopsy, liver or blood culture
• If TB meningitis or tuberculoma is suspected, do a lumbar puncture
• If vertebral (Pott's disease) or brain involvement is suspected, a CT or MRI is required
• If complaints about genitourinary, to do a routine urine examination and urine culture

TB Patient Management

Actions that can be performed

• Ideally, patients are electrically insulated TB patient in a room with negative pressure
• Using disposable masks to filter enough basil
• Continue isolation until smear negative for 3 consecutive sputum examination (usually after about 2-4 weeks of treatment)

TB treatment regimens have several categories and lines. For the first time cases of TB, TB treatment is carried out for 6 months. Empiric treatment begins with 4-drug regimen of isoniazid, rifampicin, pyrazinamide, and ethambutol or streptomycin; This therapy will be adjusted according to the results of susceptibility testing and toxicity. Pregnant women, children, HIV-infected patients, and patients infected with drug-resistant strains require different regimen.

Prophylactic treatment is treatment given to patients who have not erect his TB diagnosis, but has the potential to be infected. For example: pregnant women at home with husband TB, or a small child whose parents live at home and infected with TB.

Special considerations for drug therapy in pregnant women include the following:

• In the United States, pyrazinamide reserved for women suspected MDR-TB
• Streptomycin should not be used
• Prophylactic treatment is recommended during pregnancy
• Pregnant women who consume isoniazid will experience liver toxicity (hepatotoxicity)
• Breastfeeding can be continued for prophylactic therapy

Special considerations for drug therapy in children are as follows:

• Most children with TB can be treated with isoniazid and rifampin for 6 months, together with pyrazinamide for the first 2 months, depending also with the bacteria culture results.
• For tuberculosis after birth, the duration of treatment can be increased up to 9 or 12 months
• Ethambutol is often avoided in children because of its effect to disrupt the senses of vision

There are special considerations for drug therapy in HIV-infected patients in the form of adjustment of dosage and treatment regimens selected.

A major problem in TB treatment is a course of treatment so that the level of patient compliance tends to decrease. It is the resistance of the germs that trigger the initial antibiotic does not work. Patients who develop resistance so-called cases of MDR-TB. For cases of MDR-TB, the treatment will be much more difficult, with a longer duration, high mortality rate of surplus, and the drug is not just a drink, but there is also a drug needle.

New TB vaccine is now being studied in view of TB is now increasingly widespread in the world. Dissemination of TB because of their increased noncompliance cases of HIV and TB patients in taking medicine