Frequently asked questions about Tuberculosis (TB)

Tuberculosis (TB) is an infectious disease caused by bacteria – Mycobacterium tuberculosis (MTB).

TB most often affects lungs – so called pulmonary tuberculosis. However, TB can affect any other part of the human body, like brain, kidneys, bones, bowels etc. when we speak of extrapulmonary TB.

Many think tuberculosis is a disease of the past. However, 1/4 of humanity today is infected with TB. World Health Organisation (WHO) estimated that 10.4 million people fell ill with TB in 2016, of which 90% were adults, 65% were men, and 10% people living with HIV. In the same year, 1.7 million people died from TB.

Yes, if properly treated, TB is in most cases curable. The success of treatment, however, does not depend only on health workers and the health system, but also on the attitude and behaviour of the patients in relation to their prescribed treatment regimen. Millions of people around the world have been successfully cured of TB and the disease never came back. TB is also preventable.

Yes. Among all causes of death, TB is the 9^th leading cause worldwide and is the leading cause of death from a single infectious agent. TB is the main cause of death in people living with HIV. Without proper treatment HIV + people with TB have no prospects for survival. Even in HIV negative population 45% of people will die if they do not receive an appropriate treatment.

There are TB cases in all countries of the world. The most burden of TB is in Africa and Asia. Seven most affected countries are: India, Indonesia, China, the Philippines, Pakistan, Nigeria and South Africa.
TB incidence in Europe is low compared to other parts of the world, however, Europe has the highest burden of Multidrug-resistant TB (MDR-TB). There are significantly more TB cases in the countries of Eastern Europe – the former Soviet republics, Romania, Bulgaria.

Everyone. However, the risk of getting TB is not the same for everyone. People with an impaired immune system, such as people living with HIV or diabetes, people who use tobacco, alcohol, drugs, are most at risk.

TB is spread from person to person through the air, when people suffering from lung TB cough, sneeze, spit, speak loudly, laugh…

No. BCG vaccine is by now the only available vaccine against TB. It does not reduce the risk of infection, but provides some protection against severe forms of tuberculosis in infants and children, which is why it is given after birth. There is no substantial evidence that the BCG vaccine protects against pulmonary TB in adults, or that repeated vaccination later in life provides lifelong protective effect.

No. You can get TB only from a person suffering from an active form of lung TB, as the tiny droplets of the air coming from lungs contain TB bacteria. People with extrapulmonary TB are not contagious. Please note that patients with lung TB, discharged from the hospital after successful completion of the initial phase of their treatment, are no longer contagious, as confirmed by laboratory findings of their sputum specimens.

People suffering from active form of lung TB are most contagious at the onset of their illness, when symptoms are present, but they are not yet aware of the disease. They are still contagious in the first few weeks since the onset of treatment. One person with active lung TB, if not treated, infects on average 10 to 15 people over the course of the year.

Not necessarily. It depends on many factors, such as on duration and closeness of the contact. Risk is not the same for family or household members and for those in short daily contact. It matters also if the contact was in indoor or outdoor areas, what is the status of your immune system, etc.

No. One in ten people will get sick after infection, sometimes during their lifetime. Usually, our immune system is strong enough to prevent the development of the disease. However, people with compromised immune systems, such as people living with HIV, diabetes, malnutrition, people who use tobacco, alcohol, drugs, are at much greater risk to get sick of TB.

No, if they do not have active lung TB. These people, however, have a “latent TB” as their organism coped successfully with the infection, but TB remained “still” in the body. One quarter of the humanity has “latent TB”. Nevertheless, only 10% will fall ill with TB, in the case of a seriously compromised immunity, which allows replication of TB bacteria in the organism.

No. All symptoms and signs of TB are non-specific, which means they can also be reported in other diseases.

Lingering cough (more than 3 weeks), fever (usually mild up to 37.5 C), night sweats, weight loss, general weakness, are symptoms and signs that can suggest TB. As they can be mild, people tend to delay seeking care, while they are actually spreading the bacteria to others. Sign of blood in sputum, which is typical of the advanced TB, usually make people immediately go to the doctor’s.

If you experience any of above mentioned symptoms or signs, contact your doctor as soon as possible. If you notice blood in your sputum, go to doctor’s immediately! The reason for a medical check-up would be if any of the above symptoms last longer than 2-3 weeks, and if you notice that you lose weight. People with extrapulmonary TB can often feel pain in the site of TB localization.

Your physician will request several laboratory analyses and perform some tests and physical examination. To confirm the diagnosis of lung TB chest X-ray and laboratory testing of sputum specimens must be performed. If deemed necessary, the physician may also request additional diagnostic tests and examinations, in order to confirm either pulmonary or extrapulmonary TB.

Accept the treatment offered by your physician immediately. Do not hesitate, start your treatment as soon as possible and adhere to it at all times, with no exception.

A very simple preventive measure is to always cover your mouth and nose when you cough or sneeze. You can also wear a surgical mask. The barrier prevents the small droplets containing TB bacteria to be spread through the air. Open the windows frequently to ventilate the room.

Nevertheless, the most important is to follow your doctor’s advice and start with the advised treatment as soon as possible. Treatment is the best prevention for TB dissemination. It is very important to tell your family and friends that you have TB and that you are on treatment. Share with them what you have learned about TB to reduce their fears.

Your household members, people with whom you spend most time at work, in school or with whom you have close and intimate physical contact.

If you are diagnosed with TB, your physician will certainly ask you some questions in order to identify the persons who were in close contact with you while you were sick and not yet aware of it. It is important to give accurate information, as based on them, your doctor will make a plan for tracing and medical check-up of those contacts who were at the highest risk.

TB is treated with antibiotics also called anti-TB drugs. TB bacteria is very resilient, therefore it takes months and a high dose of strong antibiotics to put the disease under control and recover from TB. It is important that the prescribed antibiotics are taken regularly in full dose prescribed by the doctor, with no exception. In some cases, antibiotic treatment has a better chance of success if combined with the surgical removal of destroyed tissue.

For your good and for the sake the people around you. Those who strictly adhere to the treatment have the greatest chance of getting cured. As bacterial load in your body drops, you will have less symptoms and signs of TB and will eventually stop being contagious.

Often, initial treatment in hospital is advised, until the patient is no more contagious. Acceptance of inpatient treatment is important for both – persons with TB, as it ensures better treatment control and outcomes, as well as for their families or people who live with them, since they are no more exposed to TB infection.

Yes, you can. The hospital staff will take care, either to provide masks with special filters – respirators to your visitors, or can arrange the visit outdoors (hospital balcony or yard) to prevent spreading of TB infection.

It depends on the type of TB. Treatment of simple, so-called “sensitive TB”, usually takes 6 months. If properly treated it leads to the most desirable treatment outcome – cured.

More complex, “resistant TB” cases, require much longer treatment, on average two years, with lower chances for the outcome to be “cured”.

TB bacteria is very resilient and adaptable. Until now, none of the known antibiotics is able to cure tuberculosis alone in a short time. Therefore, a combination of several antibiotics is necessary. The physician decides, based on the laboratory and clinical assessment, at which point some of the drugs might not be needed any more.

It is known that each drug has its side effects, especially if it is used over a longer period. For that reason, before any national drug regulatory authority issues a marketing authorisation, future marketing authorisation holder must demonstrate, based on data from a number of preclinical and clinical studies, that therapeutic benefits of a medicine significantly outweigh the risks of adverse drug reactions.

This is also how the internationally recommended treatment regimens for TB are composed. Each drug in the combined therapy has its role. Excluding any drug dramatically reduces the chances for success, increases the chances of chronicity and poor outcome of the disease.

So, do not try to negotiate with your physician to reduce the number of drugs in your regimen, because the doctor knows which combination of anti-TB drugs is the right one for you.

If you decide on your own to skip your daily drug intake, exclude one or more drugs from the prescribed regimen, stop the treatment since you face severe side effects, or you think you might be already cured, you are on the way to develop more complex form of the disease, so called drug-resistant TB. This form of TB is much more difficult to treat with an uncertain outcome.

The best you can do is to adhere to your prescribed treatment, with no exception. If you experience severe side effects of medicines, do not stop the treatment on your own decision, but go to your doctor, who will find the right way to help you and not jeopardize your treatment outcome at the same time.

“Anti-TB drugs” is a common name for a group of antibiotics, used for treatment of TB. Like all antibiotics, anti-TB drugs have to be taken long enough and in full dose in order to be effective. If you take less drugs than prescribed, skip your daily intakes, interrupt your treatment course, bacteria will not disappear – on the contrary, it will become stronger and resistant to the antibiotic used in this way.

Consequently, when administered again, in the same or some other patient infected with the same resistant bacteria, this antibiotic will not be effective. Thus, we lose a powerful “weapon” to fight against bacterial infection and must choose an alternative antibiotic, usually not so effective.

Yes, you still can be treated, but not with the same anti-TB drugs. In the case of resistance to first-line anti-TB drugs we use second-line drugs to which TB bacteria is still sensitive. However, second-line anti-TB drugs are not as powerful as first-line drugs.

First-line anti-TB drugs are the most effective antibiotics used for treatment of so called “sensitive” TB: isoniazid, rifampicin, ethambutol, pyrazinamide and streptomycin. TB treatment usually starts with the first four anti-TB drugs.

Second-line anti-TB drugs are used for treatment of resistant TB. Combination of the drugs in the regimen is made individually, based on drug susceptibility laboratory findings.