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24 March has been designated by the World Health Organization (WHO) as World TB Day, in commemoration of the discovery of the mycobacterium tuberculosis by Dr Robert Koch. This movement aims to promote health and social actions to reduce this epidemic disease.

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What is tuberculosis?

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Tuberculosis (TB) is an infectious disease that most commonly affects the lungs as well as other parts of the body. The infection creates many small nodules, called "tubercles", in the affected organs. These gradually replace normal structures, destroy tissues and create cavities or "cavities". Tuberculosis develops slowly, over a period of weeks or months. Without treatment, it leads to death in about half of all cases. With the right treatment, it can be cured. For Greece, it is a serious public health problem.

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Where is TB most common?

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Tuberculosis is found all over the world, but it is much more common in sub-Saharan Africa, Asia and Eastern Europe.

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How is it caused?

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It is usually caused by a microbe called mycobacterium tuberculosis and less commonly by other types of mycobacteria. These mycobacteria usually affect the lungs as well as any other organ of the body. They grow very slowly and are not killed by antibiotics used to treat common pneumonia or other infections.

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How is it transmitted?

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TB is spread from one person to another by inhaling droplets containing the mycobacterium. Synchrotism and living in poor hygienic conditions favour its spread.

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Which groups are most at risk?

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Even healthy people can contract TB. However, people with weak immune systems (young children, smokers, diabetics, those taking immunosuppressive drugs and those infected with HIV) have a higher risk of developing the disease when exposed to it.

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What is the course of the disease?

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When healthy people are exposed to TB bacteria, they are usually able to fight them off through the lung's defence mechanisms.

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However, when the defence mechanisms are not effective enough or when there are too many bacteria, then the disease can develop. These people develop symptoms immediately and need immediate treatment. This infection is called "primary tuberculosis".

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But there is also the possibility that the immune system can limit the mycobacteria, but not kill them all. The bacteria can live in the body without triggering disease in the person. This is called "latent tuberculosis". People with latent TB are not contagious and do not show symptoms, but they may develop the disease later in life (5-10% of cases).

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What are the symptoms?

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General symptoms

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Fever
Fatigue
Anorexia
Weight loss without the person dieting

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Local symptoms

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Cough
Production of sputum (phlegm)
Hemoptysis
Pain in the chest

Lymph node swelling

Pains in the bones and joints

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When TB is not treated in time, there is a risk that it can cause permanent damage to the lungs and spread to other parts of the body, causing complications.

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How is the diagnosis made?

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The diagnosis of the disease is made on the basis of the history and clinical examination, in combination with the following tests:

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Mantoux test
Chest X-ray

Computed tomography of the chest
Sputum examination
IGRA immunoassay (Quantiferon or T-spot TB). Not positive after BCG vaccination.
Bronchoscopy
PCR

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What is the Mantoux test?

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The Mantoux test is a skin test in which a small amount of tuberculin (mycobacterium protein) is administered intradermally. The result is read after 2 days. A positive Mantoux test may be due either to infection by the mycobacterium tuberculosis or to the BCG vaccine. This will be judged by health professionals who will assess the Mantoux and perform the appropriate tests.

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What is the treatment?

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Treatment of active TB involves various combinations of specific drugs, usually four, for a period of 6 or 9 months. With the right treatment, patients feel better after a few weeks. It is very important that the patient complies with the treatment, as well as regular monitoring of the course of the disease and the side effects of the drugs.

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What are resistant strains of TB?

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Recently, new forms of the disease have emerged, known as multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB). This resistance is likely to result from human error, such as incorrect choice of drugs for treatment or discontinuation of treatment by sufferers before it is completed. In these cases, treatment options are extremely limited and effective treatment may not be available. For this reason, it is very important that people suffering from resistant TB are diagnosed early and consistently follow anti-TB treatment for as long as necessary.

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When do I need to visit the doctor?

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It is good to visit the doctor when:

- Has been in close contact with a positive case
- Has been coughing for over a month without improvement
- Has suspicious symptoms such as fever, night sweats and weight loss

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Is there any prevention?

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The World Health Organization (WHO) is organising campaigns, such as the Stop TB Strategy, to reduce TB cases worldwide. In particular, it urges countries to implement:

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Vaccination with the tuberculosis vaccine (BCG)
Chemoprophylaxis in patients with latent TB to prevent them from developing the disease in the future
Isolation measures
Control of people who come into contact with patients

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