Tuberculosis Management

Introduction

Tuberculosis (TB) is a contagious infection caused by the bacterium Mycobacterium tuberculosis. It primarily affects the lungs but can also target other parts of the body. This article aims to provide an informative guide for the management of tuberculosis, focusing on various aspects of diagnosis, treatment, and prevention.

Diagnosis

1. Medical History

• Assess the patient's symptoms, duration, and severity of cough, night sweats, weight loss, and fever.
• Evaluate for risk factors, such as recent exposure to TB, immunosuppression, or travel to endemic regions.

2. Tuberculin Skin Test (TST)

• Administer the TST using purified protein derivative (PPD) and measure the induration after 48-72 hours.
• Interpret the result based on the patient's risk factors and local guidelines.

3. Interferon-Gamma Release Assays (IGRAs)

• Utilize IGRAs (e.g., QuantiFERON-TB Gold) as an alternative to TST.
• These blood tests measure the release of interferon-gamma in response to TB-specific antigens.

4. Chest X-Ray or CT Scan

• Evaluate the presence of pulmonary abnormalities suggestive of TB, such as infiltrates, cavities, or lymphadenopathy.
• Consider additional imaging studies for extrapulmonary TB.

Treatment

1. Drug Regimens

• Initiate treatment with a combination of four first-line drugs: Isoniazid, Rifampin, Pyrazinamide, and Ethambutol (or Streptomycin).
• Continue the intensive phase of treatment for 2 months, followed by the continuation phase for 4-7 months.
• Adjust the regimen for drug-resistant TB based on susceptibility testing.

2. Directly Observed Therapy (DOT)

• Implement DOT for all patients to ensure adherence to treatment.
• Designate a healthcare worker or trained observer to directly supervise medication administration.

3. Monitoring and Follow-up

• Monitor liver function tests, visual acuity, and symptoms during treatment.
• Perform monthly sputum smears and cultures to assess treatment response.
• Evaluate treatment completion using sputum culture conversion and clinical improvement.

4. Contact Tracing

• Identify and screen close contacts of individuals diagnosed with infectious TB.
• Offer preventive treatment to those at risk of developing active TB.

Prevention

1. Bacillus Calmette-Guérin (BCG) Vaccine

• Administer the BCG vaccine to infants in countries with a high prevalence of TB.
• Note that the BCG vaccine does not provide reliable protection against adult pulmonary TB.

2. Tuberculosis Infection Control

• Implement infection control measures in healthcare settings to prevent transmission.
• Use respiratory isolation for suspected or confirmed cases until they are no longer infectious.

3. Latent Tuberculosis Infection (LTBI) Treatment

• Offer preventive treatment to individuals with LTBI who are at an increased risk of progressing to active TB.
• Use isoniazid monotherapy for 6-9 months as the preferred regimen.

Conclusion

Effective management of tuberculosis involves prompt diagnosis, appropriate treatment regimens, and preventive measures. By following the guidelines outlined in this article, healthcare professionals can contribute to the control and prevention of tuberculosis, reducing its burden on individuals and communities.