The World Health Organization has declared India to be a high-risk endemic country for tuberculosis (TB). Tuberculosis is an infection caused by a bacteria Mycobacterium tuberculosis. This bacteria spreads by droplets produced by an infected person and primarily affect the lungs. From the lungs the bacteria may travel to other parts of the body to cause disseminated infection involving the intestines, lymph nodes, brain, bones or skin.

What are the symptoms of tuberculosis?

Tuberculosis causes appetite loss, loss of weight or poor weight gain in children, low grade fever that may rise in the evening for more than 2 weeks, cough for more than 2 weeks. It can cause the following problems in the lungs:

• Pneumonia
• Pleural effusion (accumulation of water in the lungs)
• Enlarged lymph nodes
• Lung fibrosis
• Lung nodules or calcification

These symptoms often persist for months before the diagnosis of tuberculosis is made.

How do we diagnose tuberculosis?

Any child with fever >2 weeks, cough >2 weeks, loss of appetite, weight loss must be investigated for tuberculosis. If there is a contact with a person having TB (living with that person in close proximity for more than 2 weeks), screening tests must be done to rule out TB.

The following tests are done to screen for tuberculosis:

• Chest Xray
• Mantoux test
• Sputum test

Sputum Test for Tuberculosis is the most important diagnostic test. Sputum is collected and sent for microscopic examination and TBXPert testing. In case if the child is not able to expectorate, we employ other methods of collecting sputum. These are:

• Gastric Aspirate: Sputum is collected from the stomach by putting a tube through the mouth. This is done mainly in infants and young children.
• Induced sputum: Cough is induced by using saline nebulisations and sputum is coughed out.
• Bronchoalveolar lavage: Sputum is collected from the airways by flexible bronchoscopy.

What is the treatment of Tuberculosis?

Tuberculosis is completely curable with antibiotics. Anti-TB treatment (ATT) is given for a period of 6 months daily for all types of TB except the disseminated TB and NeuroTB. Symptoms start improving with in 1 week of starting ATT and sputum conversion takes 2-3 weeks. Improved appetite and weight gain are usually the first signs of improvement.

There are 4 specific antibiotics for tuberculosis that prescribed by a doctor after complete assessment of your child. These are Isoniazid, Rifampicin, Pyrazinamide and Ethambutol. Supplementation with Pyridoxine is very important to avoid side effects.

How can we prevent TB?

Tuberculosis spreads by droplet infection from an infected person. Wearing a mask is mandatory for a person with TB for atleast 1 month after start of treatment. Spitting in public places must be strictly prohibited. In case of TB contact , early screening can help in reducing the severity of infection. In children who have contact with a TB positive person, Isoniazid is given prophylactically to prevent TB infection after screening tests have come negative.

What is MDR-TB?

With time the tuberculosis bacteria has now undergone mutations and changes leading to drug resistance. Multidrug resistant TB (MDR-TB) is a form of TB where the tuberculosis bacteria is resistant to the first-line 4 drug ATT. In such cases second-line drugs need to be given for a longer duration. Diagnosis of MDR-TB is cumbersome and treatment is longer with a greater number of medicines. Therefore, every effort is made to test for the bacteria and its antibiotic sensitivity before starting treatment.