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Tuberculosis (TB)

Published by Bupa's health information team, March 2010.

This factsheet is for people who would like information about tuberculosis (TB).

TB is an infectious disease caused by a type of bacterium. It can lead to serious complications and even death, especially if the body is weakened by other health problems. TB is rare in the UK and it can usually be treated with antibiotics. However, it's a common cause of death in less developed parts of the world.

• About tuberculosis
• Symptoms of tuberculosis
• Causes of tuberculosis
• Diagnosis of tuberculosis
• Treatment of tuberculosis
• Prevention of tuberculosis
• Questions and answers
• Related topics
• Further information
• Sources

About tuberculosis

A third of the world's population (two billion people) is infected with the tuberculosis bacterium but only one in 10 of these people will go on to develop the disease. Most cases of TB occur in developing countries in Africa and South East Asia. In 2007, 1.7 million people died from TB.

In the UK, about 8,000 cases of TB are reported each year, but this number is rising slowly. Most of these cases are in large cities, particularly in London.

What is tuberculosis?

TB is an infectious disease caused by a bacterium called Mycobacterium tuberculosis. It's mainly a disease that affects your lungs, but it can affect other parts of your body such as your skin or other organs.

TB is passed on from person to person by droplets carried in the air, usually from coughs and sneezes. Your body's immune system, which fights infection, usually destroys the germs once they are inhaled.

In a small number of people, the immune system successfully builds a defensive barrier around the infection. The bacteria stay in the body, but you won't usually have any symptoms and can't pass the infection on to other people. This is called latent TB.

Sometimes, the immune system fails to destroy the bacteria, or latent TB becomes active years later. This is more likely to happen if your immune system becomes weakened by other problems such as HIV, poorly controlled diabetes, or if you are underweight. At first, a TB infection normally affects the lungs. This is called pulmonary TB. However, TB often spreads to the lymph nodes (glands throughout your body that are part of your immune system). It can also affect your bones, joints and kidneys. TB can also cause meningitis (inflammation of the membranes surrounding the brain and spinal cord), though this is rare.

Symptoms of tuberculosis

Depending on how effectively your immune system fights the infection, you may have:

• no symptoms at all
• minor symptoms, which then go as you fight the infection off
• symptoms that develop in the months following infection
• symptoms that develop years after you were infected

The symptoms of tuberculosis infection in your lungs may include:

• a persistent cough - there may also be lots of phlegm, sometimes containing blood
• fever
• tiredness
• loss of appetite
• weight loss
• night sweats
• chest pain when you breathe in, caused by inflammation of the membranes lining your lungs (pleurisy)

If you have TB in other parts of your body, you may also have other symptoms such as swollen glands in your neck, pain in your joints or a headache.

Causes of tuberculosis

You can catch TB by breathing in droplets in the air that contain the bacterium M. tuberculosis. These are spread through the air when someone with TB coughs or sneezes. Only some people with TB in their lungs are infectious to others.

Although it's spread through the air, you need to be closely exposed to a person with TB for some time before you catch it. People most commonly catch TB from people they live or work with. When you start treatment for TB, you remain infectious to others for the first two weeks.

Although anyone can get TB, it's quite difficult to catch in the UK. You're more likely to get TB if you:

• already have a weakened immune system (for example if you have HIV/AIDS or are taking medicines that suppress your immune system)
• have diabetes
• have regular close contact with people who have TB lung infection
• are young or elderly
• live in overcrowded housing
• are dependent on drugs or alcohol
• are in poor health generally and have been for some time

Diagnosis of tuberculosis

To diagnose active TB infection you will usually be asked to give at least three separate samples of your phlegm for testing. These will be examined in a laboratory. A chest X-ray can also be used to diagnose active TB.

To diagnose latent TB you can have a skin test called a Mantoux test. This test involves injecting the tuberculin protein just under your skin, usually on the inside of your forearm. Over the next two to three days a reaction to the injection will develop. This reaction is then graded.

The greater the reaction the more likely it is that you have TB infection. If this is the case your doctor may ask you to have further tests.

If you are diagnosed with TB those people who have been in close contact with you, such as family members or work colleagues, may also be tested for the infection.

Treatment of tuberculosis

TB can be completely cured by taking antibiotics. Most people with either active or latent TB are treated with a combination of four antibiotic tablets which kill the bacteria. Treating latent TB prevents the infection from becoming active in the future.

You will probably have treatment at home and won't need to go to hospital, unless you're very unwell. There are teams of doctors and nurses who specialise in caring for and treating people with TB.

Medicines

You will usually need to take antibiotics for six months. You're likely to have a combination of four antibiotics for the first two months. After this time, you will usually stop taking two of the tablets and continue with the remaining two for another four months.

It's very important to take the full six-month course of antibiotics, and to take them regularly, otherwise the bacteria may develop resistance to the antibiotics. Treatment with antibiotics is usually effective, provided that you take the full course as prescribed.

Some people may get side-effects from the antibiotics and occasionally these can be serious. Your doctor will monitor you closely during your treatment. Side-effects can include:

• a red-orange colour to your urine, saliva and other body fluids
• feeling sick or being sick
• fever
• jaundice (yellowing of your skin and eyes)
• pins and needles

If you develop a fever, feel sick and tired, and if your skin or eyes become yellow in colour, you should see your doctor straight away. These are symptoms of possible liver damage and you should get medical help as soon as you can.

Some of the antibiotics used to treat TB can make the oral contraceptive pill less effective. If you're taking oral contraceptives, ask your GP about other methods of contraception.

Always ask your doctor for advice and read the patient information leaflet that comes with your medicines.

Drug-resistant tuberculosis

The bacteria that causes TB can, in rare cases, become resistant to some of the main antibiotics used to treat it. It's more likely to develop if you don't finish your antibiotic treatment course for TB. This makes it much more, difficult to treat. In the UK, around one in every 100 people with TB has drug-resistant TB.

Prevention of tuberculosis

Until quite recently, there was a large-scale immunisation programme in the UK to help prevent TB. However, this has been replaced by a more targeted programme of immunisation. The vaccination strategy in the UK targets people who are most at risk of getting TB, such as:

• babies born in areas where TB is common
• children who have a parent or grandparent born in a country where TB is common
• those who have immigrated from a country where TB is common
• people who have had a family member with TB within the last five years
• healthcare workers and laboratory staff who have contact with TB

Immunisation is given as the BCG (Bacille Calmette-Guérin) vaccination. This protects between seven and eight out of 10 people who receive it. Before giving the vaccination, your doctor or nurse will first check whether you are already immune to TB. This is done with a Mantoux test. If the test is negative, then you will be given the BCG vaccine. The vaccine is given as a single injection usually in the top of your arm.

It's rare to get a strong reaction to the vaccination, but a small ulcer on the skin of the arm often forms in the weeks after the injection. This may take several weeks to heal properly. A flat scar often develops later. This is normal and a sign of successful immunisation.

Related topics

• Childhood immunisation

Further information

• British Lung Foundation
  08458 505020
  www.britishlungfoundation.org

Sources

• Tuberculosis. Department of Health. www.dh.gov.uk, accessed 30 September 2009
• Tuberculosis facts. World Health Organization, 2009. www.who.int
• Tuberculosis. World Health Organization. www.who.int, accessed 30 September 2009
• Tuberculosis. Health Protection Agency (HPA). www.hpa.org.uk, accessed 30 September 2009
• Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford. Oxford University Press, 2007:488
• Tuberculosis: Frequently asked questions. Health Protection Agency (HPA). www.hpa.org.uk, accessed 30 September 2009
• Tuberculosis: assessment. Clinical Knowledge Summaries. www.cks.nhs.uk, accessed 30 September 2009
• Tuberculosis. National Institute for Health and Clinical Excellence (NICE), 2006. www.nice.org.uk
• BCG. NHS Immunisation. www.immunisation.nhs.uk, accessed 30 September 2009

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: March 2010.