Tuberculosis (TB) is a bacterial disease that mainly affects the lungs. It is caused by the bacteria Mycobacteria tuberculosis and is spread through airborne droplets from an infected person. Before the discovery of certain antibiotic drugs in the 1940s, TB was the leading cause of death in the United States. Even though TB is not as common as it was in the U.S., it has been seen more in recent years due to HIV, AIDS, and the spread of drug resistant forms of TB. It is still a major health problem throughout the world, especially in poorer areas. Up to one third of the world's population may be infected with TB, though the infection may not be active.
If you have been exposed to TB, you may be infected but have no symptoms and not be contagious. For that reason, doctors usually distinguish between infection (or a positive TB test) and an active infection. After you are infected, your immune system will attack the bacteria. Your body may kill all the bacteria, the bacteria may remain in your body but not cause an active infection, or you may develop the disease. TB can affect other areas of your body outside of the lungs, but lung infection is most common. Typically, TB bacteria that grow in the lungs may cause:
Mycobacterium tuberculosis causes most cases of TB. The disease is spread from one person to another through airborne bacteria. However, it isn't easy to catch TB. You need consistent exposure to the contagious person for a long time. For that reason, you're more likely to catch TB from a relative than a stranger. Typically what happens is that a person with TB in the lungs or the throat coughs or sneezes. Others nearby then breathe in the bacteria. When a person breathes in TB bacteria, the bacteria can settle into the lungs and begin to grow.
Because TB is only spread through inhalation of infected respiratory particles in the air (see What Causes It? section), you are not likely to contract the infection through other means such as handshakes or sharing of dishes and utensils. It is also important to know that people with TB are most likely to spread it to people with whom they spend the most time -- family members, friends, classmates, and coworkers. Risk factors for developing TB include:
If your doctor suspects a TB infection, you will need a skin test. A positive reaction to the test means you are likely infected with TB, although false positive and false negative results are possible. To confirm the diagnosis and determine if the infection is active, you may need a chest x-ray and have samples taken of your sputum (mucus and other material coughed up from the lungs) or stomach fluid to check for TB bacteria.
TB is difficult to treat (see "Drug Therapies") so prevention is important. Prevention of TB begins with rapid diagnosis and treatment to avoid spread to noninfected persons. In countries where TB is common, a vaccine called BCG may be administered. However, the vaccine causes a false positive on the skin test and is not very effective in adults, so it's rarely given in the U.S.
If you are at risk, you should be tested for TB every 6 months. If you test positive but have no signs of active infection, you may be given the medication isoniazid to prevent an active infection.
The most important way to keep TB from spreading is for infected people to take their medications exactly as prescribed. If you do not take all of your medications, you run the risk of developing multidrug resistant TB, which you can then spread to others. Drug resistant TB is a major health problem in the U.S. and around the world. If you have TB, keeping all of your clinic appointments is essential so that your doctor can check for side effects from the drugs and evaluate the effectiveness of the treatment. If you are sick enough with TB to go to a hospital, you may be put in a special room with air vents that keep the TB bacteria from spreading. You will most likely be prevented from leaving your room while you are contagious (about 2 weeks after treatment begins). People who come into the room will wear special face masks to protect themselves from TB bacteria and to prevent the spread of TB bacteria to others.
If your doctor suspects TB, treatment may begin before all lab tests return. This may include more than one anti-TB drug. Emergency treatment may be necessary if, for example, you are coughing up blood.
TB bacteria die very slowly. It takes 6 months to a year for the medicine to destroy all of the TB bacteria -- longer for multidrug resistant TB. If you have TB, you will need to take several different drugs. You will be tested first for drug resistance to determine the most effective combination of drugs to prevent the bacteria from becoming resistant to the drugs. The most common drugs used to fight TB are:
TB should never be treated with alternative therapies alone. To cure the disease, and to avoid spreading it to other people, you must be treated with prescription medications. Some CAM treatments may be useful as supportive therapies.
Even if complementary therapies are used, conventional prescription drugs must be taken exactly as directed. Complementary therapies do not allow patients to get by with less medicine or to skip doses. Skipping doses is a major cause of the development of drug resistant strains and greater spread of the disease.
Following these nutritional tips may help reduce risks and symptoms:
You may address nutritional deficiencies with the following supplements:
Animal studies suggest that TB may be more severe in persons with diets rich in omega-3 essential fatty acids. These studies are not comprehensive, and it's not clear whether there is a similar effect in humans. Until researchers know more, however, it may be wise to avoid omega-3 supplements (such as fish oil) if you have or are at risk for TB.
Herbs are generally available as standardized, dried extracts (pills, capsules, or tablets), teas, or tinctures/liquid extracts (alcohol extraction, unless otherwise noted). Mix liquid extracts with favorite beverage. Dose for teas is 1 - 2 heaping teaspoonfuls/cup water steeped for 10 - 15 minutes (roots need longer). Although herbs should never be used alone to treat TB, some herbs may be helpful along with conventional medical treatment.
Few studies have examined the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend one or more of the following treatments for tuberculosis based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.
Acupuncture can help strengthen your immune system response, as well as support your lung function.
A full course of medication can cure TB in people who do not have a multidrug resistant strain. It can be fatal in the elderly, in those who have TB that has spread to locations other than the lungs including miliary TB (which spreads through the bloodstream affecting many organ systems), in those with multidrug resistant strains of TB, or in those with HIV.
Possible complications of TB include:
U.S. public health policy requires health care providers to report cases of TB and to treat or quarantine all patients. Most patients may remain at home, but all should be kept from any new contacts for at least 2 weeks after treatment begins. The elderly and those who are acutely ill or have multidrug resistant TB should be hospitalized for the first few weeks of treatment.
It is essential to take all TB medication exactly as prescribed in order to cure TB and prevent drug resistance. Sputum samples are collected and tested monthly. If tests are still positive after 3 months of treatment, the infection is considered multidrug resistant and a change in medications is in order.
Since effective treatment of TB depends on taking multiple antibiotic drugs for an extended period of time, it is essential that you consult with your health care provider before using any complementary or alternative therapies, including taking herbs and vitamin supplements.
Bafica A, Scanga CA, Serhan C, Machado F, et al. Host control of Mycobacterium tuberculosis is regulated by 5-lipoxygenase–dependent lipoxin production. J Clin Invest. 2005 June 1; 115(6): 1601–1606.
Bastian I, Colebunders R. Treatment and prevention of multidrug-resistant tuberculosis. Drugs. 1999;58(4):633-661.
Bednall R, Dean G, Bateman N. Directly observed therapy for the treatment of tuberculosis -- evidenced based dosage guidelines. Respir Med. 1999;93(11):759-762.
Ben m'rad M, Gherissi D, Mouthon L, Salmon-Ceron D. Tuberculosis risk among patients with systemic diseases. Presse Med. 2009;38(2):274-90.
Bope: Conn's Current Therapy 2010, 1st ed. Philadelphia, PA: Saunders. 2009.
Bornman L, et al. Vitamin D receptor polymorphisms and susceptibility to tuberculosis in West Africa: a case-control and family study J Infect Dis. 2004 Nov 1;190(9):1631-41.
Cantrell CL, Abate L, Fronczek FR, Franzblau SG, Quijano L, Fischer NH. Antimycobacterial eudesmanolides from Inula helenium and Rudbeckia subtomentosa. Planta Med. 1999;65(4):351-355.
Chanarin I, Stephenson E. Vegetarian diet and cobalamin deficiency: their association with tuberculosis. J Clin Pathol. 1998;41(7):759-762.
Chaulk CP, Kazandjian VA. Directly observed therapy for treatment completion of pulmonary tuberculosis: Consensus statement of the Public Health Tuberculosis Guidelines Panel. JAMA. 1998;279(12):943-948.
Curtis AB, Ridzon R, Vogel R, et al. Extensive transmission of Mycobacterium tuberculosis from a child. N Engl J Med. 1999;341(20):1491-1495.
Delaha EC, Garagusi VF. Inhibition of mycobacteria by garlic extract (Alliumsativum). Antimicrob Agents Chemother. 1985;27(4):485-486.
Donald PR, Lamprecht JH, Freestone M, et al. A randomised placebo-controlled trial of the efficacy of beta-sitosterol and its glucoside as adjuvants in the treatment of pulmonary tuberculosis. Int J Tubercul Lung Dis. 1997;1:518-22.
Douglas JG, McLeod MJ. Pharmacokinetic factors in the modern drug treatment of tuberculosis. Clin Pharmacokinet. 1999;37(2):127-146.
Havlir DV, Barnes PF. Tuberculosis in patients with human immunodeficiency virus infection. N Engl J Med. 1999;340(5):367-373.
Hirsch CS, Johnson JL, Ellner JJ. Pulmonary tuberculosis. Curr Opin Pulm Med. 1999;5(3):143-150.
Jain RC. Anti tubercular activity of garlic oil [letter]. Indian J Pathol Microbiol. 1998;41(1):131.
Karp CL, Andrea M. Cooper AM. An oily, sustained counter-regulatory response to TB. J Clin Invest. 2005 June 1; 115(6): 1473–1476.
Kliiman K, Altraja A. Predictors of extensively drug-resistant pulmonary tuberculosis. Ann Intern Med. 2009;150(11):766-75.
Liu PT, Stenger S, Li H, Wenzel L, Tan BH, et al. Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science. 2006 March 24; 311:1770-1773.
Newton SM, Lau C, Wright CW. A review of antimycobacterial natural products. PhytotherRes. 2000;14(5):303-322.
Niu HR, Lai ZH, Yuan L. Observation on effect of supplementary treatment by Astragalus injection in treating senile pulmonary tuberculosis patients. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2001 May;21(5):349-50.
Schlossberg D. Acute Tuberculosis. Infectious Disease Clinics of North America. 2010;24(1).
Wilkinson D. Drugs for preventing tuberculosis in HIV infected persons. Cochrane Database Syst Rev 2000;No. 2:CD000171.
Wilkinson RJ, Llewelyn M, Toossi Z, et al. Influence of vitamin D deficiency and vitamin D receptor polymorphisms on tuberculosis among Gujarati Asians in west London: a case-control study. Lancet. 2000;355(9204):618-621.
Wright A, et al. Epidemiology of antituberculosis drug resistance 2002 - 07: an updated analysis of the Global Project on Anti-Tuberculosis Drug Resistance Surveillance. Lancet. 2009;373(9678):1861-73.
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