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:

• Mild fever, headache, chills, night sweats
• Malaise (feeling unwell), fatigue
• Loss of appetite, weight loss
• Cough, with or without mucus and pus
• Coughing up blood
• Chest pain from pleurisy (an inflammation of the lungs)
• Difficulty breathing
• Swollen glands

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 section titled What Causes It? ), 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:

• Working in the health care profession or as an embalmer
• Being born in or spending time in a country where TB is common (for instance, most countries in Latin America and the Caribbean, Africa, and Asia, excluding Japan)
• Living in overcrowded, unsanitary settings where TB is common (for example, homeless shelters, migrant farm camps, prisons and jails, and some nursing homes or long-term care facilities)
• Having HIV or AIDS. As HIV attacks the immune system, existing TB infections may become active, or it may make it easier for someone to catch TB. The TB bacteria, in turn, causes the HIV virus to replicate more quickly.
• Using medications that suppresses the immune system (Remicade, Enbrel)
• Having no or inadequate access to health care

If your doctor suspects a TB infection, he or she will perform 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, your doctor may order a chest X-ray and take samples of your sputum (mucus and other material coughed up from the lungs) or stomach fluid to check for TB bacteria.

Prevention

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 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.

Treatment Plan

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.

Drug Therapies

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:

• Isoniazid (INH)
• Rifampin
• Pyrazinamide
• Ethambutol
• Streptomycin

Complementary and Alternative Therapies

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.

Nutrition

Poor nutrition can contribute to a weakened immune system, which can make it more likely that you'll catch TB or develop an active infection. Make sure you get enough of the following nutrients in your diet:

• Vitamin B6 -- Treatment with isoniazid can reduce levels of vitamin B6 in the blood, so your doctor may prescribe a supplement.
• Vitamin B₁₂ (500 mcg per day)
• Vitamin C (1 - 6 g per day) -- Vitamin C may interfere with vitamin B12, so take doses at least 2 hours apart. Lower dose if diarrhea develops.
• Vitamin D -- Several studies show that low levels of vitamin D may explain why some ethnic groups tend to be more susceptible to TB. This early research is very promising, although it isn't yet known whether vitamin D can help prevent or treat TB. Talk to your doctor about taking supplemental vitamin D, so the doctor can establish the proper dose for you.
• Vitamin A (5,000 mg per day)
• Zinc (15 mcg per day)

Beta-sitosterol (60 mg per day), a compound present in some plants, may be helpful when given along with conventional medication, although results from one study were uncertain.

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

Although herbs should never be used alone to treat TB, some herbs may be helpful along with conventional medical treatment.

• Garlic (Allium sativum ) -- Has antimicrobial properties and slowed the rate of growth of M. tuberculosis in animal studies. However, very high doses were used, which could prove toxic to humans. Ask your doctor about taking garlic along with conventional prescription TB medications. Do not take garlic if you take blood-thinning medication.
• Astragalus (Astragalus membranaceus, 5 - 15 g per day) -- A preliminary study indicates that astragalus may be helpful in treating TB. However, more research is needed.

Other herbs have been used traditionally for TB but lack scientific evidence:

• Agrimony (Agrimonia eupatoria)
• Ashwagandha (Withania somnifera)
• Barberry (Berberis vulgaris)
• Echinacea (Echinacea spp.)
• Elecampane (Inula helenium)
• Horsetail (Equisetum arvense)
• Mullein (Verbascum thapsus)
• Sweet coneflower ( Rudbeckia subtomentosa)
• Tamarisk ( Tinospora cordifolia)
• White horehound (Marrubium vulgare)

Homeopathy

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.

• Arsenicum album -- for cough and chest pain, particularly from infectious causes. Symptoms worsen at night and are often accompanied by fever, chills, weakness, exhaustion, and restlessness. This remedy is most appropriate for individuals who often feel scared and anxious.
• Calcarea carbonica -- for chills, drowsiness, perspiration (especially at night), and swollen lymph nodes. This remedy is particularly appropriate for individuals who are susceptible to infection, tend to be stubborn, and crave eggs and cold drinks.

Acupuncture

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, 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), those with multidrug-resistant strains of TB, or those with HIV.

Possible complications of TB include:

• Development of a multidrug-resistant strain
• TB beyond the lungs, frequently associated with HIV
• TB-related meningitis, in children
• Pneumothorax (collapse of a lung due to a buildup of gas between the membranes that surround the lungs)
• Massive coughing up of blood

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.

• Infants born to mothers with infectious TB should be separated from the mother until she is no longer contagious. The infant should then be tested for TB at 4 - 6 weeks and 3 - 4 months.
• Women can be treated for TB during pregnancy and while breast-feeding but should avoid streptomycin and pyrazinamide.

Since the 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.

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