Tuberculosis (ganglionic, pulmonary): what is it, symptoms, cause

Tuberculosis is a bacterial infection caused by Mycobacterium tuberculosis , also known as Koch’s bacillus.

The main symptoms of the disease are: fever , fatigue , night sweats, loss of appetite, shortness of breath and cough , which may be accompanied by secretions containing blood.

The infection occurs by inhaling droplets of saliva expelled through the cough of infected patients.

Therefore, the risks of acquiring the disease increase in closed places and with low air circulation.

According to data collected by the World Health Organization (WHO) in 2017, of 10 million cases of tuberculosis registered in the world, 1.6 million were fatal, exceeding even the number of deaths from AIDS .

That same year, there were about 4,500 deaths from tuberculosis in Brazil – many of them seen in patients with HIV – a number that made WHO put the country on the list of priority nations to fight the disease.

Do you want to know more about the disease?

Follow the article to the end and learn its main features, forms of prevention and treatments available!

What is tuberculosis?

Tuberculosis refers to a group of infectious diseases that affect the tissues of various organs in the human body.

It initially affects the lungs and can spread to other organs if the patient does not seek medical treatment.

The types of the disease depend on the region it affects, and may be the lungs or several other organs, such as the heart and intestine.

The pulmonary form has as main symptoms: fever and night sweats, shortness of breath, physical indisposition, loss of appetite, chest pain and cough – which can be dry or present secretion containing pus and blood.

The etiologic agent of the disease is a bacterium called Mycobacterium tuberculosis and its transmission occurs directly from person to person.

That is, the contamination occurs through the inhalation of saliva droplets disposed in the air.

The other types (extrapulmonary or miliary) cannot be transmitted between people.

Tuberculosis is curable and its treatment involves the combined use of antibiotics .

In ICD-10 you can find the disease under the code A15.0 – Pulmonary tuberculosis , confirmed by microscopic examination of the sputum, with or without culture.

Types of tuberculosis

Tuberculosis has 2 main types, the pulmonary being the most frequent.

If not properly treated, pulmonary infection can compromise other organs, giving rise to a series of conditions called miliary or extrapulmonary tuberculosis , which are the 2nd type of the disease.

Each can also be subdivided into other forms of manifestation. Know more:

Pulmonary Tuberculosis

It is the most common form of the disease and begins with the fixation of M. tuberculosis in the pulmonary alveoli.

After penetrating the host, that is, the patient, through the upper airways (nose and throat), this bacterium reaches the lungs and begins its multiplication process, which generates tissue necrosis.

Pulmonary tuberculosis is divided into:

    • Primary: affects individuals who have not been previously exposed to the bacillus (causative agent), being more common in childhood, a stage in which the immune system is not yet fully developed.
    • Secondary: it can occur either due to a new infection or due to the reactivation of bacilli that have remained in the body.

Ganglionic tuberculosis

More common in HIV-positive children and HIV-positive people. Patients with this form of the disease may experience pain and swelling of the lymph nodes, which are lymph glands located in the neck.

Pleural tuberculosis

It is the most common extrapulmonary form in HIV-negative individuals. In addition to the more general symptoms, there is usually pain in the chest area.

Tuberculous meningitis

It is characterized by the infection of the membranes that surround the central nervous system.

Intestinal Tuberculosis

It is a very rare subtype that can be transmitted through ingestion of unpasteurized milk and contaminated by M. bovis , or as a result of complications from pulmonary tuberculosis.

The most characteristic symptoms are fever and diarrhea .

Bone tuberculosis

It affects the joints and bones, especially those of the spine (vertebrae) and the long ones, such as those of the thighs, causing pain in these regions. It is more common in children and adults over 40 years old.

Cutaneous tuberculosis

It is the rarest form of extrapulmonary tuberculosis, with only 1.4% of registered cases.

It is characterized by the appearance of reddish nodules on the skin. In adults, it can be caused by the BCG vaccine if the patient injures the area of ​​application of the vaccine, in recent cases of vaccination.

In these cases, cutaneous tuberculosis causes skin rashes that resemble wounds and injuries.

Bearing in mind that non-pulmonary tuberculosis, such as cutaneous tuberculosis, is not contagious.

What is miliary (extrapulmonary) tuberculosis?

Miliary or extrapulmonary tuberculosis consists of the set of diseases that result from pulmonary tuberculosis, in cases where the bacterium affects other organs or settles outside the lungs.

These types have no risk of transmission, as soon as the patient does not release agents through saliva.

Causes: mycobacterium tuberculosis

Tuberculosis is caused by a bacterium called Mycobacterium tuberculosis , also known as Bacillus de Koch. This bacillus belongs to the genus Mycobacterium , which also includes M. bovis , which causes tuberculosis in cattle.

In developed countries, infection in humans is caused exclusively by M. tuberculosis , although contamination by M. bovis in humans still occurs in underdeveloped nations.

In these cases, transmission occurs through the consumption of unpasteurized milk, causing gastrointestinal tuberculosis.

The M. tuberculosis is an obligate aerobic microorganism, ie, as human beings, lives only in the presence of oxygen.

This is the reason why after infecting the host organism, the bacillus initially settles in the pulmonary alveoli, since it is a highly oxygenated region.

As this bacterium is slow to grow, its incubation period in the body takes an average of 4 to 12 weeks.

The M. tuberculosis is sensitive to sunlight and can have its contagion decreased in naturally – lit places and with enough air circulation.

Transmission: how does contagion happen?

When a patient with pulmonary tuberculosis speaks, sneezes or coughs, he releases droplets of saliva into the air containing the bacterium M. tuberculosis .

These droplets containing the bacillus end up being inhaled by other people and taken to the lungs by breathing.

Once lodged in the lung tissues, the bacterium starts to reproduce giving rise to new bacteria.

When the patient’s immune system is able to prevent the development of the disease, the bacilli can remain in the body in a latent form .

This means that there is no development of symptoms or transmission of the disease.

Since the bacterium’s incubation period lasts around 4 to 12 weeks, symptoms can appear within that period.

This also initiates the phase of transmission of the disease, which can last for a long time if the patient does not seek medical help.

When there is professional monitoring and use of antibiotics, contagion tends to cease after 2 or 3 weeks.

Groups of risk

Among the factors that increase susceptibility to infection are:

  • HIV: HIV- positive individuals are 20 to 30 times more likely to develop the disease due to the fact that their immune system is compromised;
  • Diabetes: people with chronic diseases such as diabetes may have difficulty responding to treatment for tuberculosis;
  • Smoking: because it affects the lungs more frequently, patients with smoking end up becoming more vulnerable to contraction of the disease, since the use of tobacco harms the lung tissues.

In addition, people who live with carriers of the active disease, circulate in hospitals or in crowded places are more susceptible to contact with the bacteria.

Symptoms of pulmonary tuberculosis

The symptoms of tuberculosis vary depending on the subtype to which they belong. In cases of pulmonary tuberculosis, the most characteristic features are:

Cough

Persistent cough is one of the most characteristic symptoms of tuberculosis, and can manifest itself in its dry version or with secretions containing mucus, pus and blood.

It is also the means by which strains of Koch’s bacillus spread through the air, infecting other individuals.

However, it is important to note that the symptoms of the disease vary depending on the affected organ.

Thus, although cough is the symptom most associated with tuberculosis, it is not always present in the symptomatic picture.

Read more: Pneumonia or tuberculosis? Learn how to differentiate diseases

Shortness of breathe

When bacteria lodged in the lungs degrade organ tissues, secretions form that obstruct the airways.

As a consequence, the patient may have shortness of breath and, consequently, tiredness and little physical disposition.

Fever and night sweats

 

Fever is a recurrent symptom in many infectious diseases. This is because it acts as a natural defense mechanism for our body.

Upon detecting the presence of agents, such as bacteria and viruses, an increase in body temperature occurs, due to the body’s attempt to eliminate the infection more quickly.

But in addition, the increase in temperature also prevents the growth of bacteria that invade our body, as they thrive better at room temperature.

The high rate of sweating usually appears as an effect of warming the body, however, in some cases sweating can occur in the absence of fever.

Chest pain

Chest pain is usually associated with the effort the patient makes when he coughs.

In more severe cases, it may be a symptom of the rupture of the pleura, which consists of a membrane that covers the lungs. When it ruptures, water in the lungs may occur.

Loss of appetite

Loss of appetite is related to other symptoms of malaise, and may be accentuated at the beginning of treatment due to stomach discomfort caused by the use of antibiotics.

Symptoms of miliary tuberculosis

 

Miliary (or extrapulmonary) tuberculosis has symptoms in common with pulmonary tuberculosis, such as fever, pain, tiredness and loss of appetite.

However, in addition to them, there may be other symptoms related to the affected organ.

The most common are:

  • Chest pain and difficulty in breathing (pleural tuberculosis and tuberculous pneumonia);
  • Pain and swelling of the glands in the neck (ganglion tuberculosis);
  • Head and face pains (tuberculous meningitis);
  • Pain in bones and joints (bone tuberculosis);
  • Diarrhea (intestinal tuberculosis);
  • Skin lesions (cutaneous tuberculosis).

How is the diagnosis made?

 

The diagnosis of the disease is usually made by the general practitioner or pulmonologist , and is obtained through a series of laboratory tests.

The first step consists of a physical examination done at the doctor’s office, at which time the professional will ask a series of questions about the symptoms observed by the patient.

As tuberculosis presents symptoms similar to those of the flu , it is important that, in addition to the clinical examination, the condition is confirmed through laboratory tests.

Thus, the doctor will ask the patient to collect certain content (such as secretions expelled by the cough) so that the presence of the bacillus is investigated.

Exams

The medical professional may order tests to confirm the disease and indicate the best treatment.

The content collected for laboratory analysis varies according to the clinical picture presented by the patient.

In cases of pulmonary tuberculosis, the most common are:

  • Sputum collection;
  • Bronchial and alveolar tissue;
  • Lung tissue.

When the patient already has the extrapulmonary form of the disease, the collection may involve:

  • Blood;
  • Pleural or synovial fluids (from the lungs or joints);
  • Ganglionic secretions or tissue fragments (cutaneous or removed from organs).

Blood test

The blood test for tuberculosis, known as IGRA (Interferon Gamma Release Assay) can be done to detect whether the patient has strains of the bacillus in the bloodstream.

When a person is infected, the immune system produces a substance called interferon gamma, which serves to activate the cells responsible for eliminating microorganisms from the body.

In this examination, the presence of the bacteria that causes tuberculosis is measured according to the amount of interferon gamma produced by the organism.

As with other types of blood tests, the patient must be fasting for collection. The test consists of a simple blood sample.

X-ray test

It consists of a chest X-ray of the patient with suspected infection, being one of the tests most requested by specialists.

The radiography is removed by positioning the machine in the region of the patient’s lungs, painlessly and non-invasively.

During the procedure, it may be necessary for the patient to stay in a specific position, take a deep breath or hold the breath for a few seconds.

This type of test is contraindicated for pregnant women.

Sputum smear microscopy

The smear test is performed by collecting and analyzing the phlegm expelled in the cough of patients with suspected tuberculosis. It is done to check if the person is infected with Koch’s bacillus.

For the analysis, 2 samples are collected, which must be performed in 2 consecutive days, always in the morning. The patient does not need to be fasted for the exam.

Sputum collection can be performed in two ways:

  • Spontaneous collection: when the patient expels the secretion at the time of coughing;
  • Induced collection: used when the patient has a dry cough and is unable to expel sputum spontaneously. It is made from the inhalation of a medication that facilitates the collection (nebulization of hypertonic saline), lasting between 5 and 20 minutes.

The collection can be performed at home by the patient himself, as long as he follows the guidelines given by the health professional, ranging from oral hygiene to the correct way to expel the sputum in the collection container.

Tuberculin skin test (PPD)

Tuberculin is an injectable substance containing the cultivation of 7 sterile Koch bacillus strains.

It is applied intradermally (application to the superficial layers of the skin) on the patient’s left forearm to measure the immune response to the antigens contained in the substance.

The latent form of the disease is diagnosed if there is cutaneous hypersensitivity to tuberculin, that is, an inflammatory reaction at the application site.

The result can take 3 to 12 weeks to be ready.

It is worth noting that the tuberculin test may have its result altered if the patient has received the BCG vaccine less than 3 years ago.

Bronchoscopy

Bronchoscopy is an exam to analyze the patient’s tracheas, bronchi and lungs in a more direct way (structures of the respiratory system).

It consists of using a tube (bronchoscope) containing a camera at its end.

The test is an alternative for patients who have suspected tuberculosis although they have received a negative smear test.

It can also be recommended in cases where there is blood sputum in the cough and when the X-ray of the lungs changes.

The procedure is done with the aid of local anesthesia and lasts an average of 20 minutes.

In general, the recovery of the exam is quick and does not involve complications. However, some patients may experience discomfort and expectorate small amounts of blood after the procedure.

Can tuberculosis be cured?

-Yeah . And besides being curable, the treatment is completely free! However, for the cure to be achieved it is essential that the patient follows the guidelines of the specialist doctor to the letter, making the treatment until the end and taking the correct dose of the medication.

How is the treatment?

 

Treatment for the disease lasts an average of 6 to 9 months and is based on the combined use of some antibiotics, always done with medical supervision.

In addition to drug treatment, experts recommend that tuberculosis patients maintain a balanced diet to boost immunity.

Rest and health care in general are also great alternatives to relieve symptoms.

Antibiotics

Medical treatment is usually done using 4 different antibiotics.

The drug combination is made to decrease the rate of mutability of the bacilli, which, when multiplying in the host organism, can generate strains of strains resistant to these drugs.

If this occurs, the patient will show no improvement in symptoms, acquiring a condition known as multidrug-resistant tuberculosis .

Thus, to avoid this condition, treatment generally follows the following schedule: in the first 2 months, the doctor prescribes the associated use of 4 antibiotic drugs.

In the next 4 or more months that follow, the patient reduces to 2 drugs.

The combination of drugs maintained in the second phase of treatment depends a lot on the individual response of each patient.

According to the Department of Health, treatment with antibiotics carried out over 9 months proved to be more effective, however, the patient should not prolong the use of these drugs without the specialist’s indication!

In addition to antibiotics, it is common for doctors to prescribe inhaled medications and syrups to mitigate the effects of coughing.

Read more: Aspirin helps the body fight tuberculosis, says study

Follow-up

In view of the high rates of abandonment of treatment for tuberculosis, the Ministry of Health started offering follow-up for patients over 10 years old.

Monitoring is free and consists of at least 2 monthly assessments, one made by the doctor and the other by nurses or other health professionals.

In these evaluations, the professionals provide guidance and request exams, such as smear microscopy, to find out if the medication is working properly.

As the treatment is long, this follow-up is done for 6 months. The frequency of visits to the doctor can be increased depending on the severity of the symptoms presented by the patient.

Medicines

Among the main drugs used in the treatment are:

  • Isoniazid ;
  • Rifampicin ;
  • Pyrazinamide ;
  • Ethambutol .

Important: rifampicin can interfere with the contraceptive pill’s effect, it is essential that women inform the doctor if they use the pill. Likewise, doctors must advise patients on this drug interaction .

Attention!

NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.

Living together

Has he been diagnosed or has any family member with tuberculosis? Do not worry! With some basic daily care, it will be possible not only to relieve the symptoms of the disease, but also to cure it.

Make proper use of medication

If you make the correct use of the antibiotics prescribed by your doctor, it will be possible to obtain significant improvement of the symptomatic picture in a short period of time.

It is true that the drugs used in the treatment can cause very uncomfortable side effects, such as stomach pains. However, it is important that you do not fail to do so, as it is essential for your healing!

Rest

Rest is very important for the recovery of the patient with tuberculosis.

It is very common for the symptoms of the disease to cause shortness of breath and physical indisposition. So give your body a break and try to rest.

The patient can continue to live with the family, it is very important that she participates in the treatment, encouraging the correct use of the medication.

These small precautions can make the routine lighter, in addition to reducing the risks of transmission to other individuals.

Follow the treatment until the end

It is very common that in the first months of treatment some symptoms disappear, such as cough, fever and indisposition.

As a result, many people end up abandoning the treatment in the illusion that they are already cured, which ends up compromising their health even more.

However, when interrupting the medication, some more resistant bacteria may remain in the patient’s body, multiplying and worsening the disease state.

So, trust your doctor and take the treatment to the end!

Prognosis

Most patients without autoimmune diseases have a high chance of recovery in the first months after the start of drug treatment.

However, healing can only be achieved if the therapy is carried through to the end!

People with HIV end up taking more risks with the disease, including children. So, care must be redoubled!

According to statistics from the Ministry of Health, people with acquired immunodeficiency are the ones who die the most as a result of tuberculosis in Brazil, and it is essential that they seek medical attention in the first symptoms.

What are the complications of tuberculosis?

If the patient’s immune system fails to fight the bacteria that affects the lung, it can spread to other organs and tissues through the blood and lymphatic currents.

When this occurs, the patient may develop other serious clinical cases, such as miliary tuberculosis and other conditions.

Among the complications of tuberculosis are:

Bacterial spread (miliary tuberculosis)

Miliary tuberculosis is a type of tuberculosis, but it is also a complication of pulmonary tuberculosis.

It occurs when the disease-causing bacteria leaves the lungs through the bloodstream and spreads to other organs and tissues in the body.

The types of miliary disease are:

  • Pleural tuberculosis;
  • Tuberculous pneumonia;
  • Ganglionic tuberculosis;
  • Tuberculous meningitis;
  • Bone tuberculosis;
  • Intestinal tuberculosis;
  • Cutaneous tuberculosis.

Acute renal failure

Renal failure occurs when the kidneys lose the ability to filter blood, a condition that is also related to the dispersion of the bacteria that causes tuberculosis into the bloodstream.

Digestive Bleeding

Digestive bleeding is an advanced symptom of intestinal tuberculosis that consists of the appearance of blood in the patient’s stool .

Like acute renal failure, digestive bleeding is more common in patients with autoimmune problems.

Septic shock

Septic shock consists of a generalized inflammatory reaction caused by the immune system in response to the invasion of microorganisms in the bloodstream.

When bacteria or viruses spread through the body affecting different organs, the immune system reacts by releasing substances that cause infections in an attempt to eliminate these bacteria.

These infections cause symptoms and reactions, such as fever.

However, when inflammation occurs in different parts of the body, the condition is called septic shock, in which there are risks to the patient’s life.

Multiple organ failure

It occurs when the microorganisms spread in a generalized way through the organisms, affecting the functioning of the organs.

It is the most serious complication of tuberculosis, being more common in patients with congenital or acquired autoimmune diseases.

However, this condition can also affect patients without autoimmune problems if there is no treatment for tuberculosis.

Prevention: how to protect yourself?

Tuberculosis can be prevented through a series of measures that, if applied together, can considerably decrease the number of incidences in the population. Between them:

Get vaccinated

The main way to prevent tuberculosis is to immunize the population. The BCG vaccine should be applied in early childhood (age 0 to 5 years).

HIV-positive children or daughters of HIV-positive parents should receive it as soon as possible, except in cases where they have clear symptoms of low immunity.

In general, the BCG vaccine is more effective as a protection against miliary tuberculosis, but it should always be taken as a form of immune booster.

Read more: BCG vaccine is effective even in children without scarring, says WHO

In addition to vaccination, there are other simpler ways to prevent the disease:

Eat well

A balanced diet is essential for strengthening the immune system, as it is responsible for preventing entry or fighting microorganisms in our body.

In conjunction with vaccination, the right amount of vitamins , proteins and other nutrients helps to fight infections.

Read more: Benefits of quinoa: grain prevents disease and improves immunity

Have good hygiene habits

Washing your hands thoroughly before eating and after going to the bathroom also prevents the body from being exposed to disease-causing microorganisms.

In addition, when the person is already infected, little care is required. It is essential that she take preventive measures to prevent the spread of the disease.

Avoid crowds

As pulmonary tuberculosis is transmitted through the air, it is important not to stay in places with poor ventilation and high circulation of people.

Patients who have already developed the disease must wear surgical masks or cover their mouth at the time of coughing to prevent the bacillus from being released into the air.

People who have had contact with patients should go to the nearest health facility to be examined by professionals.

Tuberculosis vaccine (BCG)

The BCG vaccine (Bacillus Calmette-Guérin) has as active ingredient live attenuated strains of the bacillus M. bovis , which, like M. tuberculosis , belongs to the genus Mycobacterium .

When applied in an attenuated form in humans, it works by preventing the most severe forms of the disease in children, reaching 80% efficacy against miliary tuberculosis and 33% against pulmonary tuberculosis.

BCG is distributed free of charge by the Ministry of Health and is part of the vaccination schedule.

However, it is contraindicated for:

  • People with congenital or acquired immunodeficiency, such as those with HIV who have symptomatic symptoms;
  • People who have recently received a dose of another vaccine containing live microorganisms, such as measles, yellow fever or polio. In such cases, it is important that an interval of at least 4 weeks is established for BCG to be applied.

Read more: Minute Investigate: can having a vaccine cause autism?

Bovine tuberculosis

Bovine tuberculosis is caused by the bacterium Mycobacterium bovis . It mainly parasites cattle, although it can also infect domestic animals like dogs and cats.

The agent can be transmitted to humans through the ingestion of contaminated milk or in a similar way to person-to-person contagion (by inhaling droplets of saliva expelled into the air).

The second case usually affects rural workers who maintain contact with cattle.

In animals, tuberculosis can become chronic, causing lesions and necrosis in various organs, such as the kidneys and lungs.

Symptoms consist of a dry cough, difficulty breathing and weight loss. To date, there is no vaccine or treatment available for bovine tuberculosis.

Common questions

Tuberculosis catches?

-Yeah . Tuberculosis is an infectious disease transmitted in person-to-person contact through the inhalation of droplets of saliva expelled by infected people.

Therefore, it is close to patients with the active form of the disease, or sharing items in common use can cause the bacteria to spread.

What are the forms of contagion of tuberculosis?

Tuberculosis is transmitted from person to person through saliva. When a patient with the active disease coughs, particles of saliva are released containing the bacillus that causes the infection.

These particles of saliva are dispersed in the air, being inhaled by other people.

As the bacteria are expelled only through coughing, it is important to note that only pulmonary tuberculosis is contagious, since coughing is not a characteristic symptom of other types of tuberculosis.

How do you know if a person has tuberculosis?

It is through medical diagnosis that tuberculosis can be confirmed. However, there are some signs that can be seen when the infection starts.

When the bacterium that causes tuberculosis attacks the organism, it first settles in the lungs.

Therefore, the first symptoms are cough, fever, night sweats, difficulty breathing and chest pain. It is also common for the infected person to experience loss of appetite and get thin very quickly.

The cough may be dry at first, but it gets more intense and comes with a secretion containing pus and blood.

It is usually recommended that the patient seek medical help if the cough lasts for more than 3 weeks, even if the cough does not show any secretion.

Ganglionic tuberculosis is cancer?

No . Ganglionic tuberculosis is an infection caused by a bacterium ( Mycobacterium tuberculosis ), when the bacteria leaves the lungs and spreads through the bloodstream, affecting other organs and tissues.

But the cancer is caused by the uncontrolled multiplication of cells, which may be linked to genetic and external factors such as smoking, radiation, pesticides and other chemicals in food.

Tuberculosis is treated with antibiotics, while cancer requires more complex treatments, such as chemotherapy.

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