Tuberculosis (TB): Symptoms, Causes & Treatment

Tuberculosis (TB) is a chronic infectious disease caused by the bacterium Mycobacterium tuberculosis, spreading from person to person through respiratory droplets when an infected individual coughs or sneezes. It primarily affects the lungs (pulmonary TB), but can involve other organs including bones, brain, kidneys, and lymph nodes.

TB remains one of the world's deadliest infectious diseases, with millions of cases recorded annually. In the Middle East and Arab region, including Jordan, TB continues to be a significant public health concern, particularly in crowded urban areas and vulnerable populations. The disease's spread is linked to poverty, malnutrition, overcrowding, and compromised immune systems.

Infection usually requires prolonged and repeated exposure to transmit the disease, and not everyone exposed to the bacterium develops active illness. TB exists in two forms: latent TB infection (person harbors bacteria but shows no symptoms) and active TB disease (bacteria multiply, causing symptoms and complications). Early diagnosis and consistent antibiotic therapy are essential for cure and preventing transmission.

TB symptoms develop slowly over weeks or months, not immediately. In early stages, no clear symptoms may appear (latent TB), but when the disease becomes active, respiratory and systemic symptoms emerge. There are no major gender-based differences in symptoms, though children may present with milder manifestations.

• Persistent cough: Initially dry, may progress to productive cough with sputum or blood after several weeks. Lasts longer than 3 weeks.
• Low-grade fever: Usually 37.5 - 38.5°C, typically appearing in late afternoon and evening.
• Severe night sweats: Profuse sweating during sleep that may drench clothes and bedding.
• Unexplained weight loss: Gradual weight loss despite unchanged diet.
• Fatigue and general weakness: Severe tiredness and inability to perform normal activities.
• Chest pain: Especially with deep breathing or coughing.
• Shortness of breath: In advanced cases or with complications.
• Loss of appetite: Unwillingness to eat and early satiety.
• Pallor and general body weakness: Due to anemia and malnutrition.
• Lymph node enlargement: Small swellings may be noted in the neck or armpits (in extrapulmonary TB).

• Infection with Mycobacterium tuberculosis bacterium: Direct entry of bacteria into the lungs through inhalation of respiratory droplets from an infected person. Bacteria spread easily in enclosed, crowded spaces.
• Prolonged and close contact: Sharing a bedroom, house, or workplace with someone with active TB for extended hours. Brief encounters (seconds) rarely transmit the disease.
• Weakened immune system: People with HIV/AIDS or those taking immunosuppressive medications for other conditions are at higher risk of latent TB progressing to active disease.
• Malnutrition and poverty: Lack of essential nutrients weakens the immune system and increases disease risk.
• Chronic underlying diseases: Patients with diabetes, heart disease, kidney disease, and cancer are more susceptible.
• Smoking and alcohol use: Both negatively impact immune and respiratory system efficiency.
• Crowding and poor housing: Overpopulated areas and homes with poor ventilation facilitate disease transmission.

• HIV/AIDS infection: The strongest risk factor, increasing progression from latent to active TB by up to 100-fold.
• Healthcare workers: Doctors, nurses, and hospital staff face higher exposure risk.
• Prisoners and institutionalized persons: Severe overcrowding and poor ventilation increase infection rates.
• Migrants and refugees: From high-TB areas, especially without adequate health screening.
• Infants and young children: Weaker immune systems increase risk of severe forms.
• Elderly populations: Declining immunity with age raises disease risk.
• Poorly controlled diabetes: Impairs immune response and increases complications.
• Use of prescribed immunosuppressive medications: Rheumatoid disease and TNF-inhibitor drugs.
• Low body weight and severe malnutrition: Vitamin and mineral deficiencies weaken defenses.
• Working in contaminated environments: Factories, mines, and poorly ventilated workplaces.

TB diagnosis combines clinical examination, laboratory tests, and imaging. Early diagnosis is crucial to prevent disease progression and complications.

• Clinical examination: The physician listens to the lungs with a stethoscope for abnormal sounds (crackles). Reviews medical history and symptoms.
• Mantoux test (tuberculin skin test): TB antigen is injected intradermally; reaction is read after 48-72 hours. Induration of 5-15 mm (depending on risk factors) suggests past or current infection. Criteria vary by patient status (HIV, TB history, etc.).
• IGRA (Interferon Gamma Release Assay): Blood test detecting antibodies to TB, more accurate than Mantoux, unaffected by prior BCG vaccination.
• Sputum smear microscopy: Patient collects sputum for 3 consecutive mornings. Examined under microscope using special staining (Ziehl-Neelsen). Presence of bacteria confirms active TB.
• Sputum culture: Sample cultured on special medium. Takes 2-8 weeks but is the gold standard for diagnosis and drug-susceptibility testing.
• DNA testing (PCR/GeneXpert): Rapid and accurate test detecting bacteria and drug resistance within hours. Available in major hospitals and advanced health centers.
• Chest X-ray: Shows TB lesions typically in upper lung lobes (white infiltrates or cavities). May appear normal in very early or severely immunocompromised cases.
• CT scan: For complicated cases or suspected complications.
• Blood tests: May show possible anemia, reduced immune cells in HIV+, or inflammation markers.

Medications

• Standard four-drug intensive phase: For the first two months, the patient receives four daily medications: Isoniazid (INH), Rifampicin (RIF), Pyrazinamide (PZA), and Ethambutol (EMB). This phase rapidly controls active bacteria and reduces symptoms.
• Continuation phase (dual therapy): For four months after the initial two months, INH and RIF are given. This phase ensures elimination of remaining bacteria and prevents relapse.
• Complete medication adherence: The patient must take medications daily for the full six months, even if feeling better. Non-adherence can lead to treatment failure and drug resistance.
• Monitoring side effects: TB drugs may cause nausea, rash, peripheral neuropathy, or liver problems. The physician monitors monthly and performs periodic blood tests.
• Drug-resistant TB (DR-TB): If cultures show resistance to first-line drugs, longer treatment (18-24 months) with stronger agents (Fluoroquinolones, Bedaquiline, Linezolid) is used. Treatment is complex with potentially severe side effects.
• Nutritional support: The physician may recommend Vitamin B6 supplements with Isoniazid to reduce neurological effects and good protein-rich nutrition.

Procedures / Surgery

• Initial isolation: Patients with active pulmonary TB should remain home or in a separate room for 2-3 weeks from treatment start until no longer infectious.
• Regular monitoring: Monthly check-ups include sputum examination to confirm bacteria elimination (sputum conversion from positive to negative) and liver/kidney function tests.
• Surgery (rare): In highly drug-resistant TB or complications like large cavities unresponsive to therapy, surgical removal of affected lung portion may be considered. This is very rare with modern medications.
• Complication management: If liver or kidney failure occurs, intensive supportive care or medication changes may be needed.

Lifestyle Changes

• Good nutrition: Balanced diet rich in protein, vitamins, and minerals to strengthen immunity. Milk, meat, eggs, and leafy vegetables are crucial.
• Adequate rest: At least 8 hours of daily sleep aids body recovery.
• Avoid smoking and alcohol: Both weaken immunity and worsen lung damage.
• Limit strenuous work: Reduce physical exertion initially, gradually increasing as improvement occurs.
• Initial isolation: Avoid close contact with others at home during early treatment weeks; use masks when necessary.
• Strict medication adherence: Phone reminders or family support help ensure medications are not missed.
• Regular follow-up: Attend all scheduled medical appointments and tests, even after symptom improvement.
• Psychosocial support: Patients may experience depression or anxiety due to long treatment and social stigma. Family support and counseling are important.

• Extrapulmonary TB: Disease spreading to other organs such as bones and spine (Pott's disease), meninges (TB meningitis), kidneys, and lymph nodes. These forms are more serious, require longer treatment, and may cause permanent disability.
• Major hemoptysis: Heavy coughing of blood (>100-250 mL in one hour) threatening life, requires immediate emergency care. May need radiological or surgical intervention.
• Secondary bacterial pneumonia: Other bacterial infections may occur due to weakened immunity overlying TB.
• Acute respiratory failure: Widespread TB in lungs may prevent adequate breathing, requiring mechanical ventilation support.
• Pulmonary fibrosis: Untreated or delayed-treated TB may cause permanent scarring, affecting breathing function even after cure.
• Liver failure: TB drugs may cause acute hepatitis, especially in chronic liver disease or HIV+ patients. Requires close liver function monitoring.
• Drug-resistant TB (DR-TB and XDR-TB): Development of TB strains resistant to first-line or even second-line drugs. Treatment is longer, more toxic, and less effective. Cure rates are much lower.
• Progressive primary TB: In children and elderly, latent TB may rapidly progress to active severe disease within weeks.

• BCG vaccination: Given to newborns shortly after birth (1 day to 1 week). Provides partial protection against TB for 10-15 years, especially against severe forms in children. Available free at health centers in Jordan.
• Early detection and isolation: Rapid TB diagnosis and immediate isolation breaks transmission chain. Anyone with cough longer than 3 weeks should be screened.
• Contact investigation: All family members and close contacts of TB patients must be screened for infection. Preventive medications may be given if latent TB is confirmed.
• Preventive therapy: People with confirmed latent TB infection (positive Mantoux or IGRA), especially HIV+ and children, receive Isoniazid alone for 6 months to prevent disease development.
• Improved ventilation and housing: Well-ventilated rooms at home and work reduce infectious droplet concentration. Avoid severe crowding.
• Better nutrition and overall health: Balanced diet rich in vitamins (especially A, D, C), regular exercise, and adequate sleep strengthen immunity and reduce disease risk.
• Periodic screening for high-risk groups: Healthcare workers, TB patient contacts, prisoners, and migrants should be screened annually or semi-annually.
• Eliminate bad habits: Quitting smoking and alcohol reduces lung damage and immune suppression.
• Chronic disease control: Good management of diabetes, heart and kidney diseases reduces TB complications.
• Health education and public awareness: Spread information about TB symptoms, importance of early treatment, and adherence, especially in at-risk communities.