UNDERSTANDING TUBERCULOSIS: CAUSES, TYPES, SYMPTOMS, TREATMENT, AND DIETARY
GUIDANCE
Introduction:
Tuberculosis is a chronic disease primary
caused by mycobacterium tuberculosis. It affects the lungs and also affects the
other organs of respiratory system/ tract. It is transmitted throw airborne
droplets when an infected person cough or sneezes.
When inhaled, and the M.
tuberculosis reached the alveoli, where they are typically involved by alveolar
macrophages. The bacterium evolves mechanism to survive within immune cells and
can lead to latent infection or active disease.
The body forms clusters of
immune cells; granulomas to try to contain the infection but in some
individuals, specially those with we can immune system, the bacteria may bread
out of granuloma and spread causing tissue damage.
People with HIV are most
likely to have Tuberculosis (because their immune system is weakened).
Types of Tuberculosis
Based on Site of Infection:
Tuberculosis can be
classified into two types based on site of infection.
Pulmonary
tuberculosis: it affects the lungs. It is the most common type/ form of
tuberculosis. (About 85% of cases). (Can be contagious via airborne droplets).
Extrapulmonary tuberculosis: it affects organs other than lungs. It is common in
people with weak immune system. (e.g. HIV-positive individuals).
It
includes:
Lymph node tuberculosis
Pleural tuberculosis
Meningeal tuberculosis
Genitourinary tuberculosis
Abdominal
tuberculosis
Skeletal tuberculosis (Pott's disease)
Based on Clinical
Status:
Latent Tuberculosis Infection (LTBI): The person is infected
bacteria are dormant. No symptoms, no transmission.
Active Tuberculosis
Disease: Bacteria are actively replicating. The patient in symptomatically can
be contagious especially in pulmonary tuberculosis.
Based on Mode of
Infection:
Primary Tuberculosis: First time infection, usually in children
or immunocompromised individuals often asymptomatic or mild symptoms.
Secondary Tuberculosis: Occur when latent tuberculosis reactivates, usually and
adults with weekend immunity. More severe and symptomatic.
Based on
Dissemination:
Localised Tuberculosis: confined to single organ (e.g.
lymph node, lungs).
Disseminated or Military Tuberculosis: Affects multiple
organs.
Ratio of Tuberculosis in Pakistan:
Pakistan has a high burden
of tuberculosis(TB) according to the World Health Organisation(WHO) estimates
that Pakistan accounts for approximately 6.3% of the global tuberculosis cases.
Key Tuberculosis (TB) Statistics in Pakistan (2023)
Estimated New Cases:
510,000 annually.
Incidence Rate: 276 cases per 100,000 population per
year.
Prevalence Rate: 348 cases per 100,000 population.
Mortality
Rate: 34 deaths per 100,000 population annually.
MDR-TB Cases: 15,000
yearly; Pakistan ranks 4th globally in multidrug-resistant TB burden.
Regional Incidence Rate:
Sindh: 292 per 100,000
Khyber Pakhtunkhwa:
269 per 100,000
Punjab: 243 per 100,000
Stmptoms of Tuberculosis(TB):
Symptoms of tuberculosis can vary depending on whether it’s pulmonary
tuberculosis or extrapulmonary tuberculosis.
Pulmonary Tuberculosis
Symptoms:
Affects the lungs and is contagious.
Persistent cough
(lasting more than 2–3 weeks).
Coughing up blood or sputum (hemoptysis).
Chest pain or discomfort during breathing or coughing.
Shortness of breath
(in advanced cases).
General Symptoms:
Seen in both pulmonary and
extrapulmonary Tuberculosis:
Fever (especially in the evenings).
Night
sweats.
Unexplained weight loss.
Loss of appetite.
Fatigue and
weakness.
Extrapulmonary Tuberculosis Symptoms:
Depends on the organ
affected:
Lymph node TB: Swollen, painless lymph nodes, often in the neck.
TB meningitis: Headache, stiff neck, confusion, seizures.
Spinal TB (Pott's
disease): Back pain, spinal deformity, paralysis.
Renal TB: Blood in urine,
flank pain.
TB pleuritis: Sharp chest pain, difficulty breathing due to
fluid in pleural space.
Diagnosis of Tuberculosis (TB):
1. Clinical
Evaluation:
Symptoms: Cough >2 weeks, fever, weight loss, night sweats.
2. Laboratory Tests:
Sputum Microscopy: Detects acid-fast bacilli.
GeneXpert (CBNAAT): Detects TB DNA and drug resistance.
Sputum Culture:
Confirms TB but takes weeks.
Mantoux Test (TST): Detects TB exposure.
IGRA: Blood test for latent TB.
3. Imaging:
Chest X-ray: Shows lung
damage.
CT/MRI: Used for extrapulmonary TB.
4. Other Tests:
Biopsy, fluid analysis (pleural, CSF, urine) based on TB site.
Role of
Nutrition in Curing and Managing Tuberculosis (TB):
While medication is
essential for curing TB, nutrition plays a critical supportive role in recovery
by boosting the immune system, reducing treatment side effects, and promoting
tissue healing.
1. High-Calorie, High-Protein Diet:
TB patients often
lose weight and muscle mass. They need:
Calories: To meet increased energy
demands.
Sources: Rice, whole grains, potatoes, healthy oils.
Protein:
To repair tissues and fight infection.
Sources: Eggs, meat, chicken, milk,
pulses, nuts.
2. Micronutrients Essential in TB:
Vitamin A – Enhances
immune response
Sources: Carrots, mangoes, sweet potatoes.
Vitamin D –
Helps in immunity and lung health
Sources: Sunlight, fortified milk, egg
yolk, fish.
Vitamin C – Promotes healing and tissue repair.
Sources:
Citrus fruits, guava, tomatoes.
Vitamin B-complex – Prevents nerve damage
(important if taking isoniazid).
Sources: Whole grains, dairy, meat.
Iron – For anemia and energy.
Sources: Red meat, leafy greens, dates.
Zinc & Selenium – Strengthen immunity.
Sources: Seeds, nuts, seafood.
3. Hydration:
Adequate fluids help reduce medication side effects and aid
digestion.
4. Small, Frequent Meals:
Helps improve intake in patients
with poor appetite or nausea.
5. Avoid:
Alcohol, smoking, and junk
food – weaken immunity and interfere with treatment.
TB Medication:
2
Months: Isoniazid, Rifampicin, Pyrazinamide, Ethambutol (HRZE).
4 Months:
Isoniazid, Rifampicin (HR).
MDR-TB: Second-line drugs (e.g., Bedaquiline,
Linezolid) for 9–20 months.
Vitamin B6: Prevents nerve damage with
isoniazid.
Note: Full course and regular dosing are essential for cure.
References:
1. Harrison's Principles of Internal Medicine.
2. Guyton
and Hall Textbook of Medical Physiology.
3. Ganong's Review of Medical
Physiology.
4. World Health Organization (WHO).
5. National
Tuberculosis Control Program (Pakistan).
6. CDC (Centers for Disease
Control and Prevention).
7. Medical News Today.
8. WebMD.
9. NCBI/StatPearls.
10. Oxford Textbook of Medicine.
11. Cochrane – Students 4 Best Evidence.
12. Cleveland Clinic.