It is an infection caused by a minute germ Bacillus Mycobacterium Tuberculosis (shortly called T.B) which was identified, in 1882, by Koch and characterised by formation of tubercles (or nodular lesions, the latter symptom popularly known as Consumption and Pthisis (wasting).
Origin of Disease : Though the chief causative factor is the T.B. germ, detailed above, that sets in tone the spread of disease. The germ gains entry into our lungs through inhalation of fine particles of cough when a pthisical patient coughs/sneezes on our face, the germs enter lungs of a healthy person or when the sputum, spat long back, dries up, by a pthisical patient, is swept into the air of a cool room. So, it is the tubercular patient who is responsible for spreading the germs of his disease to healthy persons.
When the expelled sputum is disposed of in water, reservoirs or fields, the disease enters through contaminated water or food. Flies also are carriers of such germs. When such flies, sit on a pthisical patient’s sputum and foods and water, they transmit the germs to these articles which, when eaten/drunk by healthy persons, help the germs to enter our system through our digestive canal. In either case, the disease is spread by the said germ initially, but is propped up by patient’s sputum, flies, infected and contaminated water and food items.
At the first stage, the patient may not show any signs of the disease due to the fact that his natural defences may serve as potent barriers in not allowing the symptoms to surface but its spread to healthy persons, cannot and should never be ruled out. The disease may smoulder for months/years and fluctuate as per resistance capacity of a patient. I went though many persons are infected but, apparently, show no symptoms/sign of infection.
Symptoms
It is hardly of any consequence whether the tubercle bacilli lodge inside our body through lungs, intestines, liver or bones or eyes, it is a fact that they give rise to small inflammatory pimples/ elevations which break down, cause ulceration, form pus (which in the case of lungs, is thrown out in the form of phlegm) or many give rise to bleeding from the lungs (Hameoptysis) or bleeding from bowels (malaena).
General symptoms are : Night-sweat, low fever (in the evening), loss of weight, and emaciation in progression, hacking cough, pain in chest – all in pthisis of lungs. The germ can go beyond in the lungs, liver, bones, intestines, coverings of animals brain, sputum, urine, faeces.
Causes
Chronic malnutrition, heredity, lack of or improper rest, working for long hours at a stretch without aid of requisite diet, living in ill-ventilated, dark, crowded and damp rooms; debilitating and exhausting diseases, viz repeated pregnancies, diabetes, strenuous labour etc are the leading causes. Expelled sputum may be blood-tinged or there can be bleeding from lungs itself or spit-ting of blood.
When the bacillie spread from lungs to blood-stream, setting up millions of thin tubercels throughout the body, it is called Milliary Tuberculosis; when they travel to meninges, they cause ‘Tuberculous Menengitis’. ‘Periotinitis’ is caused by entry of bacilli through mouth (usually an infected cow’s milk is the cause) when they set up a primary complex in abdominal lymph Nodes; when they spread to joints, bones and other organs of the body, a disease called ‘Pott’s disease’ surfaces. These subtitles are men-tioned for the knowledge of the readers, simply to impress upon them gravity and complexity of this multifaceted disease which ought to be controlled and not allowed to progress.
The disease is fully curable but is liable to recui il the gemis invade the body again and that when treatmenl is given up in between or when the dosage is tapered by the patient of his own, or when usual safeguards and precautions are not adhered to. The treatment is a bit costly but not so costly as compared to brain, heart and kidney diseases. It is imperative that the patient remains under guidance of a doctor so that he is able to control and treat other minor/major complications also, he has to guard against the recurrence of contributory causes.
Periodical check up, x-ray films, sputum, blood test etc, from part, rather an essential part, of control, management and medication so as to know as to what extent the disease has been controlled and also whether dose needs to be adjusted and/or aided by other medicines, follow up measures.
If the disease is detected at the inception stage, management is quite easy, due to the fact that, at that stage, complications are far less. The disease has three stages which are indicated below:
I Stage : Here, turbercles appear at small spots in the upper part of lung of 2-3 cms below. After a lapse of few months, weeks, years, new turbercles form on the lower part of lung. When examined with the help of stathescope, there are sounds of rales which are audible, either above the clavicle or on the upper part of the affected lung.
II Stage : Symptoms resemble with those of II stage of pneumonia when chest movement is impeded and slowed down while inhaling, tubercles are changed, there is swelling and an element of solidity, colour changes to yellow.
III Stage : Now the tubercles break up and form or convert into cavities on the portion of lung which has assumed solidity. After some time, these cavities coalesce and major portion of the lung assumes the form of a big hollow cavity. Lower ribs come into closer proximity to each other, but the upper ribs get distanced from each other.
Other forms of T.B
1. Pneumonia T.B. (already explained.)
2. Fibroid T.B. The disease occurs after chronic pneumonia or pleuresy. It has effect on one lung only which atrophies to half or one-fourth size of its original (normal) size; sputum is purulent, there is dyspnoea, blood comes out with expectorated sputum. The left ventricle expands, swelling all over, diarrhoea and albuminurea-surface. Ultimately the patient meets his terminal end.
The disease can be controlled by Streptomycin, loniazid (INH), Paraminosalicyclic acid (PAS). The patient should never take these or an other medicines without the doctor’s advice because he won’t be able to determine the extent of damage and at what stage the disease has reached.
Preventive measures include BCG Vaccination for those who have no immunity to the disease.
Supportive Measures
Food ought to be such as can be easily digested and that the same should be nutritious also.
Change of place and climate, preferably a sanatorium or hilly place, can show quicker and better results.
Patient’s sputum and other ejecta should be disposed of in a barren place, but Pot. permanganate or dettol/phenyle must be used to kill the germs and also that healthy persons are not infected.
Any concomittant symptom should also be treated with suitable medicines.
Utensils, clothes, bed-sheets, used by a patient, should never be used by healthy persons and also by the attendants.
keep the rooms ventilated, open (not in chill) and * old SVCltllli i i so that there is free entry of air. Dust, smoke and odoui I should not, in case, affect the patient.
Change clothes of patient, pillow and bed-covers dad\ AI lergic factor should always be kept in mind while using clothes