Conditions Tuberculosis

Tuberculosis

Pulmonary tuberculosis (TB), is a bacterial disease affecting the lung and it is caused by Mycobacterium tuberculosis. It is transmitted through droplets when a patient coughs in the air. Furthermore, it is common in the third world countries. However, due to the high number of foreigners form third world countries visiting and residing in Singapore, there is an increased number of tuberculosis cases among Singapore residents and foreigners residing in Singapore.

In our specialist clinic, we do see a number of TB cases every week. They usually present with the following symptoms:

• Prolonged cough with phlegm
• Coughing up blood-hemoptysis
• Excessive sweating, especially at night
• Prolonged fever
• Weight loss
• Breathing difficulty

Diagnosis

Diagnosis of active TB is suspected by chest X-ray. Confirmation requires microscopic examination and microbiological culture of sputum. Tests may include:

• Chest X-ray – Posterior anterior view, apical view
• Chest CT Scan – if Chest X-ray shows non specific opacity
• Blood tests like the TB T Spot test and Quantiferon test
• Sputum examination and cultures
• Bronchoscopy
• Thoracentesis/pleural tap
• Pleural biopsy

Treatment

Treatment of TB in the lung involves a combination of multiple drugs (usually at least 3 drugs initially) for an average of 6-12 months. The most commonly used drugs include:

• Isoniazid
• Rifampicin
• Pyrazinamide
• Ethambutol
• Streptomycin

Cure rate is very high (>95%) if patients are compliant with daily medicine intake over prolonged period. It is crucial that patients take the anti-TB medicine as prescribed by the doctor. When patients take less than the duration required or are not compliant with treatment, TB relapse can occur and the emergence of multi-resistant TB bacteria can happen.

Patients with pulmonary tuberculosis are advised to stay at home for 2 weeks at the beginning of treatment period to avoid spreading the disease to others. They are also advised not to travel by air during this period to avoid transmitting the disease to other passengers. Symptoms often improve by 4^th week and regular follow up with specialist during treatment period is important to monitor side effects of anti-TB drugs and to ensure adherence to treatment.