HEALTH WATCH

A look at tuberculosis

by Dr. Elliot Neufeld and Gary Avis

Mycobacterium tuberculosis (more commonly known as TB) is most often identified as a disease that affects the lungs. This is only partially true. Actually, TB can infect any major organ, although it is the lungs that are primarily affected. In the HIVpositive population, this is particularly true.

The disease is called tuberculosis because it causes the formation of tubercules (small rounded masses of tissue) and caseous necrosis (tissue which is damaged to the point of being soft, dry, and cheesy in substance). If TB is allowed to progress, this tissue damage will cause death.

Tuberculosis is very contagious. It can be spread from person to person by casual contact or through coughing and sneezing. The risk of catching TB from someone with an active case of TB is quite high, regardless of HIV status. If medical personnel consider it possible that you have active TB, they may wear masks and gloves to prevent infection.

The usual symptoms of TB are cough, weight loss, fever, night sweats, and fatigue. Since these are basically the same symptoms that someone with AIDS will have, it is essential if you are HIV positive to be tested for TB at least once a year, in order to ensure that you not have a latent TB infection. It should be noted that the most common tuberculosis skin test, the PPD (the one you may have been given in school) is often much less sensitive in people whose immune systems are suppressed. The Mantoux test is the one that is recommended for diagnosis for the HIV-positive population. Other TB tests include the isolation of mycobacterium tuberculosis by culture or by other methods such as X-rays.

If you have TB, treatment is a long process. It requires that several drugs be taken over several moths. Despite this, people with HIV usually respond well to treatment, if the treatment has been started before the person has progressed to an advanced stage of the disease. The standard treatment for TB usually involves these four drugs: isoniazid, rifampin, pyrazinamide, and ethambutol. Other drugs such as ciprofloxacin, olfoxacin, or streptomycin may be added if drug resistance is suspected or established.

If it has been determined that you have a latent (not active) infection with TB, prophylaxis is available. It usually involves long term (one year) treatment with isoniazid. Various studies are being conducted to determine other drugs that can be used as a prophylaxis.

It is essential for these drugs to be taken as prescribed for the entire period of time for which they have been prescribed-which can be for up to a year.

This is because of:

1. The highly contagious nature of TB

2. The likelihood of recurrence if not treated properly

3. The development of drug resistant strains that can occur when TB has not been successfully treated.

One area of considerable concern is the development of multi-drug resistant strains of TB. While there are a few drugs such as streptomycin and PAS that are available for treating drug resistant strains, it is becoming increasingly difficult to find new drugs to fight the new strains. This is especially true because of the length of time that is required to treat TB. At this time the drug resistant strains are more prevalent in certain areas of the U.S. such as Miami and New York City.

Because TB is highly contagious, difficult to treat and fatal if left untreated, it is the only disease in which you may be required legally to avoid contact with other people and be required to take medication.

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