Tuberculosis: Symptoms, Diagnosis and Why Completing Treatment Matters
India carries the largest share of the world’s tuberculosis cases. It is curable, treatment is available free through the national programme, and yet it continues to kill, largely because of delayed diagnosis and incomplete treatment.
How TB works
Mycobacterium tuberculosis spreads through airborne droplets when a person with infectious pulmonary TB coughs, sneezes or speaks. It does not spread through shaking hands, sharing food or utensils, touching surfaces, or sexual contact.
Most people who inhale the bacterium do not become ill. The immune system walls it off, producing latent TB infection: the person is not sick, not infectious, and has no symptoms, but carries dormant bacteria. Roughly 5 to 10 percent of those with latent infection will develop active disease at some point, the risk being far higher with HIV, diabetes, malnutrition, smoking, silicosis, kidney failure, immunosuppressive drugs and in young children.
Symptoms of pulmonary TB
- Cough lasting two weeks or more, which is the key screening symptom
- Coughing blood or blood-streaked sputum
- Fever, characteristically low grade and in the evening
- Drenching night sweats
- Unintentional weight loss
- Loss of appetite
- Chest pain
- Fatigue and weakness
The onset is gradual, over weeks to months, which is why it is so often attributed to smoking, dust or a lingering cold.
TB outside the lungs
Around a fifth of cases are extrapulmonary and present quite differently:
- Lymph node TB: painless, firm, enlarging neck nodes, sometimes discharging
- Pleural TB: breathlessness and chest pain from fluid around the lung
- Spinal TB: persistent back pain, deformity, and in advanced cases leg weakness
- Abdominal TB: pain, distension, altered bowel habit, ascites
- TB meningitis: headache, fever, vomiting, neck stiffness, confusion. A medical emergency
- Genitourinary TB: blood in urine, recurrent sterile pyuria, infertility
- Miliary TB: widespread disease with systemic illness
Extrapulmonary TB, other than laryngeal and some pulmonary-associated forms, is generally not infectious to others.
Diagnosis
- Sputum examination, ideally two samples, with microscopy
- Molecular tests such as cartridge-based nucleic acid amplification, which detect the organism and rifampicin resistance within hours and are now the preferred first test
- Chest X-ray
- Culture and drug susceptibility testing, the reference standard, taking weeks but defining resistance
- Tissue sampling for extrapulmonary disease, including fine needle aspiration of nodes and pleural or ascitic fluid analysis
- Tuberculin skin test and interferon gamma release assays detect infection, latent or active, and cannot distinguish between them; they are used for latent infection, not to diagnose active disease
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Everyone diagnosed with TB should also be tested for HIV and screened for diabetes.
Treatment
Standard drug-sensitive TB is treated for six months: an intensive phase of four drugs, typically isoniazid, rifampicin, pyrazinamide and ethambutol, for two months, followed by a continuation phase. Extrapulmonary TB at some sites, particularly bone and central nervous system, needs longer.
Treatment, diagnostics and follow-up are provided free under India’s national programme, along with nutritional support payments.
Side effects to report rather than to manage alone: jaundice or dark urine with nausea, suggesting drug-induced hepatitis; visual changes, particularly difficulty distinguishing red and green, with ethambutol; tingling or burning in the hands and feet, prevented with pyridoxine given alongside isoniazid; joint pain; rash; and hearing changes with injectable agents. Orange-red discoloration of urine, tears and sweat from rifampicin is expected and harmless, though it stains soft contact lenses.
Rifampicin reduces the effectiveness of hormonal contraception and interacts with many drugs, including antiretrovirals, anticoagulants and some diabetes medicines, so every other medication must be declared.
Why stopping early is dangerous
Symptoms usually improve within two to four weeks, long before the bacteria are eradicated. Stopping then leaves the hardiest organisms alive. The result is relapse with a strain that is now resistant.
Multidrug-resistant TB requires treatment lasting many months with more toxic and more expensive drugs and has markedly lower cure rates. Nearly all of it is created by interrupted or inadequate treatment. Completing the course is the single most important thing a patient controls.
If you must travel or relocate, transfer your treatment through the programme rather than pausing it.
Protecting the household
- The patient should cover the mouth when coughing, use a tissue or the inner elbow, and wear a mask in the first weeks
- Keep rooms well ventilated with open windows and natural light
- Sleep in a separate, airy room during the infectious phase if possible
- Infectiousness falls sharply within about two weeks of effective treatment
- All household contacts should be screened, especially children under five, who should be offered preventive therapy
- Nutrition matters: undernutrition is both a risk factor and a consequence
Prevention
BCG vaccination at birth protects infants against severe forms, particularly TB meningitis, though it gives limited protection against adult pulmonary TB. Preventive treatment for latent infection is offered to high-risk contacts. Stopping tobacco, controlling diabetes, improving nutrition and reducing indoor air pollution all lower risk.
When to get tested
Any cough lasting two weeks or more, unexplained weight loss, prolonged low-grade fever, night sweats, or a painless enlarging neck lump. Testing is free, and early diagnosis protects both the patient and everyone they live with.
This is general information. TB treatment must be taken under medical supervision through a recognised programme; never self-medicate or buy TB drugs over the counter.