Tuberculosis (TB) is a bacterial disease that more commonly affects the lungs. Tuberculosis is a disease that is completely curable and preventable, though it is believed to have infected a quarter of the population at one point in their lives. This disease is completely manageable and with anti-biotics can be treated, nevertheless, if left untreated in certain populations can be fatal. This article will aim to enhance reader knowledge about the pathophysiology of the disease, as well as the signs and symptoms and pre-hospital emergency treatment.
Pathophysiology:
Tuberculosis is a disease resulting from a bacterium called Mycobacterium; this disease typically affects the lungs but can also involve other organs. The disease spreads through airborne droplets that contain the bacteria. When a person coughs, sneezes, or even speaks, the bacteria are released and potentially spread from the infected person. After an individual has inhaled the bacteria, it travels to the alveoli, whereas in an immune response, the alveolar macrophages engulf the bacteria. The immune system then activates granulomas (tiny clusters of white blood cells and other tissues) to contain the bacteria, this helps prevent the spread of tuberculosis, and in most cases, this is successful in preventing the spread. In circumstances where the immune system has not been able to contain the bacteria, active tuberculosis may develop as the bacteria replicate within the granulomas, which may manifest as pulmonary tuberculosis (in the lungs) or extrapulmonary tuberculosis (in other organs). Necrosis can occur past this point as the infection progresses within the granuloma. The immune system's response can result in inflammation, which may damage other organs and result in common symptoms such as cough, chest pain, night sweats, weight loss and fatigue. If the diagnosis of tuberculosis is not identified promptly, the cycle of spread from an untreated patient may spread and serious medical deficits may occur as well as death for said patient.
Signs and Symptoms:
Tuberculosis is a disease that can vary in infection site and therefore may vary in clinical manifestations, some of the more common signs and symptoms seen are:
Pulmonary tuberculosis:
- Chronic cough
- Hemoptysis
- Chest pain
- Fatigue
- Weight loss
- Night sweats
Renal tuberculosis
- Flank pain
- Hematuria
- Frequent urination
Skeletal tuberculosis
- Bone pain
- Joint swelling
- Limited mobility
Meningeal tuberculosis
- Headache
- Neck stiffness
- Altered mental status
Treatment: Treatment for tuberculosis is usually done through antibiotics which need to be prescribed by a licensed doctor/physician. When a paramedic is presented with a patient that exhibits signs of tuberculosis, treatment-wise, it is important to manage the airway and provide oxygen when needed. All other treatment is done by doctors and specialized healthcare teams; therefore, the role of a paramedic is just to manage vital signs and transport them to the appropriate hospital.
Tuberculosis is a disease that can easily affect a huge percentage of the population and in most circumstances can remain harmless, although, for specific high-risk populations such as patients with comorbidities, the disease can prove harmful and/or fatal. By clinicians being able to understand the underlying clinical manifestations, the risk of a harmful outcome will be lower and the spread of tuberculosis through the community can die down.
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