Tuberculosis - An Old Disease with a New FaceTuberculosis symptoms
Early stages of pulmonary tuberculosis present cold-like symptoms.
The symptoms during the early stages of pulmonary tuberculosis are similar to those of a common cold: cough, phlegm, and fever. However, they differ from a common cold in that the symptoms persist for more than 2 weeks, or repeat a cycle of getting better then worse.
- Phlegm secretion
- Lingering cough
- Persistent slight fever
A persistent cold is a red flag
Even if you think you just have a cold, or perhaps have just smoked too many cigarettes, consult your physician as soon as possible. The disease is easier to manage with early detection, and you are less likely to spread it to the people around you.
Infection does not necessarily lead to the active disease
Even if you are infected with the tuberculosis bacteria, you may not develop the active disease. The immune system of a healthy body will suppress the bacteria after infection. When the body becomes weakened, or its immune functions are compromised due to other illnesses, the suppressed TB bacteria reactivate, potentially causing you to experience disease symptoms.
Figure 5 The development of TB from infection to the active disease
Here is an example case displaying a typical course of disease progression for tuberculosis:
Mr. A is in his 60s. He was relatively healthy, and had never had a major illness.
- He started coughing, and assumed that he had caught a cold. He took some cold medicine that he had on hand. This helped relieve the symptoms a little in 3-4 days, so he just left it at that.
- After 2 weeks, he started coughing again. This time, the cough was accompanied by a mild fever of around 37.5℃ in the evenings. When he consulted his physician, he was told that his cold had returned, and was prescribed antibiotics, antipyretics, and a cough suppressant.
- 3Blood-tinged phlegm
- The symptoms eased a little, perhaps due to the medication he was taking, but a week later, he saw some blood in his phlegm, and became concerned. He had a chest X-ray, and his phlegm tested. He was diagnosed with infectious pulmonary tuberculosis (Figure 6-①).
- He was immediately admitted to a hospital that had a TB unit, and started on a standard course of treatment. Medication was administered following the “Directly Observed Treatment, Short course (DOTS)” method, whereby the patient was given his medication by a nurse after breakfast every day, along with a cup of water, which he then ingested in front of the nurse (Figure 6-②).
- 5Treatment progress
- 2 months after the start of the treatment, Mr. A tested negative on the bacterial smear test, 3 times in a row. Moreover, the chest X-ray revealed a reduction in shadows, indicating that the treatment had been successful (Figure 6-③).
- A DOTS meeting was held, where the physician and nurse from the hospital, a caseworker, and a regional public health nurse discussed Mr. A's treatment going forward. It was determined that he could continue his regular treatment as an outpatient. He was then discharged from the hospital and switched to an outpatient treatment program (Figure 6-③).
- 7Outpatient visit
- As an outpatient, his treatment was reduced to just 2 drugs. He visited the outpatient department on a monthly basis to receive one month’s worth of drugs, which he took daily. His wife marked “administered” on the calendar in his medication logbook, which had been issued by a local public health center. His physician verified and signed it during Mr. A’s monthly visits. The public health nurse, who visited him at home every month, also checked this logbook and signed it, as well as offering words of encouragement (Figure 6-④).
- 8End of treatment
- 4 months of outpatient treatment ended without any major side-effects. When his recovery was confirmed through a chest X-ray during his last appointment, his treatment officially ended (Figure 6-⑤).
Figure 6 Timeline from diagnosis to the end of treatment
Tuberculosis is not a problem for the patient alone.
People who had contact with Mr. A were checked to make sure that they were not infected (a contact investigation).
When Mr. A was admitted to the hospital, a nurse from a public health center visited him to explain his disease and treatment, and also to ask about his activities prior to experiencing symptoms. Based on his response, the local public health center narrowed down the list of potentially infected individuals (his wife, his children's families who had been to visit a few times after the coughing started, friends from a local Go club, etc.). The local public health center contacted these individuals and asked them to get tested.
Based on the test results, his wife, while she was asymptomatic, was deemed to be potentially infected, and received preventative treatment. The families of his children were all uninfected. His friends from the Go club all showed no abnormalities on their chest X-rays.