Life after tuberculosis

Tuberculosis is a chronic multisystemic disease caused by mycobacterium tuberculosis. It is spread by droplet infection, i.e. germs are expelled from the patient’s mouth while speaking, coughing or sneezing, and enter the lungs of a person opposite through inhalation. Lungs are the main target organs but it can also affect any organ of the body, commonly the brain, abdomen, kidneys, and adrenal glands.Tuberculosis starting from the lungs may be symptomatic or may be clinically silent. But if not checked, infection can spread to other parts of the body either directly or via blood stream or lymphatics. Diagnosis is made by clinical features and diagnostic relevant tests. Following diagnosis, treatment is given mostly by WHO recommended short term chemotherapy by 3 drugs or 18 months therapy in select cases. The chemotherapy consists of a combination of multiple drugs given according to the phase of treatment. But things are not as simple and straightforward as that, where tuberculosis is concerned. A person may recover his health completely after finishing antitubercular chemotherapy. But all may not be so lucky. Some may suffer from the complications and sequel of the disease, while some may suffer from drug toxicity. Anorexia or loss of appetite is one of the salient features of tuberculosis which, along with low grade fever, raises suspicion of tuberculosis. This anorexia results in chronic malnutrition in the sufferer. He not only becomes malnourished but also cachexic in most of the cases. Medicines add to the nausea and loss of appetite. The result is some of the persons continue to be very weak even after finishing the course of medicine and the infection being eradicated. If treatment has been delayed for want of approaching the doctor or diagnosis, many times permanent damage ensues in the part of lung or lungs affected. Even after completion of treatment, part of the lung tissue may be damaged for ever. At times healing occurs by fibrosis, i.e. the normal lung tissue is replaced by fibrous (inelastic) tissue. Healing of the tubercular focus may occur by calcification which would cause localized loss of elasticity. The net result of all these factors is impaired ventilation of the affected lung, because elasticity of lung tissue is necessary for good ventilation, i.e. exchange of gases which is the basic function of lungs in the body. The patient thus affected suffers from breathlessness on exertion. His working efficiency is decreased as he is not able to put in much effort. Because of decreased ventilation ability of the lung, he also gets tired very easily. Needless to say this has repercussions on the job of the sufferer. Particularly in case of poor people working as manual labourers, this means end of job in a way as they are no longer able to work. These persons are also at high risk of sudden death due to respiratory failure. Impairment of ventilatory capacity of the lungs is further aggravated in case of smokers or persons working in places of excess exposure to dust such as in mines, factories or in fields. A person having permanent damage to the lungs is more prone to develop recurrent respiratory tract infections, because the lungs can no longer effectively expel infectious germs and potential toxic substances. In chronic cases there are more chances of malignancy developing in the affected lung. Those suffering from tuberculosis of intestines or peritonitis (i.e. tuberculosis of the peritoneal cavity) are prone to suffer from chronic constipation and pain in abdomen even after completion of therapy because of adhesions formed around the intestines. If one has suffered from tubercular meningitis, or any other infection of the brain, the neurological damage and sequel may take much longer to heal and sometimes the unfortunate person may suffer from a lifelong handicap. A person who has finished the full course of therapy for TB pericarditis i.e. covering of the heart, may continue to suffer from cardiac failure because of the increased burden on the diseased heart. Ironically the above mentioned sequels of tuberculosis masquerade as reinfection or incomplete tuberculosis treatment, thus at times making the person take another 3 to 6 months of anti tubercular chemotherapy. Inadvertently, the person is exposed more to the medicines as well as their toxic effects. On one hand these medicines eradicate the dangerous tubercle bacilli but on the other hand they also produce toxic effects which may sometimes persist even after duration of therapy is over. Particularly troublesome is peripheral neuritis induced by isonex in which one suffers from severe burning pain in the feet. This problem is further aggravated in diabetics and smokers. Ethambutol, one of the anti TB drugs, can cause inflammation of the optic nerve (nerve concerned with sight) and cause blurring of vision and even blindness. Alcoholics are susceptible to developing chronic liver damage by alcohol which is further complicated by antitubercular drugs like Rifampicin and pyrizanamide. Rifampicin, one of the first line antitubercular medicines reduces the effectiveness of many other medicines by means of drug interaction. This upsets the good control of diabetes and cardiac failure, thus putting these people at risk of complications of these diseases along with those of TB. Those suffering from epilepsy also have to be very careful if they develop tuberculosis, because, firstly their previous history of seizures may mask or delay the diagnosis of TB, especially of the brain. Secondly, rifampicin also interacts with dilantin sodium, a commonly used antiepileptic medication, thus reducing its efficacy and aggravating the seizures. Thus in summary we can say that once a person has tuberculosis their problems do not end with the treatment. After that he has to suffer from the results of damage to the body parts and the chronic asthenia which sets in. Attention to nutrition is vital for a patient suffering from tuberculosis. Even if he suffers from anorexia, he should be made to eat small frequent meals. Food taken should be balanced and containing essential nutrients. Intake of water in large amounts along with green vegetables and fruits ensures that constipation does not develop. Proteins are very necessary to repair the tissue breakdown, while vitamin B. complex helps in combating peripheral neuropathy. Breathing exercises done regularly help to build the ability to ventilate in the damaged lung and also enhance the function of the intact lung. Thus a person will not suffer from breathlessness and be able to carry out his routine work. Developing pulmonary tuberculosis should be a high point in the life of a smoker to give up smoking. Otherwise he is bound to suffer from chronic cough, breathlessness and asthenia. Same thing applies to alcoholics too. Good control of diabetes and cardiac failure is very important to avoid aggravation of these conditions in a person suffering from TB and taking chemotherapy for the same. This should be done vigorously by means of diet control and drugs. In this era of effective chemotherapy, tuberculosis should not be a cause for chronic morbidity and poor health of a person. A man or woman may acquire tuberculosis from any source but can lead a good quality normal life as before. The only thing needed is to pay attention to good nutrition and other factors associated with the illness and treatment. Contact: rachna212002@yahoo.co.uk