The sequel of tuberculosis

Tuberculosis is a chronic multisystemic diseases caused by mycobacterium tuberculosis. It is spread by droplet infection. 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 relevant tests. Following diagnosis, treatment is given. 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. Loss of appetite is one of the salient features of T.B. This results in chronic malnutrition in the sufferer. He not only becomes malnourished but also cachexic in most of the cases. Anti-T.B. 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 medicines.If treatment of T.B., has been delayed for want of approaching the doctor or diagnosis, permanent damage can occur in the part of lung or lungs affected. This affects lung function. Many times, pulmonary T.B, heals by fibrosis, whereas elastic tissue of lungs is replaced by fibrous bands in patches, thus affected ventilatory capacity. The man thus affected suffers from breathlessness on exertion. He also gets tired easily and is at risk of death due to sudden respiratory failure. Impairment of function of the lungs is further aggravated by chronic exposure to smoke or dust as in smokers or persons working 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 potentially toxic substances. Those suffering from tuberculosis of intestines or peritoneal cavity are prone to suffer from chronic constipation and pain in abdomen even after completion of therapy because of adhesions formed around intestines. If somebody has T.B. of the spine (Pott’s spine), he can suffer from chronic backache even after finishing treatment.If one has suffered from tubercular meningitis, or any other affection of the brain, the neurological damage and sequel may take much longer to heal and sometimes the unfortunate person may suffer from life long handicap. A person, who has finished full course of therapy for T.B. pericarditis i.e. covering of the heart, may continue to suffer from cardiac failure because of the damage incurred to the heart.Ironically the above mentioned sequels of tuberculosis masquerade as reinfection or incompletely treated tuberculosis, 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 isoniazid in which one suffers from severe burning pain in the feet. This problem is further aggravated in diabetics and smokers. Alcoholics are susceptible to develop chronic liver damage by alcohol which is further potentiated 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 T.B. Those suffering from epilepsy also have to be very careful if they develop tuberculosis. Because the history of seizures in an epileptic can mask or delay the diagnosis of T.B especially of the brain. Thus one has to be aware of tuberculosis and get tests done on the slightest suspicion. Because more is the delay in treatment, more is the risk of sequel. Attention to nutrition is vital in 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 containing essential nutrients. Intake of water in large amounts along with green vegetables and fruits ensures that constipation does not develop. Proteins are important to repair the tissue breakdown, while vitamin B. complex helps in combating peripheral neuropathy. Breathing exercises done regularly, help to rebuild the ability to ventilate in the damaged lung and also enhance the function of the intact lung. 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 weakness. Good control of diabetes and cardiac failure is very important to avoid aggravation of these conditions in one suffering from T.B. 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 person may acquire tuberculosis from any source but can lead a good quality normal life as before. Only thing needed is to pay attention to good nutrition and other factors associated with the illness and treatment.

Insight

The sequel of tuberculosis