After the doctor interacts with you and examines you to get the symptoms and signs respectively, he may suspect TB and request for some test that will help him confirm it.
These Test include
- Sputum microscopy: Here the patient will have to provide his Sputum ( saliva coughed up from deep within the lungs) for examination under the microscope. If the organism is seen under the microscope, the person has TB.
Before then, stain is applied to the slide of the Sputum. The organism being acid-fast retains this stain after passing it through a decolorizing acid. And it is so seen with the stain under the microscope.
Note that in this test, patient has to provide his specimen (the Sputum in this case) twice, day 1 and day 2. If one or both of the test comes out positive, then the patient is said to have tested positive for TB
- Gene expert test and Line probe assay: These two tests have similar mechanism. They are more advanced and sophisticated tests and results can be confirmed in a few hours as opposed to the Sputum microscopy that has to be done on days 1 and 2. In this tests, there exists a mechanism that can amplify part of the genetic material of the organism. Every organism has a unique gene. and this forms the basis of identifying the organism. Even if the Mycobacterium is present in the specimen in a very minute, the organism can be detected with this test.
- Culture: this test involves introducing a sample that you suspect may have the organism into an environment where it can grow naturally. The environment/medium most be favorable for the Mycobacterium in terms of oxygen and other nutritional needs. It is also maintained at a temperature ( like the body temperature) that is adequate for its growth. If the organism is present in the sample, it will grow in this medium. If it's not, there won't be growth of the organism.
The disadvantage of this test is that it takes long as the organism is slow growing. It usually takes 3 to 4 weeks. Some advantage is that it can be used to test for the drugs that are most effective in treating the organism ( sensitivity test). A drug that kills this organism that is grown/cultured will kill it in the patient's body and is said to be effective/ sensitive. If it doesn't kill it, the drug is said to be resistant.
Another advantage is that it requires a smaller concentration of the organism in the specimen ( when compared to Sputum microscopy) to be able to detect the organism ( grow the organism in this case)
Notice that the above tests help to diagnose pulmonary TB.
There are some other tests that can help to conclude that one has TB when it occurs in others parts of the body( extrapulmonary TB).
- Some of tests (like the chest X-ray) don't necessarily isolate the organism but shows features that may be due to the effect of the Mycobacterium in these parts of the body.
- This can help diagnose TB in the abdomen and the pericardium ( outer covering of the heart)
where applicable, specimen may be taken/aspirated from a part of the body and examined for the presence of the organism.
- Here small part of the body, for instance part of a lymph node, may be removed from the body and examined by some specialists under the microscope. These specialists/Histopathologist may see features in this part of the body that suggests TB
- Tuberculin skin test. Here a small particle of the organism, not capable of causing infection, is introduced to the skin of the body. If you remember the secondary reaction we discussed earlier, if the body had been exposed to the organism before it will mount a strong reaction to this particle.The reaction is limited to the skin in this case as the particle cannot cause Infection. The reaction is seen an an induration (hardening) on the skin. This test only tells that one has been infected with TB before. It doesn't tell if the person has the disease ( it doesn't tell whether or not the bodies immunity was able to contain the disease).
- Chemistry of Cerebrospinal fluid analysis; Cerebrospinal fluid is the fluid that coats the brain and and spinal cord. In TB meningitis, some changes are seen in the fluid and these changes valuable in making the diagnosis
TB is a treatable and curable disease. Treatment is for a prolonged period usually 6 to 24 months. To achieve cure it is important for patient to take the required TB drugs in the right dosage and right drug combination and for the specified duration. This is made possible by giving patient adequate information, supervision and support. When drugs are not taken as they should it leads to; treatment failure, drug resistance ( the drug no longer being able to cure the disease), and encourages spread of the disease. Hence the emphasis on supervision and support.
A supervisor may be a health worker or a trained volunteer. He/she is to ensure patient takes his medication everyday.
A TB patient who abuses his medication (doesn't take it as he ought to), is not only a risk to himself, but also to his environment because his or her actions will encourage the Mycobacterium to be resistant. And one can transmit this resistant strain to others, thereby making cure difficult for, not just oneself, but for others.
TB is treated with a combination of drugs. Though there are various drugs used in treatment of TB, some of them are called the first line drugs. They are so called because they are the safest, most effective of drugs.
The following are the first line drugs:
These 4 drugs are combined to treat TB
There are 2 standard treatment regimens/courses;
In regimen 1, treatment is for 6 months. This one is used for treatment pulmonary (lung) TB and extrapulmonary TB with exception of TB meningitis and Osteo-articular TB ( TB of the bones)
In this regimen; Rifampicin, isoniazid,pyrazinamide and ethambutol is given for the first 2 months while rifampicin and isoniazid alone is given for the remaining 4months. The initial 2 months is called intensive phase while the remaining 4 months is called continuation phase
The dose of each of the drug depends on the weight
In Regimen 2, treatment is for 12 months. Here Rifampicin, Isoniazid, pyrazinamide,and ethambutol is given in the first 2 months, while Rifampicin and isoniazid alone is given for the remaining 10 months. It is used in treatment of TB meningitis and Osteo-articular TB( TB of the bones).