DEFINITIONS TUBERCULOSIS

Tuberculosis can give a lot of symptoms to a person but there are cases in which patients came to the doctor for other problems and they are discovered this disease too. Sometimes tuberculosis gives only night sweats and the patient will not go to the doctor only for such a mild symptom. Generally extra pulmonary tuberculosis is encountered in those who have a weakened immune system and have other important diseases associated too.

The most affected of extra pulmonary TB and military TB are the patients who have AIDS. In those patients symptoms vary from chest pains and night sweats to morning coughing with blood. In those who are in a bad status loss of weight might be encountered along with these other symptoms. At the physical exam the doctor will hear with his stethoscope diminished breath sounds and coarse crackles.

It is not easy to diagnose tuberculosis as the symptoms can be found in other diseases too, like: lung cancer, asperigollosis, pneumonia, sarcoidosis, pneumoconiosis, diabetes mellitus, hyperthyroidism and mediastinial lymphadenopathy.

The doctor will ask for a thoracic X-ray. If tuberculosis is present on the thoracic X-ray cavitation, calcification and nodes will be seen. Other tests must me done to be sure the disease is tuberculosis. A biopsy is indicated also, and if it shows granulomas and caseation then there is a confirmation of tuberculosis. Sputum can also be tested to see if it contains the Koch bacteria. If the tuberculosis is not localized in the lungs then the urine can be taken as a sample and analyzed or the LCR or even the blood. The lymph noses biopsy can be made because tuberculosis can shed there too. If the doctor thinks the tuberculosis affected some other organs he will take a sample of liquid from the pleural space, the pericardial space, or the peritoneal space.

In those patients in which the sputum test got negative the bronchoalveolar lavage can be tested too to eliminate any possibility of misdiagnosing. This is done with an optic bronchoscope which is passed from the mouth or the nose towards the trachea and then the lungs. This procedure is not painful as the doctor uses a lidocaine spray to locally sedate the patient. With the bronchoscope a sample will be taken from the alveolar space as a saline solution will be entered the lungs to flush out bacteria and loose cells. This solution will be collected and tested in the end of the procedure.

With the help of the bronchoscope biopsy can be performed from small tissue samples from the bronchi. These samples will be analyzed in the laboratory to see if they are infected with the Koch bacilli.

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Although antibiotics had been discovered a few years before, sulfonamide and penicillin proved no effect on the bacteria causing Tuberculosis. After years of research In California about soil fungus, in 1039 Waksman isolated the fungus Actynomices that was able to inhibit the development of Mycobacterium Tuberculosis. But the chemo was to dangerous toxic and could not be used in treating Tuberculosis.

In 1943streptomycin was found inside Streptomyces griseus and it was proven to totally inhibit the bacterial strains. In 1944 it was administered to a Tuberculosis patient that immediately improved. Although streptomycin causes side effects like damages to the inner ear, it was for a few years the best medication against Mycobacterium.

The medical treatment of Tuberculosis was put in danger after the assumption that bacteria rapidly gains resistance even to the newer discovered antibiotics. But the issue was quickly solved by using combinations of antibiotics in the treatment.

After streptomycin other major anti Tuberculosis chemo were introduced. P-aminosalicilic acid, Isoniazid, Pyrazinamide, Ethambutol, Rifampicin and Cycloserin showed benefic results in the cure of Tuberculosis. Newer Aminiglicosides such as Viomycin and Kanamycin as well as the quinolones Ciprofloxacin and Ofloxacin are only prescribed in cases of resistant strains. Latest treatment methods like the Macrolides or the combination of Beta-lactamase and Beta-lactams have not been yet enough studied.

The two most important characteristics of the antituberculous ant biotherapy are:

1. The antibacterial activity best resulted in Streptomycin, Isoniazid and Rifampicin.

2. The inhibition of the development of resistance with best results in Rifampicin, Ethambutol and Izoniazid.

After a month of treatment with the four basic antibiotics, the patient should be fever free, feel much improved and show decreased number of bacteria in the sputum. The weight of the patient must increase and the lesions visible on the X-rays should minimize. As the medication persists the bacterial organism in the sputum will become more and more difficult to be cultivated on synthetic cultures inside the laboratories.

If no signs of improvement appear on the radiography after 3 months, the medication and the patient's compliance must be again verified. Most relapses after treatment appear in the first 6 months after the patient has stopped taking chemo. Also the capacity of developing resistance must be taken into consideration. The National Tuberculosis Center must carefully monitories rebel cases of Tuberculosis.

In case of a recurrence at the same patient, doctors must find another schedule of therapy as the bacteria has already developed resistance to the antibiotics used before. A possibility is adding other few antibiotics to the initial medication. If bacteria is resistant to all kind of standard chemical products, other drugs, more toxic however will be put in the schedule: Ethionamide, Cycloserine, Viomycin, Kanamycin, Pyrazinamide or Capreomycin.

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Mycobacteria are abundant in soil and water but are more infamous for the diseases that they can cause. Mycobacterium tuberculosis is perhaps the most well known member of the group and is the bacterium that causes tuberculosis. However, there are other species of mycobacteria, for example Mycobacterium leprae causes leprosy, Mycobacterium bovis causes tuberculosis in cattle, Mycobacterium avium causes disease in immunocompromised people, Mycobacterium bovis Bacille Calmette-Guérin (BCG) is a strain of Mycobacterium bovis used as a vaccine and Mycobacterium smegmatis is a non-pathogenic species used in laboratory research. (Reference: Mycobacterium: Genomics and Molecular Biology ISBN: 978-1-904455-40-0)

About one-third of the world's population is infected with tuberculosis, although the infection is latent because the immune system is usually able to control the Mycobacterium tuberculosis infection. About 10% of infected people become ill with an active form of tuberculosis.

Latent tuberculosis infection is when a person is infected with Mycobacterium tuberculosis but does not have symptoms of disease. They are said to be asymptomatic. Active tuberculosis disease is the full-blown disease which, if not treated, will kill half of the patients. One in ten latent infections will progress to active tuberculosis disease. Typical symptoms of an active tuberculosis patient include weakness, fever, chest pain, respiratory insufficiency, fever and cough. Strains of Mycobacterium tuberculosis have become multidrug-resistant making the disease particularly difficult to treat. Treatment includes chemotherapy and a combination of different types of drug. Tuberculosis is spread by infective particles produced through coughing by patients with active tuberculosis. The air-borne particles carrying the bacteria can be inhaled by other people.

Leprosy is a disease caused by Mycobacterium leprae, a bacterium related to the species that causes tuberculosis. In medical terms, leprosy is described as a granulomatous disease of the peripheral nerves and mucosa of the upper respiratory tract. Skin lesions are the main visible symptoms. According to the World Health Organization as many as three million people have been disabled due to leprosy. In recent years, leprosy has become a problem in HIV patients using anti-retroviral drugs.

Different species of Mycobacterium cause tuberculosis, leprosy and other illneses. Mycobacterium is a genus of Actinobacteria, given its own family, the Mycobacteriaceae. Much scientific research is being conducted on these microorganisms. In particular much effort is being directed to the understanding of the genome of Mycobacterium with a view to developing and improving strategies for treatment. (Reference: Mycobacterium: Genomics and Molecular Biology ISBN: 978-1-904455-40-0)

Reference about mycobacterium at Mycobacterium: Genomics and Molecular Biology. Recent scientific developments in microbiology at the Microbiology Blog and details of microbiology conferences, meetings, symposia, workshops and advanced courses at Microbiology Conference

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