Tuberculosis

Also called TB, Consumption

Not a disease of the past. Curable with six months of treatment, and finishing the course is the whole of the problem.

What it is

A bacterial infection, usually of the lungs, caused by Mycobacterium tuberculosis. Rates in the UK are low by global standards but have been rising again, and it is concentrated in specific groups: people born in countries with high TB rates, people experiencing homelessness, people in prison, people who use drugs or alcohol heavily, and people who are immunosuppressed.

Most people who are infected never become ill. **Latent TB** means the bacteria are present and dormant, causing no symptoms and not infectious. Around one in ten will develop active disease at some point, and treating latent TB prevents that. Screening for latent TB in new entrants and contacts is a public health programme that works and is under-used.

Active pulmonary TB is infectious through the air, though far less readily than measles or COVID. Close household contacts are traced and screened.

TB outside the lungs is common in the UK, affecting lymph nodes, bones, joints, the abdomen and the brain, and produces very different symptoms. TB meningitis is a medical emergency.

It is curable, with four drugs for two months and two for four more. The whole difficulty is completing six months of treatment when people feel better after three weeks. Directly observed therapy exists for people at risk of not completing.

Drug-resistant TB arises mainly from incomplete treatment, and takes much longer and much more toxic drugs to cure.

Signs you might notice

A cough lasting more than three weeks, often with phlegm and sometimes with blood.

Fever, and drenching night sweats.

Unintentional weight loss and loss of appetite.

Extreme tiredness.

Chest pain and breathlessness.

Outside the lungs: swollen lymph nodes, usually in the neck; bone or joint pain; abdominal pain and swelling; and, in TB meningitis, headache, confusion, vomiting, stiff neck and drowsiness, which is an emergency.

Any cough lasting more than three weeks warrants a chest X-ray, and that applies to everybody, not only people in higher-risk groups. See lung cancer.

How it can affect day-to-day life

Stigma is severe and is a public health problem in itself. People conceal a diagnosis, avoid contact tracing, and delay presenting, all of which spread it.

The treatment is demanding: several tablets daily for six months, with real side effects including nausea, liver problems and, with one drug, orange discolouration of urine and tears that stains contact lenses. Warning people about the orange prevents a lot of alarm.

Vision must be checked before and during ethambutol, and any change in vision or colour vision reported immediately.

TB treatment interacts with a long list of medicines, notably contraception, which becomes unreliable on rifampicin. That is regularly missed.

TB nurses are the most valuable resource in this whole entry: they coordinate treatment, contact tracing and adherence, and they know the system.

Housing, immigration status and destitution are frequently entangled with TB care, and treatment is free to everybody in the UK regardless of immigration status. That should be said explicitly.

Supporting someone well

A cough for more than three weeks: get a chest X-ray.

Finish the whole course. This is the entire message. Feeling better at three weeks is expected and is not the end of treatment.

Take the tablets at the same time daily; ask about a dosette box or directly observed therapy if that is difficult.

Expect orange urine and tears on rifampicin, and do not wear contact lenses.

Report yellowing of the eyes, severe nausea, or any visual change immediately.

Use alternative contraception on rifampicin.

Cooperate with contact tracing; it protects the people around the person.

Say clearly that treatment is free regardless of immigration status.

Ask about latent TB screening for household contacts and for anyone starting immunosuppressive treatment.

Where to get help

A GP practice for a persistent cough; TB services are specialist and referral is straightforward.

The TB nurse specialist, who is the single most useful contact once diagnosed.

999 or A and E for suspected TB meningitis: headache, confusion, drowsiness and neck stiffness.

TB Alert provide information in many languages and work on stigma.