11301 Tuberculosis

Overview

Tuberculosis (TB) is a bacterial infection that most often affects the lungs. It can also affect other parts of the body, such as the kidneys, spine, or brain. TB spreads through the air when a person with active TB in their lungs coughs, sneezes, or speaks.

TB is less common in many high-income countries, but it is still one of the most widespread infections in the world. In the UK, rates are relatively low, but certain groups have a higher risk.

Anyone can get TB, but it is more likely to affect people with weakened immune systems, people living in crowded conditions, and those who have close contact with someone with active TB. It is also more common in certain parts of the world, such as parts of Asia, Africa, and Eastern Europe.

Symptoms

Common symptoms

• A cough that lasts longer than 3 weeks
• Coughing up phlegm or blood
• Chest pain or pain when breathing
• Feeling very tired or weak
• Fever or chills
• Night sweats
• Unexplained weight loss

Symptoms in children

• Poor weight gain or failure to grow as expected
• A cough that does not go away
• Mild fever
• Swollen glands in the neck

Symptoms in older adults

• Symptoms may be less obvious, such as just feeling unwell or tired
• Loss of appetite
• Confusion or changes in thinking
• A cough that may be mild or absent

Causes

Main causes

• Infection with bacteria called Mycobacterium tuberculosis
• The bacteria spread through the air when an infected person coughs, sneezes, or talks

Risk factors

• Close contact with someone who has active TB
• A weakened immune system – for example, from HIV, diabetes, or some medicines
• Living in crowded conditions, such as shelters or prisons
• Poor nutrition or being underweight
• Smoking or heavy alcohol use
• Travel to or birth in a country where TB is more common

When to see a doctor

See a doctor urgently if:

• If you have a persistent cough that lasts more than 3 weeks
• If you are coughing up blood or phlegm
• If you have night sweats or a fever that will not go away
• If you have unexplained weight loss

Book a routine appointment if:

• If you have been in close contact with someone diagnosed with TB
• If you have a persistent cough and also feel tired or unwell
• If you are worried about TB for any reason

Diagnosis

Your doctor will ask about your symptoms, your health history, and any possible exposure to TB. They may listen to your lungs and then arrange tests. TB can take a while to diagnose, and you may need a few different tests.

Tests that may be done

• A chest X-ray to look for changes in the lungs
• A sputum test – you cough up phlegm, which is sent to a lab to check for TB germs
• A blood test or skin test (such as the Mantoux test) to see if your immune system has reacted to TB bacteria

What to expect at your appointment

If you have symptoms of active TB, you may be asked to provide a sputum sample and have a chest X-ray. Results can take a few days to a few weeks. If the tests show active TB, your doctor will explain the next steps, including treatment and how to avoid spreading it.

Treatment

Active TB is treated with a combination of antibiotics taken for at least 6 months. You must take every dose of your medicine, even if you start feeling better. Stopping early can cause the infection to come back and become resistant to medicines.

Self-care at home

• Take your medicines exactly as prescribed, at the same times each day
• Cover your mouth and nose when coughing or sneezing until you are told you are no longer contagious
• Stay away from crowded places and close contact with others until your doctor says it is safe
• Get plenty of rest and eat a healthy diet to help your body recover

Medical treatments

Treatment uses a combination of antibiotics that are taken together for several months. In many places, a healthcare worker may directly watch you take your medicines – this is called directly observed therapy (DOT). This helps you stay on track and ensures the infection is fully treated. Never take any antibiotic without a full prescription from a qualified healthcare provider.

When is surgery considered?

Surgery is rarely needed for TB. It may be considered for serious complications, such as drug-resistant infections or severe lung damage, but this is uncommon.

Living with this condition

Living with TB means following your treatment plan carefully, attending all follow-up appointments, and taking steps to protect others. During the first few weeks of treatment, you may need to stay home and avoid close contact with others. Your healthcare team will tell you when you are no longer contagious.

Lifestyle tips

• Set a daily routine for taking your medicines – for example, with a meal or before brushing your teeth
• Avoid alcohol and smoking, as they can affect your liver and make TB harder to treat
• Get enough sleep and reduce stress where you can
• Wash your hands often and keep your living space well ventilated

Diet and exercise

Eating a balanced diet with enough protein and calories can help your immune system fight the infection. Light activities like walking may help you feel better, but avoid strenuous exercise until you have more energy. Always talk to your healthcare team about what is right for you.

Mental health and emotional wellbeing

Treatment for TB is long, and it can feel isolating or stressful. You may feel anxious about spreading the illness or frustrated with the length of treatment. These feelings are normal and important to talk about. A counsellor, support group, or even a trusted friend can make a big difference.

Prevention

Yes, TB is preventable. The most important steps are finding and treating active TB early, avoiding close contact with people who have active TB, and for people with latent TB, taking treatment to prevent it becoming active. Good ventilation and covering coughs also reduce the spread.

Vaccines

In some countries, the BCG vaccine is given to babies and children to protect against severe forms of TB. It is not routinely given everywhere. Ask your healthcare provider whether you or your child should have it.

Screening programmes

People at higher risk may be offered screening tests. This includes close contacts of someone with active TB, health workers, and people who have recently moved from a country with high TB rates. Screening usually involves a blood test or a skin test, and sometimes a chest X-ray.

Complications

If left untreated

• The infection can spread throughout the lungs, making breathing harder
• TB can spread to other parts of the body, such as the brain, kidneys, or spine
• It can cause serious, life-threatening illness if not treated

Long-term outlook

With proper treatment, the vast majority of people with TB are cured. Treatment takes time and commitment, but most people make a full recovery and return to their normal life. Even people with drug-resistant TB can often be treated with longer, more complex regimens. Early diagnosis and following your care plan are the keys to a good outcome.

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