Tuberculosis (TB) has re-emerged as a major public health problem, as per the recent National Family Health Survey 2019-21( NFHS-5 ). According to the World Health Organisation (WHO), in 2022, 28.2 lakh people in India were diagnosed with tuberculosis (TB), this is 27% of the world’s TB cases, and the report also states that 3,42,000 people died from the disease, which is 12% of the cases.

TB is a persistent and age-old health challenge, capable of affecting various organs and tissues within the body, excluding only hair and nails. However, beyond its commonly known impact on the lungs or kidneys, there exists many silent and often overlooked forms of TB that profoundly affects one’s health.

TB is a clinical condition that is caused by a bacterium called Mycobacterium tuberculosis and it can affect various vital organs; it is also described as a multi-systemic infectious disease. Multi-systemic infectious disease can affect multiple organ systems in the body, not just one specific area, leading to a variety of symptoms across different bodily functions. Let’s know the different types of Tuberculosis and their symptoms along with the steps for prevention.

There are two main types of Tuberculosis.

1. Active tuberculosisis when the individual infected by the bacteria has active symptoms and can transmit the infection to other people. Here, the bacteria that cause TB are multiplying in the body, causing symptoms like a persistent cough, fever, and weight loss, and can spread from one person to another (highly contagious).
2. Latent tuberculosisis a condition where the TB bacteria are present in the body but remain inactive without causing symptoms, and are not contagious. Here, the individual carries the bacteria but has no symptoms. It is because the immune system fights the infection and suppresses it to an extent. Though at some point, the bacteria can get reactivated and the infection can become active tuberculosis.

The other types of tuberculosis are classified depending on the organs they affect.

• Pulmonary Tuberculosis: Pulmonary TB is a form of tuberculosis that primarily affects the lungs. It is caused by the bacterium Mycobacterium tuberculosis. When an individual with active pulmonary TB coughs, sneezes, speaks, or spits, they propel the TB bacteria into the air, making this form of TB contagious.

Dr. Atri Gangopadhyay, Consultant Pulmonologist at Ranchi Jharkhand explains, “The infection begins when the TB bacteria are inhaled and reach the alveoli, the small air sacs in the lungs. The immune system responds by sending white blood cells to attack the bacteria, leading to the formation of granulomas, which are small, dense clusters of immune cells surrounding the bacteria. In some cases, the bacteria are contained within these granulomas, leading to a latent TB infection, where the bacteria remain inactive and the individual shows no symptoms. However, if the immune system fails to contain the bacteria, the infection progresses to active pulmonary TB”.

Symptoms of active pulmonary TB include a persistent cough that lasts for three weeks or longer, chest pain, coughing up blood or sputum, weakness or fatigue, weight loss, fever, and night sweats. The severity of these symptoms can vary widely from person to person. Diagnosis of pulmonary TB typically involves a combination of medical history, physical examination, chest X-rays, and microbiological examination of sputum samples. Sputum samples are tested for the presence of TB bacteria through staining techniques, culture, and molecular tests.

• Extrapulmonary TB refers to tuberculosis infections that occur outside of the lungs. While pulmonary TB, which affects the lungs, is the most common form of TB, the bacteria that cause TB, Mycobacterium tuberculosis, can infect other parts of the body as well. When this happens, it is known as extrapulmonary TB. The symptoms and severity of extrapulmonary TB can vary widely depending on the organs or systems involved.

Common Forms of Extrapulmonary TB:

• Skeletal TB, also known as Pott’s Disease when it involves the spine, is a form of extrapulmonary tuberculosis that affects the bones and joints. The bacterium Mycobacterium tuberculosis causes it, the same organism responsible for pulmonary tuberculosis and other forms of the disease. While less common than pulmonary TB, skeletal TB is significant due to its potential to cause severe pain, disability, and deformity if not properly treated. The form commonly involves the hips and knees with symptoms including joint swelling, pain, reduced joint movement, and eventual destruction if untreated.

“The bacterium reaches the skeletal system through the bloodstream from a primary site of infection, often the lungs, in a process known as hematogenous spread. Once the bacteria settle in the bone or joint, they cause a localized inflammatory response. Over time, this can lead to the gradual destruction of bone tissue and the formation of an abscess, a collection of pus caused by the infection,” Dr. Gangopadhyay elaborates.

• Genitourinary TB, affects the organs of the genitourinary system, which includes the kidneys, ureters, urinary bladder, urethra, and the male and female reproductive organs. This type of TB results from the spread of Mycobacterium tuberculosis bacteria from the lungs to the genitourinary tract, typically through the bloodstream. It represents a significant portion of extrapulmonary TB cases and can lead to serious health complications if not promptly diagnosed and treated.

A specific subset of this condition is known as female genital tuberculosis (FGTB). FGTB arises when Mycobacterium tuberculosis bacteria, having initially infected the lungs, spread through the bloodstream to the female reproductive organs. This dissemination can lead to TB infections in structures such as the fallopian tubes, endometrium (lining of the uterus), ovaries, and, less commonly, the cervix, vagina, and vulva.

FGTB primarily involves the fallopian tubes in most cases, which can subsequently spread to the endometrium and ovaries. The infection can cause a range of tissue responses, from granuloma formation to severe scarring and adhesions. This scarring can lead to tubal blockage, affecting fertility.

According to Dr JB Sharma, Obstetrician and Gynecologist at All India Institute of Medical Sciences in New Delhi, FGTB is a major cause of morbidity in females. Dr. Sharma explains that women with FGTB may either show no symptoms or experience symptoms similar to other gynaecological conditions such as ovarian cysts, ectopic pregnancy, or even genital cancer, particularly in the early stages. Often, infertility is the only presenting symptom.

“It leads to infertility, dyspareunia, menstrual dysfunction, chronic pelvic inflammatory disease, and chronic pelvic pain,” says Dr. Sharma.

• Cutaneous TB is a form that involves the skin. It is relatively uncommon and can occur through various mechanisms, leading to different clinical manifestations. The disease can appear at the site of inoculation of the bacteria into the skin or can manifest in areas distant from the initial site of TB infection, typically as a result of lymphatic or hematogenous spread (through lymph or blood).

Diagnosing cutaneous TB involves a combination of clinical evaluation, skin biopsies for histological examination and culture, PCR tests for TB DNA, and the tuberculin skin test or interferon-gamma release assays (IGRAs) to assess for TB infection. Imaging studies and investigations to identify TB at other sites may also be necessary.

• Eye TB, also known as ocular TB, is a form of extrapulmonary tuberculosis that affects the eye and its surrounding structures. This can occur when TB bacteria spread from the lungs (or another infected site in the body) to the eye through the bloodstream, or it can be a result of direct infection through external transmission, although this is much less common.

“Blurry vision and floating spots have become a part of my daily life, making simple tasks like reading, driving, and even recognizing faces increasingly difficult. The constant eye pain and redness add to the discomfort, often accompanied by a heightened sensitivity to light, which makes it hard to be outdoors or in well-lit environments,” Sagar Kumar, a patient of eye TB told HealthOnAir.

Ocular TB can involve any part of the eye and can present in various forms, making the diagnosis challenging. It’s important to note that the presence of ocular TB doesn’t always mean active TB elsewhere in the body; it can occur in individuals with latent TB infection as well.

Dr. Gangopadhyay outlined the necessary treatment options for an eye TB patient: “Early detection and proper treatment are crucial to prevent permanent vision loss and control the spread of TB. The duration of treatment can vary but often lasts for 6 to 9 months. In addition to anti-TB therapy, corticosteroids or other immunosuppressive agents may be used to control inflammation in the eye.”

For patients dealing with any form of TB, these doctors collectively shared the following tips for managing the condition and supporting recovery:

• Adhere to Treatment: Follow your TB treatment regimen precisely as prescribed by your healthcare provider, without skipping doses.
• Attend All Appointments: Regular check-ups with your healthcare provider are crucial for monitoring your response to treatment and adjusting the regimen if necessary.
• Nutritional Support: Maintain a balanced diet rich in nutrients to support your immune system. Foods high in protein, vitamins, and minerals can aid in recovery and overall health.
• Good Hygiene Practices: Practice good hygiene, such as regular handwashing, to reduce the risk of spreading the infection to others, particularly if you have pulmonary TB.
• Inform Close Contacts: If you have active TB, especially pulmonary TB, inform close contacts so they can get tested and receive preventative treatment if necessary.

(This article has been medically reviewed by Dr Aravind Sai Kalinga, a consultant pulmonologist based in Hyderabad, India.)