Tuberculosis (TB) is a chronic bacterial infection caused by Mycobacterium tuberculosis, primarily affecting the lungs (pulmonary TB) but capable of disseminating to other organs. In Ghana, TB remains a significant public health concern, especially among individuals with HIV, requiring early diagnosis and a standardized treatment regimen to prevent resistance and transmission.
🦠 Overview and Pathophysiology
TB spreads via airborne droplets and progresses from latent to active disease:
Causes
- Organism: Mycobacterium tuberculosis
- Transmission: Inhaled droplet nuclei from coughing
- Risk Factors: HIV co-infection, malnutrition, overcrowding
Types
- Pulmonary TB: Most common, contagious
- Extrapulmonary TB: Lymph nodes, bones, CNS
- Key Point: Latent TB can reactivate in immunocompromised states
🔍 Clinical Presentation
Symptoms vary by site and disease stage:
Symptoms
Pulmonary: Persistent cough (>2-3 weeks), hemoptysis, night sweats, weight loss
Systemic: Fever, fatigue, anorexia
Extrapulmonary: Swollen lymph nodes, back pain (spinal TB), headache (CNS TB)
Signs
Respiratory: Crackles, reduced breath sounds
General: Cachexia, lymphadenopathy
Other: Spinal deformity (Pott’s disease), neurological deficits (CNS involvement)
- Hemoptysis, respiratory distress
- Neurological signs (e.g., seizures, coma)
- Failure to improve after 2 months of treatment
🧪 Diagnosis
Confirm TB with microbiological and imaging evidence:
Investigations
First-Line: Sputum smear microscopy (ZN staining), GeneXpert MTB/RIF
Imaging: Chest X-ray (apical infiltrates, cavitation)
Culture: Mycobacterium culture (gold standard)
Supportive: HIV test, FBC, liver function tests
💊 Treatment
Standardized regimen aims to cure and prevent resistance.
Non-Pharmacological
Isolation: Respiratory isolation for contagious cases
Nutrition: High-calorie diet to support recovery
Education: Counsel on adherence and infection control
First-Line Regimen (New Cases)
- 2HRZE: Isoniazid (H) 5 mg/kg, Rifampicin (R) 10 mg/kg, Pyrazinamide (Z) 25 mg/kg, Ethambutol (E) 15 mg/kg daily for 2 months
- 4HR: Isoniazid + Rifampicin daily for 4 months
- Total: 6 months
Retreatment Regimen
- 2HRZES: Add Streptomycin (S) 15 mg/kg daily for 2 months
- 1HRZE: Continue for 1 month
- 5HRE: Isoniazid, Rifampicin, Ethambutol for 5 months
- Total: 8 months
HIV Co-Infection
- Regimen: Same as above, ensure ART compatibility
- Key Point: Start ART within 2-8 weeks of TB treatment
- Monitor for hepatotoxicity (H, R, Z) and optic neuritis (E)
- DOTS (Directly Observed Treatment, Short-course) recommended
- Refer drug-resistant cases (e.g., GeneXpert MDR-TB positive)
🤰 Special Populations
Adjust treatment based on age and condition:
Children
Dose: Weight-based, e.g., H 10 mg/kg, R 15 mg/kg
Focus: Monitor growth and adherence
Pregnancy
Safe Drugs: Isoniazid, Rifampicin, Ethambutol
Avoid: Streptomycin (ototoxicity risk to fetus)
Support: Vitamin B6 (25-50 mg/day) with Isoniazid
🚨 Referral Criteria
- Suspected or confirmed drug-resistant TB
- Severe extrapulmonary TB (e.g., CNS, spinal)
- Adverse drug reactions or treatment failure
Refer to TB control program or tertiary facility.
🧠 Key Takeaways
- ✅ Diagnose Early: Use GeneXpert and sputum tests
- ✅ Standard Treatment: 6-month regimen (2HRZE/4HR)
- ✅ Adherence: Use DOTS to prevent resistance
- ✅ Monitor: Liver function, vision, and response
- ✅ Special Care: Adjust for children and pregnancy
- ✅ Refer: For resistance or complications