Tuberculosis: symptoms, transmission, what treatments?

Tuberculosis is a notifiable disease in France. The incidence is 6.8 cases per 100,000 population. The BCG vaccine has not been mandatory for children since 2007. What are the symptoms of tuberculosis? What typical cough? Fever ? Is it contagious? how to treat it Know everything.

Tuberculosis is a notifiable disease in France. His A hit is of 6.8 cases per 100,000 population (2020). So the disease has not completely disappeared. Since 2004, Tuberculosis Centers (CLAT) are responsible for conducting investigations into tuberculosis cases and their detection in each department contact topics, and participate in the BCG vaccination children at risk. that BCG vaccination has not been mandatory since 2007.

What is tuberculosis?

“Tuberculosis is a contagious infectious disease caused by a bacterium of the genus Mycobacterium, the most commonly affected germ being Mycobacterium tuberculosis or Koch’s bacillus.” explains Dr. Jacques Amselem, general practitioner in Seine-et-Marne. After a first contact with the bacillus, which may go unnoticed or give some minor signs, the disease can be localized in one organ and remain latent. We distinguish two main forms, that pulmonary tuberculosis and the extrapulmonary tuberculosis (when it develops outside the lungs).

How common is tuberculosis in France?

Tuberculosis is a disease that has had to be declared in France since 1964. Tuberculosis has not disappeared from France, but its incidence is low: 6.8 cases per 100,000 inhabitants in the 2020 figures published by Santé Publique France. “This incidence has been steadily declining for decades” comments the agency. According to his observations, the change in BCG vaccination policy (no longer mandatory since 2007) and the shortage of vaccines over the past 6 years have had no impact on the epidemiology of childhood tuberculosis. That TB notification rates among children remain ‘very low’. That serious forms of the child (meningeal or miliary). stable (9 cases in 2020 compared to 10 in 2019). At regional level, Ile-de-France accounts for 38% of tuberculosis cases. That Seine-Saint-Denis is the French department most affected by tuberculosis (23.8 cases per 100,000 population). That risk groups are essentially the immigrant from countries with high prevalence, people homelessthat the olderThe people infected with HIV and inmates.

Development of tuberculosis in France. © Public Health France

What is Kock bacillus?

Kock bacillus is a Bacteria that infect the lungs and cause tuberculosis. This bacillus was detected by Robert Koch in 1882 who gave him his name. That Bacteria enter the airways and cause chest pain, fever and coughing up blood. The bacterium multiplies in the lungs and invades the bronchi and lung tissue. The most common form of contamination is airborne.

What is latent tuberculosis?

There are two stages of tuberculosis: the bacterial infection time and the Time of declared illness and symptomatic. After an infectious contact, the Koch bacillus usually remains silent without causing a disease: we then speak of“latent” TB infection and the person is not sick or contagious. A minority of these people will develop tuberculosis. So at the adultthe risk of progressing from latent tuberculosis to tuberculosis is of the order of 10% during life. That Risk is greater in young children, older adolescents and people with weakened immunity. The risk of illness after infection is higher in the 2 years after the infectious contact.

What is pulmonary tuberculosis?

Most commonly, it manifests itself with coughing, sneezing, and weight loss. It is a contagious disease that is airborne. Developing countries are hardest hit as patients do not always have access to treatment. The treatment is drug-based (antibiotic therapy).

Tuberculosis can also affect organs other than the lungs. For example, ganglia and bones.

What is lymph node tuberculosis?

The most commonly affected organ is the lungs, but the lymph nodes can also be targets of dormant germs. Tuberculosis is then manifested by the appearance of adenopathies, an increase in the volume of the affected lymph nodes. The diagnosis can be made by taking a biopsy of an affected lymph node, which is a sample that makes it possible to look for the presence of Koch bacilli.

What is bone tuberculosis?

Bone tuberculosis is one of the extrapulmonary forms of the disease. It affects one in two patients in the spine (Pott’s disease), knee or hip. People with a weak immune system (immunocompromised) are particularly at risk. Medical imaging (MRI, scanner) strongly suggests the diagnosis. Only detection of Koch’s bacillus confirms the diagnosis. Treatment is based on taking antibiotics.

What are the symptoms of tuberculosis?

The symptoms of tuberculosis are easily recognizable:

  • a cough that produces sputum, sometimes with blood,
  • chest pain,
  • breathing disorder,
  • fever attacks,
  • loss of appetite,
  • weight loss
  • and night sweats.

As soon as the first symptoms appear, it is best to see a doctor quickly for appropriate treatment, especially if you have been in contact with an infected patient.

Tuberculosis is a contagious disease that is transmitted through the air from man to man. Out of droplet become contaminated during the projected coughing, sneezing or spitting. Anyone who inhales these droplets will find themselves contaminated again. The risk of transmission of the Koch bacillus is high higher than the contacts were close, frequent and repeated. Transmission is facilitated in a narrow and poorly ventilated area. That is accepteda patient is contagious within 3 months before the diagnosis.

What is the incubation period for tuberculosis?

has tuberculosis 2 incubation times distinguishable:

► The first concerns the primary infection: this is the time (4 to 12 weeks) Separation of contact with Koch’s bacillus and positive turn of the tests tuberculin. This time is asymptomatic.

► After the initial infection a Time before the onset of tuberculosis “disease” and the first symptoms. This second incubation period can be short (immediate) or long (up to several years). that risk to develop the disease after infection is higher within 2 years who follow the infectious contact.

Screening is conducted around a person with contagious tuberculosis Recognize symptoms as early as possible and be able to offer treatment that avoids complications. It includes a medical consultation, a blood or skin test, and a chest x-ray screening is free. that Screening for latent tuberculosis (without symptoms) is classically based on the intradermo-reaction (IDR) to tuberculin (tuber test). This test requires a reading after 72 hours, which means people are screened in consultation. In recent years, the IDR can be replaced by the blood test of interferon gamma (Quantiferon), which requires only a consultation. Its use is only indicated for people over 15 years of age.

Who should get the BCG vaccine?

The vaccine against tuberculosis is called BCG after the names of its inventors (Bacille Calmette and Guérin). This vaccine mainly affects infants to protect them from severe forms of tuberculosis. Its efficiency would vary between 75 and 85%. Since 2007 it is no longer mandatory. Vaccination recommended from 1 month for children at high risk of tuberculosis (from 3 months for others), and up to 15. Risk factors: birth in a high-risk country, residence in Guyana, Mayotte and partly in Ile-de-France, residence in one of these countries for at least one month, family history of tuberculosis less than 5 years ago. Injection of the vaccine is contraindicated in case of hypersensitivity to any component of the vaccine, treatment with corticosteroids or immunosuppressants (chemotherapy, anti-TNF treatment) and immunosuppression or HIV seropositivity.

What are the treatments for tuberculosis?

treatment of tuberculosis usually lasts 6 months and involves taking several antibiotics simultaneously. However, with the development of resistance to antibiotics, treating some cases is becoming increasingly complicated.

If you are traveling to a country where there are many cases of tuberculosis, remember to practice enhanced hygiene by washing your hands frequently. Take care of your immune system by eating and sleeping well and limiting stressors. Primary prevention of tuberculosis, including childhood vaccination with BCG for children who are at high risk of tuberculosis in their environment or in their environment, protects against severe forms of this disease.

Sources:

Tuberculosis in France: Figures 2020. Public Health France. December 6, 2021.

Tuberculosis Questions and Answers. ARS New Aquitaine, 2015

thanks to dr Jacques Amselem, general practitioner. Comments collected in 2019.

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