Disease Description (Causes and Symptoms)
- Definition and cause: Tuberculosis is an infectious disease caused by the Mycobacterium tuberculosis complex and is mainly transmitted from person to person through the air (droplets). Even if Mycobacterium tuberculosis enters the body, not everyone progresses to active tuberculosis, and the risk of activation increases when immunity is weakened.
- Pathophysiology: Mycobacterium tuberculosis primarily affects the lungs, but through hematogenous spread it can affect almost any organ, including the kidneys, bones (spine), central nervous system (tuberculous meningitis), peritoneum, and lymph nodes. The bacteria multiply slowly, destroying tissue and causing chronic inflammation and necrosis (caseous necrosis).
- Main symptoms: Chronic cough, sputum or hemoptysis, fever (low-grade fever), weight loss, loss of appetite, night sweats, and fatigue. Extrapulmonary tuberculosis may present with hematuria, urinary tract symptoms, spinal pain, headache, vomiting, and altered consciousness (meningitis), depending on the affected organ.
Treatment Methods
- Standard drug treatment (general recommendation for active pulmonary tuberculosis)
- Initial intensive treatment (approximately 2 months): isoniazid (INH) + rifampin + pyrazinamide + ethambutol — usually a four-drug combination regimen.
- Continuation treatment (additional 4 months): isoniazid + rifampin — a total of 6 months (general standard regimen). The treatment period may be extended depending on the patient’s condition, site of lesions, and presence of drug resistance (e.g., some cases of extrapulmonary tuberculosis or drug resistance).
- Latent tuberculosis (when treatment is indicated): Short-course regimens such as isoniazid alone or isoniazid + rifampin (selection criteria depend on national guidelines and individual risk factors).
- Drug resistance and complicated cases
- Multidrug-resistant tuberculosis (MDR-TB): When resistant to isoniazid and rifampin, second-line drugs and long-term treatment (generally 18–20 months or longer), newly approved drugs (bedaquiline, delamanid, etc.), and specialized epidemiological management and monitoring are required.
- Surgical treatment: May be considered when drug treatment is ineffective or for localized lesions (continued positive sputum cultures, necrotic lesions, cases requiring diagnostic differentiation, etc.).
- Monitoring and supportive treatment during treatment
- Regular liver function tests (liver enzyme tests), vision tests (when using ethambutol), hearing tests (when using aminoglycosides), etc.
- Vitamin B6 (pyridoxine) supplementation is recommended to prevent peripheral neuritis when taking isoniazid.
- Improving medication adherence through directly observed therapy (DOT) is recommended when possible.
- Lifestyle management and infection prevention
- Infectiousness may persist even after starting initial treatment, so follow medical staff’s instructions regarding isolation and mask use, and practice proper cough etiquette.
- Smoking, malnutrition, and immunosuppressed conditions (diabetes, HIV, etc.) can worsen the prognosis and therefore require management.
- Precautions (during treatment)
- Do not stop medication arbitrarily or take it irregularly (risk of developing resistance).
- Major drug side effects: Hepatotoxicity (isoniazid, rifampin, pyrazinamide) — consult medical staff immediately if jaundice, nausea, or weakness occurs; ethambutol may cause visual impairment (visual field or color-vision abnormalities); rifampin causes reddish-orange discoloration of body fluids (urine, tears, etc.); second-line drugs such as streptomycin carry risks of hearing loss and nephrotoxicity.
- Emergency signs (visit a medical institution immediately)
- Jaundice, persistent high fever, severe abdominal pain, acute difficulty breathing, vision changes, hearing loss, or severe rash and difficulty breathing (suspected hypersensitivity reaction).
Checklist Before an Outpatient Visit (Including Example Questions)
- Items to prepare (bring with you)
- A list of all medications and supplements currently being taken (medication name, dosage, and time taken)
- Previous test results (chest X-ray, CT, sputum test results, blood test values) and medical records (if available)
- A record of when symptoms began and how they have progressed (duration of cough, whether hemoptysis occurred, fever pattern, weight changes, etc.)
- Recent contact information (whether you have been in contact with a tuberculosis patient, and your workplace/family/residential environment)
- Information about recent travel history and immune status (such as HIV test results)
- If possible, a first-morning sputum sample (when visiting for diagnostic purposes) — first-morning sputum has higher test sensitivity
- Symptom checklist to fill out before the outpatient visit (example)
- Date cough began: ___
- Hemoptysis (if present, amount/frequency): ___
- Weight change (how many kg recently): ___
- Fever (if present, time of day/pattern): ___
- Underlying diseases (diabetes, chronic lung disease, immunosuppressed condition, etc.): ___
General Example Questions to Ask the Doctor
- What are the common/serious side effects of this medication? If which symptoms occur, should I stop taking it immediately?
- How long will my treatment last? How often will I need tests during treatment?
- It is difficult for me to take the medication every day. What should I do if I miss a dose?
- Until when is there a risk of transmitting the infection to family members and coworkers? What are the criteria for isolation or returning to work?
- Do I need treatment for latent tuberculosis, and what are the benefits and risks of preventive treatment?
Examples of Disease-Specific Questions
- In my case (based on the chest X-ray/sputum results), is this active tuberculosis or latent infection? If it is active tuberculosis, am I infectious?
- How often should liver function, vision, and hearing tests be performed during treatment, and what is the plan for responding if abnormal findings occur?
(The information above is general medical information. Diagnosis and treatment of individual patients should follow the evaluation of the attending physician and local guidelines.)