29 September 2020 Author: Raquel Tavares, infectious disease physician at Hospital Beatriz Ângelo Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis . The pulmonary form of tuberculosis is the most frequent and has the more relevant public health implications. Although the lungs are the most affected organs, tuberculosis can affect other organs or systems, for example: Ganglia; Kidneys; Liver; Central nervous system; Bones and joints; Eyes. How is tuberculosis transmitted? The transmission of tuberculosis is done by air, through small particles that contain the bacillus Mycobacterium tuberculosis , expelled by the cough of an infected person with active disease. Exposed people are at risk of becoming infected and develop the disease later. However, only 10% of infected people will develop the disease. Tuberculosis can affect anyone, at any age, nationality, or social background. However, the risk is higher in immunocompromised populations, namely: Small children; People infected with the human immunodeficiency virus (HIV); People taking immunosuppressive medication. How to prevent and reduce the risk of the disease? Rapid diagnosis and adequate treatment of people with active disease If they are in hospital, they should initially be in a regime of isolation. The treatment is prolonged (6 to 9 months) and must be continued at home, as soon as after started, people no longer represent danger of contagion. Screening of close contacts of people with active lung disease Which consists of clinical evaluation, pulmonary radiography, tuberculin skin test and / or IGRA test (interferon gamma release assay), which in Portugal is carried out at the Centros Diagnóstico Pneumológico (CDP). Screening of populations with severe immunodepression This group includes people infected with HIV and people taking medication with some immunosuppressants. Since when is tuberculosis known? Tuberculosis is a very old disease: the examination of Egyptian mummies thousands of years old has made possible to identify it as a probable cause of death at that time. Tuberculosis killed hundreds of thousands of human beings around the world. Despite the advances with the discovery of the causal agent of the disease, by Robert Koch in the 19 th century, and the discovery of effective therapy in the mid-20 th century, tuberculosis remains a problem that needs to be prevented, diagnosed and treated. At the end of the 20 th century, tuberculosis appeared to be under control in most developed countries. However, in the 1990s, associated with the AIDS pandemic, the first reports of multidrug-resistant forms appeared in the United States and Europe. In the 21 st century, it was necessary to redefine resistant tuberculosis, given the appearance of almost intractable forms all over the world, but which in Eastern Europe, China and Africa are still growing. A global problem In 1991, the General Assembly of the World Health Organization (WHO) declared tuberculosis as a major and global public health problem. Still in 1994, WHO created a global project for the surveillance of antibacterial resistance, allowing to know the true dimension of the problem, and established guidelines for its control and monitor its evolution. Despite some advances with these strategies, tuberculosis continues to kill 4,500 people every day worldwide. Tuberculosis in Portugal In Portugal, in the last 10 years there has been a decrease of about 40% in the incidence of tuberculosis. Values below 20 cases / 100,000 inhabitants since 2015, are beginning to bring us closer to more developed countries. The rate of multidrug-resistant tuberculosis in Portugal is currently residual. In our country, following the implementation of measures to prevent and reduce the risk of the disease and also because the diagnosis and treatment are free for all nationals or migrants, legal or illegal (everyone has the right to be treated and the duty to properly comply with treatment), we are winning this war. Help us fight tuberculosis! The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
