ALCOHOL ABUSE AND TUBERCULOSIS

Tuberculosis has been part of humanity since centuries ravaging several lives.

CAUSE –Mycobacterium Tuberculosis

SPREAD –Primarily by airborne particles from someone with active, infectious and contagious TB.These remain suspended in air for several hours.

HIGH RISK –

Those in close contact with someone with infectious TB.
Alcoholics and those using drugs.
HIV infected individuals
Immunocompromised individuals
Homeless
Poor and unhygienic conditions of living
People exposed to TB infection on the job

INFECTION –

Those who get the infection Do not necessarily have active disease as the body;s natural immunity fights against the bacteria.
Only 10%develop active diseases.

DISEASE

Screening Tests

X ray Chest

Mantoux Screening test- involves injecting a small amount of Purified Protein Derivative (PPD) just beneath the surface of the skin on the forearm. It is marked. Results checked by health care worker after 48hrs and 72hrs. If infection with TB is present in the body there will be an induration ie the area will be raised ,swollen and hard. In a person who has been detected to have TB on x ray will show a 5mm to 10mm induration
Sputum tested by smear test and culture for three consecutive days each for the bacteria is the conclusive test.

Treatment

The drugs used are below the protocol is as required.H: Isoniazid (300 mg), R: Rifampicin (450 mg), Z: Pyrazinamide (1500 mg), E: Ethambutol (1200 mg), S: Streptomycin (750 mg) Treatment is for 6-12 months.

The Directly Observed Therapy in which the medication is directly provided by health care officials

Tuberculosis disease is completely curable provided the treatment and medication protocol is adhered to strictly. Noncompliance results in a relapse of the disease, danger to the health of those in contact with the infected individual, and the rise of MDRTB – the dreaded Multi-Drug Resistant Tuberculosis caused by the mutation of the bacteria resulting from stopping medication prematurely. The treatment of this is very difficult.

RELATION BETWEEN ALCOHOLISM AND TUBERCULOSIS

Approximately 1/3rd of the world’s population is infected with the Tuberculosis bacterium, 90% of the infected individuals will never get the clinical disease as they have an immune system adequate enough to fight the disease. Wherein the immune system is unable to fend off the illness comprises 10% of the infected populace.

Research across the world shows to date, that alcohol-consuming people are immune-compromised being susceptible to lung infections like Tuberculosis and pneumonia much more than those who do not consume alcohol.

The protective cells in the lungs fight against the bacteria of Tuberculosis and destroy it preventing the progress of infection. In acute and chronic consumption of alcohol, the response of these cells to the bacteria is reduced and suppressed, thus affecting anti inflammatory and healing properties. It thus not only compromises the immune system but also increases susceptibility to Tuberculosis.

Primarily, the continuing consumption of alcohol masks the disease process and delays diagnosis till the disease is advanced .

How does continuing Alcohol consumption affect the clinical course of TB

Alcohol results in increased relapse rates of Tuberculosis, the incidences of the more destructive forms of Tuberculosis increase.

Alcohol causes changes in the action of medications given for tuberculosis by significantly reducing their absorption by the body and accelerating their metabolism by the body thereby, the body does not get the required dose for the required duration of time.

Pre-existing liver damage as the result of alcohol consumption like hepatitis or Hepatomegaly is further deteriorated by medication administered for Tuberculosis as they are also hepatotoxic. The nutritional impairment caused by alcohol also accelerates the disease process.

The isolation required for treatment enhances emotional unmanageability. If the addiction is left untreated … there can be non-adherence to treatment, deterioration in psychological states, and resultant continuing of drinking with or without taking medications. This results in deterioration of the disease of tuberculosis in the body which can then be fatal.

Solution

The imperative matter here is that tuberculosis should be treated primarily, but also of equal importance is the simultaneous treatment of addiction through counselling, therapy beginning from the stage of starting treatment for Tuberculosis – in the isolation stage- through telephonic conversations, skype calls, assignments given to be mailed, meditations etc. Once the infectious phase is over, the person can be shifted to a rehabilitation facility simultaneously continuing his medication and care for Tuberculosis treatment.