=====Tuberculosis (TB)=====
  *<wrap em>Notifiable (within 3/7)disease</wrap>
  *airborne spread by bacterium Mycobacterium tuberculosis.
  *usually only lung infection, but kidney, spine, and brain can be affected.
  *Not everyone infected becomes sick.
    *Latent TB - asymptomatic but test +ve. Can become active if immune system compromised. 1:10 will become active at some point
    *active TB - symptomatic and test +ve

===Immunity===
  *bacille Calmette-Guérin (BCG) vaccine - does not prevent primary infection or prevent reactivation of pulmonary TB. It does seem to protect against meningitis and disseminated TB in children
  *Tests, but which do not distinguish between Latent and Active TB
    *Mantoux test (TB skin test) - injection of tuberculin under skin and skin reaction interpreted 48-72/24 later
    *interferon-gamma release assay (IGRA) - blood test preferred if patient has previously had BCG vaccine

===Management===
  *isoniazid and rifampicin for 6/12 (**Latent TB** - 3/12 combination, or isoniazid alone for 6/12)
  *pyrazinamide and ethambutol for 1st 2/12 of the same 6/12 treatment period
  *usually not infectious after 2/52 of Rx
  *steroids occasionally if TB elsewhere
  *Multidrug resistant TB - antibiotics for >9/12
  *Latent TB - recommendations vary but <65y and no C/I should be Rx.


===Presentation===
  *prolonged cough, sometimes productive or with haemoptysis
  *chest pain
  *LOW, loss of apetite
  *fevers, chills, night sweats
  *signs of other organ problems depending on site - eg localised pain, confusion ([[wiki:neurology:meningitis]], encephalitis)
==Countries with high TB rates==
  *Africa – particularly sub-Saharan Africa (all the African countries south of the Sahara desert) and west Africa
  *south Asia – including India, Pakistan, Indonesia and Bangladesh
  *Russia
  *China
  *South America
  *the western Pacific region (to the west of the Pacific Ocean) – including Vietnam, Cambodia and the Philippines

==References include:==
https://www.nhs.uk/conditions/tuberculosis-tb/\\ 
[[https://www.cdc.gov/tb/default.htm|CDC TB]]\\ 
[[https://www.who.int/biologicals/areas/vaccines/bcg/Tuberculosis/en/|WHO - TB]]\\