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who have tuberculosis baking in their lungs, they often won't know it is there unless they are given a skin test to detect the immune system's reaction to it. Or they will find out when tuberculosis enters the second of the two stages: Reactivation.

For the ten percent who progress to active tuberculosis, the reactivation stage is when symptoms are seen. People who reach this stage will typically experience coughing, sweating (especially at night), fever, and chills. They may even cough up bits of blood, which is never a good sign. When this has continued for a few weeks, the person may loose a noticeable amount of weight. When a chest X-ray of a person in this stage is taken, the lungs will classically show large round, almost "punched out" holes. These are caused by the bacteria clumping together into what are called "granulomas".

In a small subset of these patients, the bacteria will travel even further than the lungs, actively planting itself in organs throughout of the body. The tuberculosis bug will proceed to set up shop and cause massive tissue damage, which will ultimately lead to the death of the patient. This progression is called "miliary tuberculosis", and although it can take many years for the infection to reach this stage, when it does, it carries a very high fatality rate.

Prior to the advent of antibiotics, patients were sent to sanitoriums, where they were isolated from the general population. Because the bacteria require oxygen to survive, some drastic, and even downright horrid, treatments were used to fight the infection. One such procedure was called a "pleuroplasty". In this surgery, the lung and chest wall were intentionally collapsed, in a effort to starve the bacteria of the oxygen it needed to survive. I shouldn't need to point out that this had the unfortunate side effect of also starving the patient of oxygen as well.

Fortunately, doctors today have better weapons available to fight this nasty infection. A variety of antibiotics are available. A patient being treated for tuberculosis is typically given a combination of multiple antibiotics. Isoniazid and rifampin are most commonly used, with ethambutol and pyrazinamide being added in some cases. It is vitally important to use a multi-drug strategy in the treatment of tuberculosis in order to prevent the bacteria from forming a resistance to any of the individual antibiotics. People who are known to have been exposed to tuberculosis via a positive skin test, are given a 6 month prophylactic course of isoniazid to prevent the progression of the infection.

I should also mention that a vaccine, called BCG, was developed. However, it's effectiveness has been hotly debated, and it is not currently recommended for general use in the United States. For further information about tuberculosis, there are many reputable online sources. You can also speak with your doctor, who will be able to address any questions you may have.

Learn more about this author, Erich Rosenberger M.D..
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