Pulmonology focuses on diagnosing and treating lung and airway conditions such as asthma, COPD, and pneumonia, as well as overall respiratory health.

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The Path to Restoration

Recovery from tuberculosis is a transformative process. While microbiological cure (negative cultures) is the primary medical endpoint, proper recovery involves rehabilitating the physical damage to the lungs and addressing the social and psychological toll of the disease. Prevention strategies must operate at multiple levels: protecting the individual, household, and community. At Liv Hospital, we view the end of treatment not as the end of care, but as a transition to long-term health maintenance.

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Post Tuberculosis Lung Disease (PTLD)

Even after a microbiological “cure,” many patients suffer from permanent lung damage.

  • Structural Damage: Cavities, fibrosis (scarring), and bronchiectasis (widened, floppy airways) can persist.
  • Functional Impairment: Patients may have chronic airflow obstruction (similar to COPD) or restrictive lung disease, leading to lifelong shortness of breath and reduced exercise tolerance.
  • Management: Pulmonary rehabilitation, smoking cessation, and vaccination (Flu/Pneumonia) are crucial. Some patients may require long-term inhalers or oxygen therapy.
  • Aspergilloma: Old healed TB cavities can be colonized by Aspergillus fungus, forming a “fungus ball” that can cause severe bleeding years later.
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Vaccination: The BCG Vaccine

The Bacillus Calmette-Guérin (BCG) vaccine is the only licensed vaccine for TB.

  • Origin: A live, attenuated strain of Mycobacterium bovis (cow TB).
  • Efficacy: It provides excellent protection (up to 80%) against severe childhood forms of TB, such as meningitis and miliary TB. However, its protection against pulmonary TB in adults is variable (0-80%) and wanes over time.
  • Usage: It is part of the routine childhood immunization schedule in most of the world (TB-endemic countries).
  • US/Western Europe Policy: It is generally not used routinely because the risk of infection is low, and vaccination eliminates the utility of the skin test as a screening tool.
  • Future Vaccines: Research is ongoing on new vaccines (such as M72/AS01E) that could prevent latent infection from becoming active in adults.

Infection Control Strategies

Preventing transmission is the cornerstone of public health.

  • Administrative Controls: Rapid triage and isolation of suspected cases in healthcare settings to minimize exposure time.
  • Environmental Controls: Using negative pressure rooms, HEPA filtration, and Upper-Room Ultraviolet Germicidal Irradiation (UVGI) to clean the air and kill bacteria.
  • Personal Respiratory Protection: Healthcare workers must wear fit-tested N95 respirators (not surgical masks) when caring for infectious patients.

Latent TB Treatment as Prevention

Treating the reservoir of latent tuberculosis is the only way to eliminate the disease.

  • Targeted Testing: Screening high-risk groups (contacts of cases, HIV+, immigrants, healthcare workers) and treating those who test positive prevents future active cases. This is “preventive therapy.”

Addressing Social Determinants

TB cannot be eradicated by medicine alone.

  • Poverty Reduction: Improving housing ventilation and nutrition, and reducing overcrowding, lowers transmission rates.
  • Stigma Reduction: TB carries a heavy stigma in many cultures. Education campaigns emphasizing that TB is an airborne infection (anyone can get it) and is curable help encourage people to seek testing without shame.

Global Strategy: The End TB Strategy

The WHO’s “End TB Strategy” aims to reduce TB deaths by 95% and incidence by 90% by 2035.

  • Pillars: Integrated patient-centered care, bold policies/supportive systems, and intensified research/innovation.

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FREQUENTLY ASKED QUESTIONS

Does the BCG vaccine leave a scar?

Yes, the BCG vaccine typically leaves a small, raised scar on the upper left arm; this is often used as a marker of vaccination in countries where it is routine.

The US focuses on detecting and treating latent infection to control TB. Since BCG causes a positive skin test, it would make it impossible to distinguish between those who are actually infected and those who are vaccinated.

No, TB is only spread through the air (droplet nuclei). You cannot get it from surface contact, sharing food, handshakes, or toilet seats.

Protection against severe childhood TB lasts for about 15 years; its protective effect against adult pulmonary TB is limited and variable.

It takes 2-8 weeks after exposure for the immune system to react to the bacteria. If you test negative immediately after exposure, you need a repeat test 8-10 weeks later to be sure.

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