Tuberculosis (TB): Symptoms, Treatment and Why You Must Finish the Course

Pakistan is among the countries with the highest number of tuberculosis (TB) cases in the world, and every year thousands of families are affected. TB is an old disease, but it is curable. The danger lies in a cough that is ignored for months, in treatment that is stopped halfway, and in the shame that stops people from getting tested. This guide explains what to look for and why finishing the full course matters.

What is tuberculosis?

TB is an infection caused by a bacterium called Mycobacterium tuberculosis. It mostly attacks the lungs (pulmonary TB), but can also affect the lymph glands in the neck, the spine, the abdomen, the brain and other organs (extrapulmonary TB). It spreads through the air when a person with TB of the lungs coughs, sneezes or speaks. It does not spread by sharing food, utensils or touching.

Not everyone who is infected gets sick. In latent TB the germ is present but asleep, causing no symptoms and no spread. It can wake up later, particularly when the immune system is weak.

TB symptoms

• A cough lasting more than two weeks, sometimes with blood in the sputum
• Fever, often low-grade and in the evening
• Drenching night sweats
• Weight loss and loss of appetite
• Tiredness and weakness
• Chest pain and shortness of breath
• For TB outside the lungs: a painless swelling in the neck, back pain, abdominal swelling or pain, or headache with confusion, depending on the organ

These signs overlap with other illnesses, such as lung cancer, so a test is essential.

Who is at risk?

• Close contacts of someone with TB, including family members at home
• People with diabetes, HIV, malnutrition or weak immunity
• Smokers, and people with long-term kidney or lung disease
• People in crowded, poorly ventilated homes and workplaces
• Young children, the elderly and people on long-term steroids

How is TB diagnosed?

• Sputum tests: a rapid molecular test (GeneXpert) detects the TB germ and shows whether it resists rifampicin, the key TB medicine. Sputum smear and culture may also be done.
• Chest X-ray for lung TB
• Biopsy, scans and other tests for TB outside the lungs
• A skin test or blood test shows infection exposure, but cannot say whether the disease is active

Treatment: six months, no gaps

Standard TB is treated with a combination of antibiotics for at least six months: four medicines (isoniazid, rifampicin, pyrazinamide and ethambutol) in the first two months, then two medicines (isoniazid and rifampicin) for another four. In Pakistan, diagnosis and treatment are available free of charge through the government’s TB control programme centres.

• You may feel much better within weeks, but the germs are not all dead. Do not stop early. Stopping or missing doses lets the surviving germs become drug-resistant, which is much harder, longer and costlier to treat.
• Take the medicines every day at the same time, ideally on an empty stomach, as your doctor advises. A health worker may watch you take them (DOTS) to help you finish.
• Drug-resistant TB needs a longer course with different medicines under a specialist.

Side effects to know about

• Orange or red urine, sweat and tears from rifampicin. This is harmless.
• Nausea, loss of appetite and stomach upset, which often settle if you adjust timing with your doctor
• Liver injury: yellow eyes or skin, dark urine, severe vomiting or belly pain. Stop and see the doctor straight away.
• Tingling or numbness in the hands and feet from isoniazid, which vitamin B6 can prevent
• Joint pain from pyrazinamide
• Blurred vision or colour changes from ethambutol. Report this at once.

Rifampicin can reduce the effect of birth control pills and many other medicines, so tell your doctor about all you take, and use another form of contraception.

Protecting your family

• After two to three weeks of proper treatment a person is usually much less infectious.
• Cover your mouth when coughing, open windows for fresh air, and sleep in a well-ventilated room. A mask helps in the first weeks.
• Household contacts should be screened. Young children in the house may be given preventive treatment.
• Every baby should receive the BCG vaccine as part of routine immunisation.

Eating and living well

• Eat protein-rich food such as eggs, daal, milk, chicken, fish and nuts, with fruit and vegetables.
• Avoid smoking and alcohol, which make recovery harder.
• Rest, but keep gently active as you feel able.
• TB is not a shame or a curse. It is an infection, and people on treatment can usually continue normal family life once they are no longer infectious.

When to see a doctor

• A cough for more than two weeks, or any blood in the sputum
• Fever, night sweats and weight loss together
• Someone at home has been diagnosed with TB
• A painless swelling in the neck that is growing

Key takeaways

• A cough lasting more than two weeks needs a TB test, and TB is curable.
• Treatment lasts at least six months, and stopping early causes drug-resistant TB.
• Yellow eyes, dark urine or vision changes on TB medicines need urgent advice.
• Free testing and treatment are available at government TB programme centres.

Related medicines on Medimart

TB medicines are prescribed in fixed combinations and must only be taken under medical supervision:

• Isoniazid: a key first-line TB medicine
• Rifampicin: a key first-line TB medicine
• Pyrazinamide: used in the first two months of treatment
• Vitamin B complex: a supplement your doctor may add to prevent nerve side effects

Prescription medicines are supplied only against a valid prescription. Please take them only as advised by your doctor.

Browse tuberculosis medicines on Medimart with delivery across Pakistan. Prescription medicines are supplied only against a valid prescription.

This guide is for general information and does not replace advice from a doctor. Any cough lasting more than two weeks should be tested for TB.