Tuberculosis, or TB, is a disease caused by an infection of the bacteria Mycobacterium tuberculosis in the lungs. This condition is sometimes also called pulmonary TB. The tuberculosis bacteria that attack the lungs can cause respiratory problems, such as chronic cough and shortness of breath. The disease spreads through the air when an infected person coughs, sneezes, or spits.

Tuberculosis can be prevented and cured. TB is usually treated with antibiotics and can be fatal if left untreated.

In certain countries, the Bacille Calmette-Guérin (BCG) vaccine is given to babies or young children to prevent TB. This vaccine prevents TB outside the lungs but not in the lungs. Worldwide, TB is the second leading infectious killer after COVID-19 (above HIV and AIDS). Drug-resistant TB (TB-MDR) remains a public health crisis and a threat to health security. Only about 2 out of 5 drug-resistant TB patients accessed treatment in 2022. Ending the TB epidemic by 2030 is one of the health targets of the United Nations Sustainable Development Goals (SDGs).

People with latent TB infection do not feel sick and do not spread the disease. Only a small percentage of people who are infected with TB will develop the disease and TB symptoms. Infants and children are at higher risk. The symptoms experienced by a person depend on which part of the body TB becomes active in. Although TB usually attacks the lungs, it can also affect the kidneys, brain, spine, and skin. When someone is infected with TB, they will experience its symptoms. The disease may be mild for months, making it easy to transmit TB to others without realizing it.

Common TB Symptoms

• Prolonged cough (sometimes with blood)
• Chest pain
• Weakness
• Fatigue
• Weight loss
• Fever
• Night sweats

Risk Factors

Certain conditions that can increase a person's risk of developing tuberculosis:

• Diabetes
• Weakening of the immune system (e.g., HIV or AIDS)
• Malnutrition
• Tobacco use
• Living in overcrowded and unsanitary conditions
• Healthcare workers who frequently care for TB patients
• Elderly and children
• Substance users
• Alcohol addiction
• People undergoing immunosuppressive drug therapy, such as those with lupus, psoriasis, rheumatoid arthritis, or Crohn's disease.

Prevention

The following steps can help prevent TB infection and spread:

• Seek medical help if you experience symptoms such as prolonged cough, fever, and unexplained weight loss because early treatment for TB can help stop the spread of the disease and improve the chances of recovery.
• Undergo TB infection testing if at high risk, such as having HIV or contact with someone with TB at home or in the workplace.
• If prescribed TB preventive treatment, complete the treatment regimen.
• If you have TB, maintain hygiene when coughing, including avoiding contact with others and wearing a mask, covering your mouth and nose when coughing or sneezing, and disposing of sputum and used tissues properly.
• Special measures such as respirators and ventilation are important for reducing infections in healthcare settings and other institutions.

Diagnosis

WHO recommends the use of rapid molecular diagnostic tests as the initial diagnostic test in all individuals with signs and symptoms of TB. The rapid diagnostic tests recommended by WHO include Xpert MTB/RIF Ultra and Truenat. These tests have high diagnostic accuracy and will bring significant progress in the early detection of TB and drug-resistant TB. Tuberculin skin test (TST) or interferon-gamma release assay (IGRA) can be used to identify infected individuals. Diagnosing drug-resistant TB and other forms of drug-resistant TB as well as TB associated with HIV can be complex and expensive. Tuberculosis is very difficult to diagnose in children.

Treatment

Tuberculosis infection can be treated completely, as long as the patient is compliant and takes the medication regularly. In the initial stage of treatment, patients take medication daily with the following types of drugs:
R (Rifampicin),
H (Isoniazid),
Z (Pyrazinamide),
E (Ethambutol).
TB patients must take the prescribed medication for 6-9 months without interruption. Discipline is required to take medication for the patient to recover, even during fasting. Otherwise, non-compliance with medication can make the bacteria resistant to antibiotics, leading to worsening symptoms. This condition is known as multidrug-resistant tuberculosis (TB-MDR). Even though the symptoms disappear, the TB-causing bacteria are still present in the body and are non-active. The bacteria can become active and multiply when the immune system weakens.

TB TREATMENT DURING FASTING

Before deciding to fast, TB patients need to consult with a doctor first. Patients can change the medication schedule with the doctor's knowledge. Make sure to take the medication at the same time every day during fasting. The aim is to prevent forgetting to take the medication, which can have negative effects on the patient's health. If a patient forgets to take the medication, they should take it as soon as they remember and consult with a doctor, but do not take two doses at once.

For TB patients who can fast, there is no need to worry because fasting is beneficial for our body's health, as it can improve the immune system of TB patients. During fasting, the tuberculosis-causing bacteria, Mycobacterium tuberculosis, are slowly killed. TB patients who fast experience changes in their eating patterns and the quality of food consumed. In this case, the fasting that is carried out can be considered a stressor. Changes in eating patterns and daily habits make the body respond to the immune system of TB patients.

In addition to taking medication, TB patients need to lead a healthy lifestyle during fasting. Starting from consuming healthy foods during suhoor (pre-dawn meal) and iftar (meal to break the fast). Pay attention to the nutritional intake that needs to be fulfilled, such as calories, protein, vitamin A, vitamin C, vitamin D, minerals, zinc, and selenium. Malnutrition in TB patients can make TB worse. By adopting a healthy eating pattern, the body will be better able to fight the tuberculosis-causing bacteria, and balanced nutrition accelerates the healing process of tuberculosis.

During fasting, it is advisable to limit the consumption of beverages containing soda or caffeine, such as coffee or tea. Increase water intake to maintain body health and avoid dehydration and other diseases. Additionally, TB patients who fast should limit their consumption of high-fat foods, such as fried foods or fast food. Also, avoid smoking and exposure to cigarette smoke, as they can worsen lung conditions. If you have questions about how to manage nutrition or are still confused about determining the appropriate nutritional intake for your health condition, do not hesitate to consult with a doctor or nutritionist.