Tuberculosis is a contagious disease caused by bacteria. The bacteria mainly infect the lungs, but can also affect almost every other organ and cause severe illness. In most cases, however, the disease does not break out. The abbreviation is TB or Tbc. TB is a notifiable disease. That means that doctors are legally obliged to report tuberculosis that requires treatment to the public health department. As a patient, you do not have to fear any negative consequences - such as effects on your residence title. The aim of the notification is to find any persons who may have contracted the disease from you, so that your contacts can also receive early preventive treatment. This prevents the disease from breaking out and spreading further.
The local public health department can provide you with further advice. Since tuberculosis has to be reported, information on the current situation is available there as well as a great deal of experience in dealing with the disease.
Tuberculosis is usually transmitted from person to person: In case of open pulmonary tuberculosis, patients mainly release the pathogens when they cough or sneeze. In this way, very fine droplets containing the pathogen (so-called aerosol) get into the air and can then be inhaled by other people. Tuberculosis is not highly contagious. Whether someone becomes infected depends, among other things, on how long and intensive the contact with the infected person was and how susceptible the individual is to infection.
Vaccination against tuberculosis has not been recommended in Germany since 1998. However, if you have a cough that has lasted longer than three weeks, you should be sure to see a doctor.
Preventive treatment is recommended if an infection is detected in the contact person after contact with an infected person. It can prevent the disease from breaking out. In case of young children, due to their particular susceptibility and the higher risk of contracting the disease, preventive treatment should be started immediately after contact, even if an infection has not yet been detected. The infection or the illness can thus be prevented. Medication is prescribed by a doctor.
Close contacts of patients with open pulmonary tuberculosis are particularly at risk, as well as people with a weakened immune system, for example due to an HIV infection or medication that significantly weakens the immune system, as well as diabetics, alcoholics and small children. Likewise, people who are addicted to drugs or homeless, as this is often accompanied by malnutrition or poor hygienic conditions.
The disease mostly affects the lungs. It usually starts with non-specific symptoms such as tiredness and fatigue. Fever, lack of appetite with unwanted weight loss and night sweats may also occur. Typical symptoms also include a prolonged cough, occasionally with bloody sputum and pain when breathing.
More rarely, other organs are affected; bacteria can spread through the body via the lymph system or bloodstream and thus also affect other organs, for example bones, joints or lymph nodes. With these forms of TB, there is rather little risk of infecting others. Nevertheless, you should seek medical treatment to prevent the disease from spreading to the lungs.
Contagious pulmonary tuberculosis can most reliably be detected by x-raying the chest, also known as the thorax. Skin, saliva and blood tests are not as reliable in comparison and are usually only used for people where X-ray examination is not recommended, for example pregnant women, children under 15 years of age.
For the X-ray examination, images are taken of specific areas of the body. The x-rays used are limited to the areas where a change is suspected. Pulmonary tuberculosis can then be identified on the images by a doctor.
Thanks to technological developments, the X-ray examination has a very low radiation dose. The exposure to radiation is therefore very low. Whether you should be examined for tuberculosis is something you should discuss with your doctor. That is the best way to protect yourself and others.
An infection can be diagnosed from 6 to 6 weeks after transmission. However, the diagnosis does not show whether a person is actually ill, only that their body is dealing with the pathogen. Only about 5 to 10 per cent of adolescents and adults become ill after infection. Among small children and people with pronounced immune deficiencies, it is about 20 to 40 percent.
If the disease does break out, tuberculosis can usually be treated well. Without treatment, however, the disease can be fatal. Therefore, if you have tuberculosis or suspect that you have it, you should always consult a doctor. In particular, a general practitioner, paediatrician or lung specialist can help you.
Patients with open pulmonary tuberculosis are contagious as long as they emit pathogens capable of reproducing when they cough and these can be detected in the sputum. If effective medication is taken, patients are usually no longer contagious after 2 to 3 weeks.
HIV stands for “Human Immunodeficiency Virus”. An infection with the HIV virus damages or destroys certain cells of the immune defence system and makes the body susceptible to diseases which are usually unproblematic for uninfected people. If untreated, an HIV infection can lead to AIDS. AIDS stands for “Acquired Immunodeficiency Syndrome”.
The HIV virus is most frequently transmitted through sexual intercourse. Another transmission route is infection through HIV-infected blood. This especially applies to the use of shared syringes and syringe accessories among drug users. To avoid the transmission of HIV when using blood products, the donors are carefully selected in Germany and the donated blood is regularly tested for the HI virus. Mothers with HIV can also infect their children during pregnancy, childbirth and breastfeeding. However, various measures can greatly reduce this risk if the mother’s HIV infection is known. If the mother receives successful antiretroviral treatment, a natural birth can take place.
Condoms, clean syringes and syringe equipment protect against HIV infection. Pre-exposure prophylaxis (PrEP) also prevents HIV infection. Since 1 September 2019, medications to prevent infection with the HI virus for people with an increased risk of infection have been covered by the statutory health insurance funds. People taking PrEP need to be tested for HIV and other sexually transmitted infections (STI) before starting PrEP and regularly while taking PrEP.
For people with HIV, taking antiretroviral drugs regularly means that the amount of virus in the blood is very low, so HIV is undetectable and cannot be transmitted (u = u: undetectable = untransmittable). Most people with HIV who are receiving treatment can live with the virus for a long time without contracting AIDS. In order to prevent the transmission of other sexually transmitted infections, it is nevertheless advisable to use a condom in many situations.
It makes sense to have an HIV test if you have been in a risk situation and an HIV infection cannot be ruled out. An HIV test is also offered and recommended during prenatal medical care. Many public health departments offer anonymous and free HIV tests in Germany. You can also have yourself tested for HIV at doctors’ surgeries and several AIDS centres. Since September 2018, it has been possible to buy CE-marked HIV self-tests, for example, in pharmacies and on the Internet. These tests cannot be used until 12 weeks after a possible risk of infection. In case of a reactive result, a confirmatory test needs to be carried out by a doctor. Only then is an HIV diagnosis certain.
To date, however, HIV infection is not curable and there is no vaccination that protects against contracting HIV.