Tuberculosis is an infectious disease that is almost always treatable and develops very slowly over weeks or months. It is widespread worldwide and causes major problems, particularly in countries with insecure medical care. In Germany, it has become rare due to successful control measures.

Infection usually occurs through inhalation of tiny droplets that a person suffering from open tuberculosis excretes when speaking, coughing or sneezing. However, only around five to ten percent of infected people ever contract tuberculosis.

The tuberculosis bacteria enter the lungs with the air we breathe. The body produces antibodies against the bacteria. Defense cells trap these bacteria and a small focus forms in the lungs. The lymph nodes in the chest also react and the so-called primary complex develops. In some people, this complex remains visible on X-rays for the rest of their lives, but does not constitute a disease. Around six to eight weeks after infection, the body develops an immune response that can be detected using test methods (skin or blood test).
(skin or blood test). If the human immune system is unable to render these bacteria harmless, the infection will continue to develop. The tuberculosis bacteria can, for example, enter other organs via the bloodstream and cause tuberculous foci there (e.g. in lymph nodes, pleura and bones). All foci, including those in the lungs, can remain dormant for a long time and often only cause tuberculosis after many years (a so-called reactivation).

In the most common form of tuberculosis, pulmonary tuberculosis, a distinction is made between the open and closed form. In the open form, tuberculous tissue is coughed up (through very fine droplets). Sufferers can then infect those around them.
In closed pulmonary tuberculosis, there is no connection to the airways (bronchi) and therefore no tuberculosis bacteria are coughed up. In this case, there is no risk of infection, just as with tuberculosis of other organs.

Initially, typical symptoms are absent. Sometimes mild symptoms such as coughing, loss of appetite, tiredness, weight loss, slight fever, stinging in the chest and night sweats are not noticed.

Young children, HIV-infected people and patients who require immunosuppressive medication (e.g. cortisone tablets over 5mg/day or medication for cancer or rheumatism therapy) are particularly at risk of contracting tuberculosis. Diabetics, dialysis patients and drug addicts, patients with silicosis and people whose stomach has been surgically removed are also at increased risk.

A doctor should therefore be consulted if the cough persists for more than three weeks. These patients are examined using X-ray methods (thorax overview or CT thorax) and possibly laboratory analyses of examination material from the lungs or other organs as well as test procedures as for contact persons (see below).

The treatment usually lasts 6 months. It is not always well tolerated and must nevertheless be carried out in full. The drugs used are called tuberculostatics. The most important are: Isoniazid (INH) and Rifampicin (RMP), as well as Pyrazinamide (PZA) and Ethambutol (EMB). In the first two months, four different tuberculostatics are usually taken at the same time. If the treatment is effective, it is continued with two drugs for a further four months. Only then is tuberculosis cured. If it is found that individual drugs are not tolerated or do not work (in the case of resistance), the therapy must be changed and possibly extended.

Without the patient's cooperation, the success of the treatment is at risk. It is therefore crucial that the patient takes all prescribed medication consistently and in the prescribed amount every day. This is also important to ensure that the medication remains effective and no resistance develops.

Medication for tuberculosis sometimes has considerable side effects. The choice of medication can therefore be changed if necessary after consultation with the attending physician. Treatment is carried out in hospital (at the start of therapy). In most cases, a patient with open tuberculosis is isolated as an inpatient for two weeks.

During treatment, blood tests, X-rays of the lungs and bacteriological controls are carried out to check tolerance and effectiveness. It is important to monitor liver and kidney function. During treatment with ethambutol, additional ophthalmologic examinations are required.

The Infection Protection Act (IfSG) stipulates that bacterial detection and the initiation of treatment must be reported to the responsible health authority. The obligation to report also applies if the patient dies or treatment is discontinued.

The health authorities ensure that treatment is carried out, initiate environmental tests and ensure that statistics are recorded.

Close contacts with people with open tuberculosis are usually examined by the responsible health authority in order to rule out sources of infection and further infections. It is essential to determine the duration of contact with the infected person, as statistical studies have shown that infection only becomes realistic after several hours of contact. The public health department therefore determines the group of contact persons who must be tested on the basis of the Infection Protection Act (§§ 16 and 25 IfSG).

Children under the age of 5 must be tested immediately. A blood and/or skin test and an X-ray of the lungs are carried out.

Children between the ages of 5 and 15 should also have a blood test carried out immediately.

For adolescents > 15 years and adults without symptoms, a blood sample is taken eight weeks after the last contact with the infected person. If the blood test is positive, this is an indication that the contact person is currently or was previously infected. This is called latent tuberculosis. People are infected but do not have tuberculosis and are not infectious to those around them. An X-ray of the lungs is required for further clarification. Preventive therapy is recommended to prevent the disease.

These examinations of contact persons ordered by the public health department are free of charge.

According to the STIKO, the tuberculosis vaccination (BCG) is currently not recommended in Germany.