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Pharmacist Parveen is taking in a prescription from Rahana Begum, who is talking to her husband Mo about his cough.

“I don’t know why you didn’t mention that cough to the GP,” says Rahana crossly. “It’s got worse and worse since we got back from Pakistan.” Parveen notices that Mo looks very tired and watches in concern as he sits down heavily on the chair next to the counter to try and regain his breath. “I’m having to change the sheets every morning because they are drenched with your sweat!” snaps Rahana. Is Mo’s cough a cause for concern?

Answer

The symptoms that Mo has are indicative of pulmonary tuberculosis (TB), which he may have picked up on his recent travels to Pakistan. The symptoms usually include a persistent productive cough, breathlessness that gradually worsens, lack of appetite, weight loss, fever, night sweat and fatigue.

Mo needs to make an appointment with his GP, who will conduct a number of tests including a chest x-ray and sputum sample analysis. If the test proves positive for TB, Mo is likely to be referred to a specialist team who will oversee his treatment. This usually involves a two-month course of rifampicin, isoniazid, pyrazinamide and ethambutol followed by four months of rifampicin and isoniazid. Rahana and anyone else in the Begum household should also be screened for TB, alongside any other close contacts of Mo’s such as work colleagues and regular social acquaintances.

The bigger picture

TB is the leading cause of death due to curable infectious disease and was declared a global emergency by the World Health Organization over 20 years ago. In the UK, around 9,000 cases are reported each year, mostly in big cities and particularly in London.

TB is a notifiable disease and is also subject to enhanced surveillance due to the increasing incidence of the infection in recent years.

TB can take forms other than pulmonary, such as extrapulmonary (e.g. in the lymph nodes, gastrointestinal system, or bones and joints), which tends to affect individuals with a compromised immune system. Latent TB occurs when the infection is present in the body, but there are no symptoms.

Concerns are growing over the rise of drug resistant TB, fuelled by incorrect treatment of the disease, erratic drug supplies and poor monitoring of patients. Between 2011 and 2012, the number of people diagnosed with multi-drug resistant TB almost doubled to 94,000 worldwide. Cases of drug resistant TB require management by a specialist experienced in this field.

Extend your learning

• Do you know the areas of the world where TB is endemic? Have a look at TB alert: Global stats and targets to make sure you are up to date.
• Which other conditions that community pharmacists and their staff may encounter are notifiable?