Pulmonary Tuberculosis

Pulmonary tuberculosis (TB) is caused by Mycobacterium tuberculosis and mainly affects the lungs. It spreads through the air when a person with infectious TB coughs or sneezes. Tanzania is among the countries with a high TB burden, and TB/HIV co-infection is common.

• Cough lasting more than two weeks
• Fever and night sweats
• Unintentional weight loss
• Coughing up blood (in advanced disease)
• Fatigue and loss of appetite
• In children: poor weight gain and persistent cough

• Spread by inhaling airborne droplet nuclei from a person with infectious pulmonary TB, usually after prolonged close contact.
• Risk is increased by HIV infection, malnutrition, diabetes, overcrowded living conditions, and close contact with an infectious case.

• Sputum GeneXpert MTB/RIF testing is the preferred initial test, as it detects both TB and rifampicin resistance.
• Sputum smear microscopy is used where GeneXpert is not available.
• Chest X-ray supports diagnosis, especially in smear-negative cases.
• All patients diagnosed with TB are offered HIV testing.

New TB patients are treated under directly observed treatment (DOTS) with the standard first-line regimen: two months of rifampicin, isoniazid, pyrazinamide, and ethambutol (intensive phase), followed by four months of rifampicin and isoniazid (continuation phase) — written as 2RHZE/4RH — using fixed-dose combination tablets dosed by body weight.

Directly observed treatment is recommended, particularly during the intensive phase, to support adherence and prevent drug resistance.

Drug-resistant TB is managed at designated treatment centres using longer second-line regimens.

Patients who test positive for HIV are started on antiretroviral therapy alongside TB treatment and given cotrimoxazole preventive therapy.

• BCG vaccination at birth as part of routine immunisation.
• Isoniazid preventive therapy for eligible household contacts and people living with HIV.
• Good ventilation and cough etiquette in households and health facilities.
• Early diagnosis and completion of treatment for infectious cases to interrupt transmission.