The relationship between Cystic Fibrosis (CF) and Tuberculosis (TB)

Cystic Fibrosis is a genetic disease which affects one’s vital organs such as the
lungs and the digestive system. The disease is not contagious; it could never be
contracted. It is an inherited disease by means of hereditary. It is mainly caused by a
faulty gene.

Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis. The

bacteria usually attack the lungs, but TB bacteria can attack any part of the body
such as the kidney, spine, and brain. If not treated properly, TB disease can be fatal.
TB is spread through the air from one person to another. The TB bacteria are put
into the air when a person with TB disease of the lungs or throat coughs, sneezes,
speaks, or sings. People nearby may breathe in these bacteria and become infected.

A person who has on copy of the Gene that causes Cystic Fibrosis (CF) could help
prevent Tuberculosis (TB). The relationship between CF and TB will be explained in
this study.

Cystic Fibrosis
Cystic Fibrosis affects about one in 2500 babies in the United Kingdom. Currently
the disease affects over 10000 people in the United Kingdom alone. Most of the
cases are detected through screening immediately after birth.

Symptoms usually start in early childhood and include persistent cough ,recurring
chest and lung infections and poor weight gain .An early sign is that an affected
child’s sweat is unusually salty, which can be noticeable when you kiss your child.
 Figure 1

Causes of Cystic Fibrosis

Cystic Fibrosis is caused by a faulty gene called the cystic Fibrosis transmembrane
conductance regulator. This prevents all the cells in the body from functioning
properly. It allows in too much salt and not sufficient water in the body causing build-
up of thick mucus in your airways and digestive system. One would have the disease
if you inherit both genes from both parents. One becomes a carrier if they inherit
from one parent and will never exhibit any symptoms. They may however pass it
onto their offspring.
 Figure 2
Diagnosis

Cystic fibrosis is one of the conditions babies are screened for with the newborn
blood spot test.

A small amount of the baby's blood is taken by a heel prick and transferred onto a
card. The blood sample on the card is then analyzed in the laboratory for cystic
fibrosis and eight other conditions, including sickle cell anemia.

Treatment
We do not have a cure for CF at present however there are several procedures used
to manage the disease. These procedures help to ease the symptoms of the
condition, to manage the lung functioning, to ensure affected persons have a
balance diet at all times to maintain growth and minimise the complications
associated with the disease.

CF patients do not digest food very well hence it is always advised to take in foods
that are high in energy to maintain healthy weight and to fight infection.

Routine exercise could help strengthen the lungs and the muscular of a patient. You
could seek advice from a physiotherapist to determine the right form of exercise if
necessary. Exercises help to clear the mucus from the lungs.
 Figure 3

There are also medications available for CF. Antibiotics are used to treat the chest
and the lungs from infections. Pancreation are also used to help replace missing
enzymes that cannot reach your bowel to allow you to properly digest food that you
eat. Mucolytic are also used to help breakdown thick, sticky mucus. Insulin is also
used in case diabetes is diagnosed; this helps to break down the amount of sugar in
the body.

Oxygen therapy is also recommended when a CF patient suffer Hypoxia. This

condition occurs when the oxygen levels in the body falls. Oxygen therapy involves
inhaling oxygen through a mask or a small tube that sit beneath your nostrils. This
helps to improve the oxygen flow in the bloodstream.
 Figure 4
The image shows how a nasal cannula and portable oxygen container are attached
to a patient.

In extreme complication, Transplant is used as a last option. That is if the lungs

functioning falls over 30% and all other avenues have failed. A lung transplant could
help avoid death in such circumstances.

Tuberculosis (TB)
TB is an airborne disease hence it could spread from one person to the other. This
occurs when the person with TB breath through the air .one would not get TB
disease however by simply shaking someone's hand, sharing food or drink, touching
bed linens or toilet seats, sharing toothbrushes or kissing.

Figure 5
There are two TB-related conditions namely latent TB infection and TB disease;

Latent TB infection
Latent TB infection could live in the body without making you sick. Many people who
have latent TB infection never develop TB disease. The body is able to fight the
bacteria to stop them from growing in most people who become infected with TB
bacteria. People with latent TB infection do not feel sick and do not have any
symptoms. People with latent TB infection are not infectious and cannot spread TB
bacteria to others. However, if TB bacteria become active in the body and multiply,
the person will go from having latent TB infection to being sick with TB disease.

TB Disease
TB bacteria become active if the immune system can't stop them from growing.
People with TB disease are sick. They may also be able to spread the bacteria to
people they spend time with every day.

The amount of time it takes to be infected may vary according to the strength of your
immune system. It may take weeks for some people to be infected while it takes
years in the case of others. People with terminal diseases such as HIV infection are
always at a high risk of developing TB disease because of their weak immune
system.

Signs and Symptoms of TB Disease

According to the World Health Organization (WHO) one-third of the world's
population has latent TB, which means people have been infected by TB bacteria but
are not (yet) ill with disease and cannot transmit the disease. People infected with
TB bacteria have a lifetime risk of falling ill with TB of 10%. However persons with
compromised immune systems, such as people living with HIV, malnutrition or
diabetes, or people who use tobacco, have a much higher risk of falling ill. (WHO,
n.d.)
Symptoms of TB disease depend on where in the body the TB bacteria are growing.
TB bacteria usually grow in the lungs (pulmonary TB). TB disease in the lungs may
cause symptoms such as a bad cough that lasts 3 weeks or longer, pain in the chest,
coughing up blood or sputum.

Other symptoms of TB disease are weakness or fatigue, weight loss, no appetite,

chills, fever, sweating at night. The disease affects other parts of the body depending
on the area you live in.

Testing and Diagnosis

There are two kinds of tests that are used to determine if a person has been infected
with TB bacteria: the tuberculin skin test and TB blood tests.

A positive TB skin test or TB blood test only tells that a person has been infected
with TB bacteria. It does not tell whether the person has latent TB infection (LTBI) or
has progressed to TB disease. Other test includes chest x-ray and a sample of
sputum to determine if a person has TB disease.

Tuberculin skin test is also called the Mantoux tuberculin skin test.it involves
injecting a small amount of tuberculin fluid into the skin in the lower part of the arm. A
person given the tuberculin skin test must return within 48 to 72 hours to have a
trained health care worker look for a reaction on the arm. The health care worker will
look for a raised, hard area or swelling, and if present, measure its size using a ruler.
Redness by itself is not considered part of the reaction. The skin test result will
depends on the size of the raised, hard area or swelling. It also depends on the
person’s risk of being infected with TB bacteria and the progression to TB disease if
infected.

Positive skin test implies the person’s body was infected with TB bacteria. Further
tests are required to determine if the person has latent TB infection or TB disease. A
health care worker will then precede treatment as needed.

Negative skin test means the person’s body did not react to the test, and that latent
TB infection or TB disease is not likely.
 Figure 6

TB blood tests: TB blood test is also called interferon-gamma release assays or

IGRAs) measure how the immune system reacts to the bacteria that cause TB. An
IGRA measures how strong a person’s immune system reacts to TB bacteria by
testing the person’s blood in a laboratory.

Positive IGRA: This means that the person has been infected with TB bacteria.
Additional tests are needed to determine if the person has latent TB infection or TB
disease. A health care worker will then provide treatment as needed.

Negative IGRA: This means that the person’s blood did not react to the test and that
latent TB infection or TB disease is not likely.

Figure 7
Treatment for TB Disease
TB disease can be treated by taking several drugs for 6 to 9 months. Regimens for
treating TB disease have an initial phase of 2 months, followed by a choice of
several options for the continuation phase of either 4 or 7 months.

It is very important that people who have TB disease finish the medicine, taking the
drugs exactly as prescribed. If they stop taking the drugs too soon, they can become
sick again; if they do not take the drugs correctly, the TB bacteria that are still alive
may become resistant to those drugs. TB that is resistant to drugs is harder and
more expensive to treat.

The relationship between CF and TB

It has been suggested that the gene that causes cystic fibrosis continue to exist in
human populations widely because having just one copy protects against
tuberculosis. Several Europeans who must have survived from having a copy of the
gene might compensate for the people who died for having two copies.

TB caused 20% of all deaths in Europe between 1600 and 1900. The long-term
presence of tuberculosis allowed CF mutations to establish themselves particularly in
Europe. Tuberculosis resistance in the CF heterozygote can explain the modern
gradient in CF incidence between Europe and the rest of the world

CF patients and carriers of the gene have some resistance to TB. Pool man and
Galvani have stated that perhaps the TB bacteria need a nutrient that CF patients do
not make.

Researchers have intimated that the incidence of CF will fall in the world where
tuberculosis is no longer responsible for significant deaths among individuals of
reproductive age. The decline amounts of 0.1% decrease in CF incidence annually
over the next 100 years will reduce the condition significantly. It will take 20
generations to reduce the incidence by 50% as required by this calculation.
Malaria

Malaria is a serious tropical disease spread by mosquitoes. It is caused by a parasite

called Plasmodium. The Plasmodium parasite is mainly spread by female Anopheles
mosquitoes. The parasites build up in the liver of sufferers, and then infect red blood
cells.

The 2014 World Malaria Report, published by the World Health Organization (WHO,
n.d.) estimates there were 198 million cases of malaria worldwide and 584,000
deaths in 2013.

Symptoms of malaria include fever, headache, and vomiting, and usually appear
between 10 and 15 days after the mosquito bite. Malaria can quickly become life-
threatening by disrupting the blood supply to vital organs where one immediate
treatment.

Treating malaria

It is always advised to seek an immediate diagnosis and treatment for a full recovery.

Antimalarial medication is used to both treat and prevent malaria. The kind of
treatment depend on the type of malaria, the severity of your symptoms, where you
caught malaria whether you took an antimalarial to prevent malaria and whether
you're pregnant

Malaria control malaria measures includes prompt and effective treatment with
artemisinin-based combination therapies, use of insecticidal nets by people at risk
and indoor residual spraying with insecticide to control the vector mosquitoes
Sickle cell

Sickle cell anemia is a serious inherited blood disorder where the red blood cells,
which carry oxygen around the body, develop abnormally. The hall mark of the
disease is pain in the joints where there is sickling.

The disorder mainly affects people of African, Caribbean, Middle Eastern, Eastern
Mediterranean and Asian origin. Sickle cell anemia is caused by an abnormal
change in the gene that instructs the body to produce hemoglobin.

The sickle cell gene is passed on between family members. To get sickle cell anemia
you have to inherit the sickling gene from both parents.

If you only inherit the gene from one parent, you have what's known as the sickle cell
trait. A person with the trait is able to produce normal hemoglobin hence they are
usually free of the disease. They may however pass on the abnormal gene to their
offspring.

Diagnosing and screening for sickle cell anemia

Sickle cell anemia can be diagnosed using a blood test. The blood is checked for
defective hemoglobin. All babies born in the UK are offered screening for sickle cell
anemia as part of the newborn blood spot test .

People in high risk groups should be tested for the sickle cell trait or thalassemia
before having a general anesthetic. This is because this type of anesthesia
temporarily lowers the amount of oxygen in the blood, which could be dangerous for
someone with these blood conditions.
Screening for abnormalities in pregnancy, including inherited disorders such as
sickle cell

Treating sickle cell anemia

If your child is diagnosed with sickle cell anemia, they'll be referred to a specialist
sickle cell center.

Sickle cell centers are specialist units usually based in large hospitals. The staff at
these units has a high level of expertise in treating people with sickle cell anaemia.

A detailed plan outlining future medical care will be drawn up and you'll be given
information and support to help manage your child’s condition.

Following simple lifestyle advice, such as drinking plenty of fluids, can help reduce
the risk of experiencing a sickle cell crisis.

Sometimes, a person with sickle cell anaemia will continue to experience pain
despite taking preventative measures. In such cases, a medication called
hydroxycarbamide may be recommended.

Malaria and Sickle Cell

It was found that individuals with the sickle cell trait are highly protected against
malaria, thus explaining the high prevalence of this mutation in geographical areas
where malaria is endemic.

Researchers have suggested that sickle hemoglobin somehow get in the way of the
Plasmodium parasite that infect the red blood cells, reducing the number of parasites
that actually infect the host and thus conferring some protection against the disease.

The sickle mutation may have been naturally selected in sub-Saharan Africa, where
malaria is endemic and one of the major causes of death because of its protective
effect against malaria. Probably, other clinically silent mutations may have been
selected throughout evolution, for their ability to provide survival advantage against
Plasmodium infection.
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