Tuberculosis (TB)

Overview

Tuberculosis, or TB, is caused by a bacterium (germ) called Mycobacterium tuberculosis. It most often attacks the lungs, but it can also affect other parts of the body, such as the lymph glands, the covering of the lungs (pleura), the brain, the kidneys, the spine and other bones. When a person with TB of the lungs or throat coughs, speaks or sings, tiny droplets carrying the germ go into the air. Other people can breathe them in. The germ spreads most easily in closed, poorly ventilated rooms. It does not spread by touching surfaces.

There are two stages. In TB infection (also called latent or inactive TB), the germ is in the body but is sleeping. The person feels well, has no symptoms and cannot pass it on. In TB disease (active TB), the germ is multiplying and makes the person ill, and TB of the lungs can spread to others. Without treatment, about 1 in 20 infected people develop TB disease within two years, and about another 1 in 20 do so later in life.

TB disease is serious and can kill if it is not treated properly, but almost everyone who completes the full course of medicines recovers. Some TB germs no longer respond to the usual medicines; this is called drug-resistant TB and needs specialist care. Pakistan has the fifth highest TB burden among the countries most affected worldwide.

Symptoms

• A cough that lasts 3 weeks or longer
• Coughing up phlegm (sputum) from deep in the chest, sometimes with blood
• Chest pain
• Fever and chills
• Night sweats
• Weight loss and loss of appetite
• Tiredness and weakness
• Firm swelling in the neck or other glands (lymph nodes) when TB affects them
• Back pain when TB affects the spine, blood in the urine when it affects the kidneys, or a hoarse voice when it affects the voice box
• Headache or confusion when TB affects the brain (TB meningitis)

Causes and risk factors

Causes

• Infection with the bacterium Mycobacterium tuberculosis
• Breathing in air containing TB germs coughed, spoken or sung out by a person with active TB of the lungs or throat
• Spending a lot of time close to an infectious person, especially indoors in a small room with little fresh air
• A sleeping (latent) TB infection waking up and becoming active, often years later, when the body's defences become weaker

What makes it more likely

• Living with or spending a lot of time close to someone who has active TB
• Having been infected with TB germs recently, as TB disease most often develops within two years of infection
• HIV infection
• Diabetes
• Low body weight or poor nutrition
• Cancer, or medicines that weaken the immune system, such as long-term steroid treatment
• Being a baby or young child, especially under 5 years of age
• Living or working in crowded places such as prisons, shelters or hospitals

Complications

If TB is not treated, or treatment is stopped early, it can badly damage the lungs and can be fatal. The germ can spread from the lungs through the blood to many parts of the body at once (miliary TB), or reach the brain and its coverings (TB meningitis), the spine, the kidneys or the glands. Stopping medicines early or taking them irregularly can also lead to drug-resistant TB, which is harder and longer to treat. Without treatment, a person with TB of the lungs can keep infecting family members and others. TB also brings heavy costs to families through lost work, travel and extra food, even where medicines are free.

Diagnosis

A doctor will ask about your symptoms, contact with anyone who has TB, and other illnesses such as HIV or diabetes. A chest X-ray is often done to look for changes in the lungs. To prove TB disease, samples of phlegm (sputum) or other body fluids are sent to the laboratory. Tests include looking for the germ under a microscope (smear microscopy), rapid molecular tests that detect the germ's genetic material (nucleic acid amplification tests), and culture, where the germ is grown in the laboratory. Culture is the most reliable test. Drug susceptibility testing shows which medicines will work, which matters for drug-resistant TB.

To look for TB infection without symptoms, for example in close contacts, doctors use a TB skin test (Mantoux) or a TB blood test (IGRA). The BCG vaccine can make the skin test falsely positive, so a blood test is preferred in vaccinated people aged 5 and over. A positive skin or blood test cannot tell infection from disease, so further tests such as a chest X-ray are needed.

Treatment

1. Get tested early if you have a long-lasting cough or other TB symptoms. Treatment starts once TB disease is confirmed or strongly suspected by a doctor.
2. TB disease that responds to the usual medicines is treated with a combination of antibiotics taken together for several months. The standard course uses isoniazid, rifampicin, pyrazinamide and ethambutol and lasts about 6 months; a 4-month combination that includes rifapentine and moxifloxacin is another option for some people, and children with milder TB may need only 4 months. Your doctor decides the medicines and the dose.
3. Take every dose and finish the whole course, even when you feel better. Directly observed therapy (DOT), where a health worker watches you take your medicines in person or by video, is the standard way to support this.
4. Go for regular check-ups, at least monthly, so your progress, blood tests and any side effects can be checked. Report any new symptoms to your doctor or TB clinic straight away.
5. Drug-resistant TB needs different medicines chosen by, or with, a TB specialist, using only medicines the germ is known to respond to. Treatment is more complex and its length depends on how severe the disease is and how well you respond.
6. People with TB infection but no symptoms, especially close contacts and those at high risk, may be offered shorter preventive treatment of a few months with isoniazid and rifampicin-type medicines to stop TB disease from developing.
7. Children, pregnant women, and people with HIV, diabetes, kidney or liver disease need special care, so their treatment is planned with TB experts.

Medicines in Pakistan

Medicines a doctor may use, by group. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.

Also used (not yet in our price list): Rifapentine (used in some shorter TB disease and TB infection regimens), BCG vaccine (given to babies and young children in countries where TB is common), Second-line medicines for drug-resistant TB, chosen by a TB specialist

Self-care and prevention

Self-care

• Take your TB medicines exactly as prescribed and finish the full course, even after you feel well
• Keep all clinic appointments and tests so your doctor can check that treatment is working
• Tell your doctor or TB clinic about any side effects or new symptoms rather than stopping medicines yourself
• While you may still be infectious, follow your doctor's or TB clinic's advice about staying away from work, school and crowded indoor places
• Keep rooms well ventilated by opening windows, as TB spreads most easily in closed spaces
• Eat as well as you can; low body weight raises the risk of TB getting worse
• Ask for a check-up for people you live with, especially young children and anyone with HIV or diabetes

Prevention

• Get babies vaccinated with BCG as part of routine childhood immunisation; it helps protect young children from severe TB such as TB meningitis
• Find and treat TB disease early so it does not spread to others
• Close contacts of a person with TB should be checked, and those with TB infection can take preventive treatment
• Keep homes, workplaces and clinics well ventilated
• Manage conditions that raise TB risk, such as HIV and diabetes, and test for TB if symptoms appear

Common questions

Is TB curable?

Yes. Almost everyone with TB disease recovers if they take the full course of the right medicines. Stopping early or missing doses can make the illness return and can lead to drug-resistant TB, which is harder to treat.

How does TB spread, and can I catch it from sharing plates or shaking hands?

TB spreads through the air when a person with active TB of the lungs or throat coughs, speaks or sings, and others breathe in the germs. It does not spread by touching surfaces. People with latent TB infection cannot spread it.

What is the difference between latent TB and active TB?

In latent TB infection the germ is in the body but inactive, so there are no symptoms and it cannot be passed on. In active TB disease the germ multiplies and causes illness, and lung TB can spread. Latent TB can turn into active TB, so treating it can be worthwhile for people at higher risk.

Is TB treatment free in Pakistan?

Yes. The National TB Control Programme provides first-line TB medicines free of charge, and tests are free or low cost. Patients may still face costs for travel, lost work, hospital stays and extra food, so ask your TB clinic about support available.

I had the BCG vaccine as a child. Can I still get TB?

Yes. BCG mainly protects young children from severe forms of TB, its protection fades over time and it does not always prevent TB. BCG can also make a TB skin test falsely positive, so tell your doctor you had it before testing.

Sources

1. WHO. WHO consolidated guidelines on tuberculosis: module 4: treatment: drug-susceptible tuberculosis treatment (2022).
2. WHO. WHO consolidated guidelines on tuberculosis: module 4: treatment and care, 2nd edition (2026).
3. CDC. Clinical Overview of Tuberculosis | Tuberculosis (TB) | CDC (2025).
4. CDC. Clinical Treatment of Tuberculosis | Tuberculosis (TB) | CDC (2025).
5. CDC. Clinical Testing and Diagnosis for Tuberculosis | Tuberculosis (TB) | CDC (2025).
6. CDC. Signs and Symptoms of Tuberculosis | Tuberculosis (TB) | CDC (2025).
7. CDC. Tuberculosis Vaccine | Tuberculosis (TB) | CDC (2024).
8. Global Health Research and Policy (Razzaq, Zahidie, Fatmi). Estimating the pre- and post-diagnosis costs of tuberculosis for adults in Pakistan: household economic impact and costs mitigating strategies (2022).

Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.

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