Tuberculosis or TB was once known as consumption, phthisis pulmonalis and the white plague.
TB is a very old disease; we’ve seen its typical spinal deformities in ancient Egyptian mummies.
Back in 1882, after meticulous research, Robert Koch rocked Berlin when he presented his discovery of the causative germ – the Mycobacterium tuberculosis. We now have effective treatment fora disease that used to kill two out of three people.
Thus, we observe World Tuberculosis Day on 24 March – the day Koch showed us the face of that deadly enemy. It is a time to reflect on how far we’ve come, and how far we have got to go. This battle ahead seems to be a long, arduous one. Despite the wealth of knowledge and anti-TB drug weaponry that Koch and others after him, first gave us the keys to, there remain many misconceptions about TB in our population.
According to World Health Organization, nearly 10 million people are diagnosed with TB per annum, with around 1.6 million deaths directly linked to it. TB remains one of the top 10 causes of death worldwide and is the world’s deadliest infectious killer. Yet it is a preventable and curable disease.
In Malaysia, around 25,000 new cases are detected every year. Contrary to common belief that TB is brought in due to immigrant workers, the statistics do not support this. A vast number of TB infected patients are Malaysian and only a small portion comprises immigrants.
Statistics released by the Ministry of Health last year revealed that out of the 26,168 cases diagnosed in 2017, 88% were Malaysian citizens. The number of foreigners afflicted was 3,133.
Watch out for that cough
Many locals still refer to TB as batuk kering, which has perpetuated the myth of a dry cough as a sign of TB when in fact, the cough in TB can be wet, bloody, mild, and yes, dry. Or there may be no cough at all, especially at the early stage of the disease.
The Chinese refer to TB as fei lao, which can be translated as consumption of the lungs.
TB is an airborne disease, and so, the lungs are the most commonly affected. A cough of more than two weeks is the most common clue, but TB can affect pretty much any other body part except our hair and nails! Lungs, heart, brain, bones, joints, kidneys, gut – it’s all fair game to this old bug.
The symptoms for other parts of body infection are vague – there could be non-resolving pain in bone; lymph node TB may present with lumps/swelling in neck; brain TB could cause seizures or changes in habit – symptoms vary for each site of infection.
To diagnose TB, we do a chest x-ray and take a simple sputum (phlegm) collection to identify the presence of the germ. However, only lung TB can be diagnosed via these methods. Initial changes will happen in the chest area even before symptoms develop.
Infection outside the lung will require more complicated and tedious tests like scans/biopsy, etc.
The perceptions about TB are varied. Some folks do not even get anxious over their co-worker who has been coughing for months in the air-conditioned office. Others are terrified of going near someone known to have had tuberculosis, even after his disease has been treated and cured.
Myths about TB range from beliefs that it has been eradicated in Malaysia, to beliefs that there is no cure for TB!
TB can be treated successfully hence, death due to TB is an avoidable outcome.
TB treatment over the years has undergone changes and most anti-TB medication is currently available in oral form. A combo of anti-TB drugs can render most people non-infectious within a fortnight of treatment, although it will take at least six months of treatment before he is truly cured.
TB patients tend to respond fast to the treatment, so they regain their energy and health very early in the course of treatment.
Although TB is curable, failure to comply with the regime of treatment and missing doses of the medicine may contribute to treatment failure.
A frequent defaulter can cause treatment-resistant strain and eventually contribute to the birth of more vigorous and dangerous TB bug. Hence, treatment compliance is always stressed among TB patients.
Nationwide, there were 2,098 deaths resulting from TB in 2017 – every year, the number is higher than deaths caused by the dengue virus (which was 177 in 2017)!
And yet, ask any man in the street about dengue, and he will tell you confidently that it is carried by mosquitoes. Ask how one gets TB ... and you’ll get guesses from poor food to poor hygiene to genetics!
How does TB spread?
One of the greatest roadblocks against eradicating TB here is lack of awareness. TB is an airborne disease. Bacteria released in droplets of a TB patient’s cough or sneeze may infect others who are exposed to it.
People do not recognise signs of TB, dismiss their symptoms, and do not seek treatment until late. And an untreated person can infect up to 10-15 others in a year.
By the time the index case, the first guy, has finally gotten himself checked out and started on treatment, he may have been coughing for months or years, and a dozen of his family, friends, co-workers have been infected.
And this cunning bug may lie dormant in them for months and years before creating havoc. By which time, most of them would have no idea how they were infected.
How do you know if you’re at risk of tuberculosis?
If you live in Malaysia, if you’re a smoker, a diabetic, living with HIV or living, working, breathing the same air space as someone who had untreated TB, then the answer is yes, you are at risk!
Remember not even a medical specialist is safe from this evil bug.
Early discovery leads to early recovery, and stops the continued spread of TB.
Dr Mirunaaleni Selvaraju is the Head of Kuching Tuberculosis Control Programme, Kuching Divisional Health Department, Sarawak. For more information, email firstname.lastname@example.org. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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