LOOK, who’s Afraid of TB? President Duterte, that’s who. “I’m 74 years old. I do not want to die of TB [tuberculosis]. I do not want to die of lung cancer,” he said in a speech delivered before TB experts during the 7th Union Asia Pacific Regional Conference.
TB is still deadly as ever. Despite advance knowledge in science and recent discovery of sophisticated drug regimes, the disease has continued its lethal progression.
“Tuberculosis is perhaps the greatest killer of all time,” wrote Dr. Frank Ryan, author of Tuberculosis: The Greatest Story Never Told. “Tuberculosis rose slowly, silently, seeping into the homes of millions, like an ageless miasma. Once arrived, TB stayed [and become] a stealthy predator.”
The “predator” is now out of control in many parts of the world. “The disease, preventable and treatable, has been grossly neglected, and no country is immune to it,” deplored the Geneva-based World Health Organization (WHO).
With every tick of the clock, someone is infected with TB somewhere. “One-third of the world’s entire population is now infected with the TB bacillus,” the UN health agency claimed.
The United Nations health agency listed the Philippines as among the four countries that account for 93 percent of the tuberculosis cases and deaths in the Western Pacific region. TB kills 75 Filipino every day.
Although the incidence of TB in the country had declined in the last 21 years, many patients still die daily due to failure to seek medical treatment, according to Dr. Enrique A. Tayag of the Department of Health.
The tenacious TB bacillus has preyed on people since antiquity. TB-induced skeletal deformities point to the disease’s existence as early as 8000 BC. Unmistakable signs of tubercular bone decay were found in the skeletons of Egyptian mummies as long ago as 2400 BC.
“Year after year, century after century, it tightened its relentless grip, worsening with wars and famines that reduced people’s resistance, infecting virtually everyone but inexplicably sparing some while destroying others,” wrote Dr. Frank in his book.
Tuberculosis infection is transmitted almost entirely by the aerial route. “TB is transmitted from person to person, usually by inhaling bacteria-carrying air droplets,” wrote Maria Luisa Padilla in Encarta Encyclopedia. “When a person sick with TB coughs, sneezes, or speaks, small particles that carry two or three viable bacteria surrounded by a layer of moisture and released in the air. When these particles are inhaled, bacteria lodge in the lungs and multiply.”
A less common route of transmission is through the skin. Pathologists and laboratory technicians who handle TB specimens may contract the disease through skin wounds. TB has also been reported in people who have received tattoos and people who have been circumcised. A person may become infected with TB bacteria and not develop the disease. His or her immune system may destroy the bacteria completely. In fact, only 5 to 10 percent of those infected with TB actually become sick.
The four most familiar signs of TB, according to health experts, are chronic cough, mild fever in the afternoon and sweating at night, chest and back pain, and progressive weight loss. In more serious or advanced cases, the symptoms are spitting blood, pale and waxy skin, and a hoarse voice.
The disease can occur in two stages: primary and secondary. “In primary TB,” explained Padilla, “a person has become infected with the TB bacteria but often is not aware of it, since this stage of the disease does not produce noticeable symptoms. Macrophages, immune cells that detect and destroy foreign matter, ingest the TB bacteria and transport them to the lymph nodes where they may be destroyed or inhibited.”
TB is not contagious in the early stage. “About three weeks after initial infection,” Padilla continued, “bacteria may be inhibited, destroyed, or allowed to multiply. If the bacteria multiply, active primary TB will develop.” Symptoms of carriers include coughing, night sweats, weight loss and fever. A chest x-ray may show shadows or fluid collection between the lung and its lining.
If the bacteria are inhibited, rather than destroyed, the immune cells form a mass known as granuloma or tubercle. In effect, the immune cells form a wall around inactive bacteria. “As long as the immune system remains strong, the TB bacteria remain walled off and inactive,” Padilla said. “The tubercle gradually collects calcium deposits to form what is known as a Ghon focus. These initial tubercles in the lung usually heal, leaving permanent scars that appear as shadows in chest x-rays.”
At this primary stage of TB, the disease does not progress, but bacteria may remain dormant in the body for many years. If the immune system becomes weakened, the tubercle opens, releasing the bacteria, and the infection may develop into active disease, known as secondary TB.
In the secondary TB, the formerly dormant bacteria multiply and destroy tissue in the lungs. They also may spread to the rest of the body via the bloodstream. Fluid or air may collect between the lungs and the lining of the lungs, while tubercles continue to develop in the lung, progressively destroying lung tissue. Coughing of blood or phlegm may occur. At this secondary stage, carriers of TB can infect others.
In the past, TB was considered the world’s deadliest disease. Then, in 1944, 21-year-old “Patricia” with progressive, far-advanced pulmonary TB received the first injection of streptomycin. She improved dramatically during the ensuing five months and was discharged in 1947. She was evaluated in 1954 and was found to be healthy and the happy mother of three children. “This injection began the age of modern anti-TB treatment and led—until recently—to dramatic reductions in TB in industrialized countries,” the WHO said.
Other anti-TB drugs are thioacetazone (first introduced in 1946), isoniazid and pyrazinamide (both first tried in 1952), and ethambutol (used for the first time in 1961). The most recent one, rifampicin, was released in 1966.
The success of drug therapy and the declining rates of disease incidence in the middle part of the 19th century instilled a sense of confidence in public health officials that TB could be conquered.
But like a phoenix that rises from ashes, TB has staged a comeback—in a deadlier and more complicated form. “The current TB epidemic is expected to grow worse, especially in developing countries, because of the evolution of MDR (multidrug-resistant) strains and the emergence of AIDS (acquired immune deficiency syndrome), which comprises human immune system and makes them more susceptible to infectious diseases,” said Anne Platt of the Washington-based Worldwatch Institute.
The MDR TB is any strain of the bacteria that is resistant to anti-TB drugs. It generally develops through improper use of TB medication. People being treated for TB normally must take a mixture of drugs over an extended period of time. If they don’t complete their full course of medication, the strongest bacilli surviving in the lungs are given the opportunity to reproduce. Those bacilli will likely be drug-resistant and, if the patient continues to suffer from active TB, can be spread by coughing to other people.
“Never self-medicate,” urged Dr. Willie T. Ong in his Philippine Star column, “Mind Your Body.” “This is the worst thing you can do. It will only strengthen the bacteria inside you and make you resistant in one tablet.”
For the six-month treatment, three to four drugs are required, usually isoniazid, rifampicin, ethambutol and pyrazinamide. There are some preparations that have three or four drugs combined in one tablet.
“The usual TB-treatment regimen is to take the four-drug combination [such as Myrin P forte] for two months, then followed by two or three drug combination [such as Myrin P] for four months,” said Dr. Ong.
Approximately, three to five tablets of the medicines are taken every day—depending on the person’s body weight.
Dr. Ong suggested to those who are undergoing treatment to stay at home during the first three weeks of treatment. “Don’t go to school, work or come in close contact with people,” he said. “Your saliva and phlegm can infect others.”
He also recommended that they wear a face mask during the first three weeks of treatment. “Cover your mouth with a tissue when you cough, sneeze or laugh too hard,” Dr. Ong urged. “Then throw the tissue away in a sealed container.”
It is recommended that all TB medications be taken one hour before meals. “It is ideal not to break the dose of the drug,” Dr. Ong reminded. The patient needs to see his doctor to undergo blood tests to check for possible liver side effects of the drugs taken.
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