ONE of the easiest to catch infectious diseases is pulmonary tuberculosis. And most often than not, people get infected without even knowing they have it and who and where they got it from. The so-called open lesion and infectious tuberculosisA recent WHO report on the regular form of tuberculosis states that this infectious airborne illness affects about 9 million people annually and kills 2 million of them. It is estimated that about 300,000 new MDR cases are diagnosed each year. A prompt and concerted global multi-level (government and the public) response to this imminent catastrophe is needed to prevent a pandemic of MDR because no country is exempt and every country is vulnerable.
Pulmonary tuberculosis, popularly known as TB, which used to kill millions and millions of people around the world before treatment was discovered, acting like a form of cancer that spreads from the lungs to the bones, brain, kidneys, liver, spleen and other organs in the body, has now “returned” with a more deadly form: the multiple drug resistant tuberculosis, or MDR.
Cases are almost at an epidemic proportion in the former Soviet Union (“the MDR capital of the world”), and, obviously, it poses a potential global problem since it is very contagious and could easily be spread by world travel. Untreated, it is a death sentence, and even if treated, MDR could still be a formidable killer.
A recent WHO report on the regular form of tuberculosis states that this infectious airborne illness affects about 9 million people annually and kills 2 million of them. It is estimated that about 300,000 new MDR cases are diagnosed each year. A prompt and concerted global multi-level (government and the public) response to this imminent catastrophe is needed to prevent a pandemic of MDR because no country is exempt and every country is vulnerable.
What is Tuberculosis?
Tuberculosis is a chronic, recurrent, infection caused by Mycobacterium Tuberculosis, M. Bovis or M. Africanum. The common TB popular in the Philippines and other Asian countries is Pulmonary (lung) Tuberculosis due to M. tuberculosis. In the United States, where tuberculosis was practically under control, there has been a resurgence, attributed to immigrant carriers. Many of these cases were also found to be resistant to the conventional multiple drug therapy against TB, hence named MDR. Even the regular TB is still a major global public health problem today.
How is Pulmonary TB transmitted?
Tuberculosis of the lungs is transmitted by inhalation of the M. tuberculosis organism dispersed as droplet nuclei from a person with pulmonary TB whose sputum is positive. The bacteria may float in the air for several hours. Other mode of transmission is by direct hand or mouth (kissing) contact with infected saliva.
The preventive measures are obvious. If one is near a person known to have active TB, one should cover his/her nose and avoid handling items previously touched by the patient, including eating utensils. Door knobs, stair or escalator handrails, any top surface of furniture or counters touches by a person with infectious TB could be a mode to transmission, or even any object touched and contaminated by someone who is in the infectious stage.
Washing hands following an unavoidable contact is a good practice. If one suspects the possibility of having TB, it is most prudent to consult a physician without delay.
What are the signs and symptoms of PTB?
Some people with pulmonary TB may not have any symptom whatsoever. The first sign could be bloody sputum, or a chest X-ray finding of TB, or a conversion to “positive” of a previously “negative” Tuberculin Skin Test, or recurrent cough and/or loss of weight. The symptoms could even be so subtle to escape attention.
How much PTB goes unrecognized?
As much as 90% to 95% of primary TB infections go unrecognized. Besides the primary or initial infection, the other stages of PTB are latent or dormant, and recrudescent or adult-type TB. The disease may become active after 1 to 2 years after initial infection, but may be delayed for years, even a decade, and activate after the onset of diabetes mellitus, during the period of stress, after steroid treatment, or when the immune system is impaired, like in AIDS.
What are the drugs used for the treatment of PTB?
About 80% of MDR are caused by “super strains” of the bacilli that are resistant to 3 or 4 of the main drugs that are effective for the treatment of the regular strain of tuberculosis. The commonest drugs are: Isoniazid, Rifampin, Streptomycin, Pyrazinamide, Ethambutol, and Capreomycin. These medications have potential side effects that can be serious, and, therefore, should be taken only under the advice and supervision of a physician.
As always, prevention is the key to maintaining good health. So, vigilance and carefulness are essential in warding off infectious diseases, like tuberculosis, or even Influenza A (H1N1) which is now a pandemic and a potential killer.
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Philip S. Chua, MD, FACS, FPCS, Cardiac Surgeon Emeritus in Northwest Indiana and chairman of cardiac surgery from 1997 to 2010 at Cebu Doctors University Hospital, where he holds the title of Physician Emeritus in Surgery, is based in Las Vegas, Nevada. He is a Fellow of the American College of Surgeons, the Philippine College of Surgeons, and the Denton A. Cooley Cardiovascular Surgical Society. He is the chairman of the Filipino United Network – USA, a 501(c)(3) humanitarian foundation in the United States. Email:[email protected]
