Spare a thought for tuberculosis

The world has seemingly over-emphasised the impact of coronavirus and turned a blind eye to the equally deadly tuberculosis.

According to the Global Tuberculosis Report (2018), “seven million people were diagnosed and treated for TB, and 1,5 million people succumbed to the disease. Around 10 million people developed TB in 2018 across the globe.”

Almost one-third of the world population is at risk of developing active TB.

One of the global top 10 killer diseases, tuberculosis has always been an immense health burden to humanity since time immemorial.

Tuberculosis, commonly known as TB, is a contagious and infectious disease caused by mycobacterium tuberculosis.

In 1720, English physician Benjamin Marten “conjectured the infectious origin of tuberculosis”.

As a result, sanatorium cure – the first successful remedy against TB – was then introduced.

Sanatorium refers to a contained medical facility, typically associated with the treatment of tuberculosis.

Before the discovery of antibiotics, open-air quarantine facilities formed the first line of defence against TB in the late 19th and early 20th century.

Sanatoriums employed most up-to-date medical equipment and techniques in the prevention and cure of tuberculosis.

Historically, TB was treated at infectious diseases hospitals, where patients could be admitted for many months.

On March 24, 1882, Dr Robert Koch discovered mycobacterium tuberculosis. Then TB killed one of every seven people living in the US and Europe.

Dr Koch’s ability to scientifically isolate the tubercle bacillus was a milestone toward the control and elimination of the lethal disease.

Sputum could be examined and a positive test was invaluable and decisive. Unfortunately, there were no X-ray machines to determine the extent of organ damage.

As with coronavirus, TB is spread from person to person through infected droplets from coughs and sneezes.

Ancient philosophers coined the disease consumption. The name was derived from wasting, a common sign of active TB infection.

Physiologically, mycobacterium tuberculosis becomes active when the immune system can no longer stop replication.

HIV/Aids and TB co-infection has apparently exacerbated the already dire situation.

Tuberculosis is one of the leading causes of death among people living with HIV.

Clinical signs and symptoms of TB include chronic and productive cough, chest pains, fever, loss of weight, loss of appetite and night sweats.

Due to loss of appetite, many TB patients present with loss of weight.

Extensive replication of bacteria causes fever and nocturnal sweating.

More often, tuberculosis affects the respiratory system, with lungs being the most affected.

Pulmonary TB is the most common form of the disease.

As the respiratory system attempts to clear infection through the involuntary process of coughing, blood-stained sputum is frequently produced.

TB can be diagnosed through radiology, sputum culture, GeneXpert and Mantoux tests.

Chest X-rays usually show lung cavities suggestive of the TB disease.

Sputum culture on active cases, more often than not, tests positive.

And a positive Mantoux test confirms the presence of TB infection.

GeneXpert test detects the presence of TB bacteria, as well as testing for resistance to Rifampicin.

Today, GeneXpert is being used in Covid-19 testing.

However, TB can cause extra-pulmonary clinical manifestations.

The blood, bones, brain, central nervous system, heart, kidney, and the pleural cavity can all be affected by mycobacterium tuberculosis.

Bacillus Calmette-Guerin (BCG) is primarily used against TB.

One dose is recommended in healthy babies as close to the time of birth as possible.

It is very important that people with TB get treated, finish antibiotic therapy and strictly adhere to prescribed medication.

Consequently, non-adherence to TB treatment leads to drug resistance of which drug resistant strains are harder and more expensive to treat.

TB can be cured with anti-TB drugs.

The WHO’s recommended Directly Observed Treatment Short course (DOTS) has largely mitigated the impact of TB in human populations.

Antibiotics in particular have played a pivotal role in treating mycobacterium tuberculosis. The drugs include Isoniazid, Ethambutol, Rifampicin and Pyrizinamide.

Tuberculosis treatment regimen lasts between six and nine months, divided into intensive and continuation phases.

Anti-TB drugs are administered as a fixed dose combination.

In first-line treatment, the intensive phase patients take all the four recommended drugs for two months. Two drugs, Isoniazid and Rifampicin, are used in the four-month long continuation phase.

In cases of TB relapse, drug susceptibility tests must be done to rule out chances of bacterial resistance. If not resistant, the standard first-line drugs can be repeated.

In multi-drug resistant TB (MDR-TB), specialised treatment is initiated.

MDR-TB treatment should be prescribed according to the World Health Organisation’s guidance.

Though a patient may already have drug resistant TB, treatment failure is usually a consequence of patients not adhering to prescribed guidelines.

Henceforth, doctors and nurses must provide patients with appropriate and compliant guidelines essential in mitigating the TB impact.

On the other hand, governments must ensure quality and regular supply and delivery of anti-TB drugs to prevent treatment failure.

In this rich vein, health authorities and non-governmental organisations ought to provide accurate information on actual and, or presumed side effects.

Addressing socio-economic issues such as lack of money for treatment and, or transport, lack of commitment to long course of drugs, and social barriers can improve treatment outcomes.

More importantly, there is need to improve contact tracing, surveillance, testing, isolation and treatment in the fight against TB.

Though the response to coronavirus is remarkable, the global health burden ought to be viewed in the context of historical disease patterns.

As the world battles Covid-19, spare a thought for tuberculosis. The TB burden is insurmountable and a cause for public concern.

Apparently, TB control measures and Covid-19 disease preventative protocols are synonymous. Let us all play our part in the fight against the twin scourge of coronavirus and tuberculosis.

Everisto Mapfidze is a registered general nurse who holds a BSc Honours in Sociology (UZ). For feedback: [email protected]