Each year we commemorate World TB Day on March 24 to raise public awareness about the devastating health, social and economic consequences of tuberculosis (TB) and to step up efforts to end the global TB epidemic. The date marks the day in 1882 when Dr. Robert Koch announced that he had discovered the bacterium that causes TB, which opened the way towards diagnosing and curing this disease.
Despite significant progress over the last decades, TB continues to be the top infectious killer worldwide, claiming over 4 500 lives a day. The emergence of multidrug-resistant TB (MDR-TB) poses a major health security threat and could risk gains made in the fight against TB.
THE THEME: “WANTED: LEADERS FOR A TB-FREE WORLD”
The theme of World TB Day 2018 – “Wanted: Leaders for a TB-free world”-
focuses on building commitment to end TB, not only at the political level with Heads of State and Ministers of Health, but at all levels from Mayors, Governors, parliamentarians and community leaders, to people affected with TB, civil society advocates, health workers, doctors or nurses, NGOs and other partners. All can be leaders of efforts to end TB in their own work or terrain.
This is a critical theme, given the political importance of the upcoming UN General Assembly high-level meeting on TB this year, which will bring together Heads of State in New York. It follows on from a very successful Ministerial Conference on Ending TB in Moscow on 16-17 November, 2017 which resulted in high-level commitments from Ministers and other leaders from 120 countries to accelerate progress to end TB.
World TB Day Provides the opportunity to shine the spotlight on the disease and mobilize political and social commitment for accelerate progress to end TB.
Last year, WHO reported that 10.4 million people fell ill with TB and there were 1.8 million TB deaths in 2016, making it the top infectious killer worldwide. This disease is deeply rooted in populations where human rights and dignity are limited. While anyone can contract TB, the disease thrives among people living in poverty, communities and groups that are marginalized, and other vulnerable populations.
These include: Migrants, Refugees, ethnic minorities, miners and others working and living in risk-prone settings, the elderly, marginalized women and children in many settings etc. Factors such as malnutrition, poor housing and sanitation, compounded by other risk factors such as tobacco and alcohol use and diabetes, affect vulnerability to TB and access to care. Furthermore, this access is often hindered by catastrophic costs associated with illness, seeking and staying in care, and lack of social protection, resulting in a vicious cycle of poverty and ill-health. The transmission of multidrug-resistant TB (MDR-TB) adds great urgency to these concerns.
SYMPTOMS
Although your body may harbor the bacteria that cause tuberculosis, your immune system usually can prevent you from becoming sick. For this reason, doctors make a distinction between:
Latent TB. In this condition, you have a TB infection, but the bacteria remain in your body in an inactive state and cause no symptoms. Latent TB, also called inactive TB or TB infection, isn’t contagious. It can turn into active TB, so treatment is important for the person with latent TB and to help control the spread of TB. An estimated 2 billion people have latent TB.Active TB. This condition makes you sick and can spread to others. It can occur in the first few weeks after infection with the TB bacteria, or it might occur years later.
SIGNS AND SYMPTOMS OF ACTIVE TB INCLUDE:
Coughing that lasts three or more weeksCoughing up bloodChest pain, or pain with breathing or coughingUnintentional weight lossFatigueFeverNight sweatsChillsLoss of appetite
Tuberculosis can also affect other parts of your body, including your kidneys, spine or brain. When TB occurs outside your lungs, signs and symptoms vary according to the organs involved. For example, tuberculosis of the spine may give you back pain, and tuberculosis in your kidneys might cause blood in your urine.
CAUSES
Tuberculosis is caused by bacteria that spread from person to person through microscopic droplets released into the air. This can happen when someone with the untreated, active form of tuberculosis coughs, speaks, sneezes, spits, laughs or sings.
Although tuberculosis is contagious, it’s not easy to catch. You’re much more likely to get tuberculosis from someone you live with or work with than from a stranger. Most people with active TB who’ve had appropriate drug treatment for at least two weeks are no longer contagious.
HIV AND TB
Since the 1980s, the number of cases of tuberculosis has increased dramatically because of the spread of HIV, the virus that causes AIDS. Infection with HIV suppresses the immune system, making it difficult for the body to control TB bacteria. As a result, people with HIV are many times more likely to get TB and to progress from latent to active disease than are people who aren’t HIV positive.
DRUG-RESISTANT TB
Another reason tuberculosis remains a major killer is the increase in drug-resistant strains of the bacterium. Since the first antibiotics were used to fight tuberculosis more than 60 years ago, some TB germs have developed the ability to survive, and that ability gets passed on to their descendants.
Drug-resistant strains of tuberculosis emerge when an antibiotic fails to kill all of the bacteria it targets. The surviving bacteria become resistant to that particular drug and frequently other antibiotics as well. Some TB bacteria have developed resistance to the most commonly used treatments, such as isoniazid and rifampin.
Some strains of TB have also developed resistance to drugs less commonly used in TB treatment, such as the antibiotics known as fluoroquinolones, and injectable medications including amikacin, kanamycin and capreomycin. These medications are often used to treat infections that are resistant to the more commonly used drugs.
COMPLICATIONS
Without treatment, tuberculosis can be fatal. Untreated active disease typically affects your lungs, but it can spread to other parts of your body through your bloodstream. Examples of tuberculosis complications include:
Spinal pain. Back pain and stiffness are common complications of tuberculosis.Joint damage. Tuberculous arthritis usually affects the hips and knees.Swelling of the membranes that cover your brain (meningitis). This can cause a lasting or intermittent headache that occurs for weeks. Mental changes also are possible.Liver or kidney problems. Your liver and kidneys help filter waste and impurities from your bloodstream. These functions become impaired if the liver or kidneys are affected by tuberculosis.Heart disorders. Rarely, tuberculosis can infect the tissues that surround your heart, causing inflammation and fluid collections that may interfere with your heart’s ability to pump effectively. This condition, called cardiac tamponade, can be fatal.
PREVENTION
If you test positive for latent TB infection, your doctor may advise you to take medications to reduce your risk of developing active tuberculosis. The only type of tuberculosis that is contagious is the active variety, when it affects the lungs. So if you can prevent your latent tuberculosis from becoming active, you won’t transmit tuberculosis to anyone else.
PROTECT YOUR FAMILY AND FRIENDS
If you have active TB, keep your germs to yourself. It generally takes a few weeks of treatment with TB medications before you’re not contagious anymore. Follow these tips to help keep your friends and family from getting sick:
Stay home. Don’t go to work or school or sleep in a room with other people during the first few weeks of treatment for active tuberculosis.Ventilate the room. Tuberculosis germs spread more easily in small closed spaces where air doesn’t move. If it’s not too cold outdoors, open the windows and use a fan to blow indoor air outside.Cover your mouth. Use a tissue to cover your mouth anytime you laugh, sneeze or cough. Put the dirty tissue in a bag, seal it and throw it away.Wear a mask. Wearing a surgical mask when you’re around other people during the first three weeks of treatment may help lessen the risk of transmission.Finish your entire course of medication
This is the most important step you can take to protect yourself and others from tuberculosis. When you stop treatment early or skip doses, TB bacteria have a chance to develop mutations that allow them to survive the most potent TB drugs. The resulting drug-resistant strains are much more deadly and difficult to treat.
VACCINATIONS
In countries where tuberculosis is more common, infants often are vaccinated with bacillus Calmette-Guerin (BCG) vaccine because it can prevent severe tuberculosis in children. The BCG vaccine isn’t recommended for general use in the United States because it isn’t very effective in adults. Dozens of new TB vaccines are in various stages of development and testing.
DIAGNOSIS
During the physical exam, your doctor will check your lymph nodes for swelling and use a stethoscope to listen carefully to the sounds your lungs make while you breathe.
The most commonly used diagnostic tool for tuberculosis is a simple skin test, though blood tests are becoming more commonplace. A small amount of a substance called PPD tuberculin is injected just below the skin of your inside forearm. You should feel only a slight .
RESULTS CAN BE WRONG
The TB skin Test isn’t perfect. Sometimes, it suggests that people have TB when they really don’t. It can also indicate that people don’t have TB when they really do.
A False-positive test may happen if you’ve been vaccinated recently with the bacillus Calmette-Guerin (BCG) vaccine. This tuberculosis vaccine is seldom used in the United States but is widely used in countries with high TB infection rates.
False-Negative Results may occur in certain populations — including children, older people and people with AIDS — who sometimes don’t respond to the TB skin test. A false-negative result can also occur in people who’ve recently been infected with TB, but whose immune systems haven’t yet reacted to the bacteria.
BLOOD TESTS
Blood tests may be used to confirm or rule out latent or active tuberculosis. These tests use sophisticated technology to measure your immune system’s reaction to TB bacteria.
QUANTIFERON-TB GOLD IN-TUBE TEST AND T-SPOT. TB TEST ARE TWO EXAMPLES OF TB BLOOD TESTS.
These Tests require only one office visit. A blood test may be useful if you’re at high risk of TB infection but have a negative response to the skin test, or if you’ve recently received the BCG vaccine.
IMAGING TESTS
If you’ve had a positive skin test, your doctor is likely to order a chest X-ray or a CT scan. This may show white spots in your lungs where your immune system has walled off TB bacteria, or it may reveal changes in your lungs caused by active tuberculosis. CT scans provide more-detailed images than do X-rays.
SPUTUM TESTS
If your chest X-ray shows signs of tuberculosis, your doctor may take samples of your sputum — the mucus that comes up when you cough. The samples are tested for TB bacteria.
Sputum samples can also be used to test for drug-resistant strains of TB. This helps your doctor choose the medications that are most likely to work. These tests can take four to eight weeks to be completed.
TREATMENT
Medications are the cornerstone of tuberculosis treatment. But treating TB takes much longer than treating other types of bacterial infections.
With Tuberculosis, you must take antibiotics for at least six to nine months. The exact drugs and length of treatment depend on your age, overall health, possible drug resistance, the form of TB (Latent or Active) and the infection’s location in the body.
Recent research suggests that a shorter term of treatment — four months instead of nine — with combined medication may be effective in keeping latent TB from becoming active TB. With the shorter course of treatment, people are more likely to take all their medication, and the risk of side effects is lessened. Studies are ongoing.
MOST COMMON TB DRUGS
If you have latent tuberculosis, you may need to take just one type of TB drug. Active tuberculosis, particularly if it’s a drug-resistant strain, will require several drugs at once The most common medications used to treat tuberculosis include:
ISONIAZID RIFAMPIN (RIFADIN, RIMACTANE) ETHAMBUTOL (MYAMBUTOL) PYRAZINAMIDE
If you have drug-resistant TB, a combination of antibiotics called fluoroquinolones and injectable medications, such as amikacin, kanamycin or capreomycin, are generally used for 20 to 30 months. Some types of TB are developing resistance to these medications as well.
A Number of new Drugs are being looked at as add-on therapy to the current drug-resistant combination treatment, including are Bedaquiline Linezolid.
Aejaz Iqbal, Microbiologist , can be reached at aijazsmile@gmail.com
