Through epidemics and pandemics, one preventable disease that refuses to play second-fiddle is tuberculosis (TB).
The Philippines in 2019 ranked fourth globally in incidence and is considered a high burden country. In numbers, from the WHO Global Tuberculosis Report in 2021, around 500 cases occur for every 100,000 of the population. Majority of those affected were adults but included children as well. In the past two years, as a direct result of disruption of services brought about by the pandemic, in one children’s hospital, more cases of disseminated and advanced disease have been seen as compared to previous years. Having shared stark data on statistics, it is not unreasonable that in patients presenting with prolonged fever without a focus, TB remains to be a major differential until proven otherwise.
Can we all help? Definitely! Let us all begin by familiarizing or reacquainting ourselves with TB. If COVID taught you to be more proactive in taking definite and preventive action to avoid disease, the same stance should be adopted. Remember this, TB can affect all of us in our lifetime and early recognition is key to prevention and management.
Here are some quick pointers to help you along. In adults presenting with unexplained weight loss, unexplained fever, night sweats, persistent cough, all more than of two weeks duration, think of TB. In children, alongside the aforementioned signs and symptoms, decreased playfulness, loss of appetite, and unexplained nonresponse to antibiotics for a respiratory infection, one should also think of TB.
Once suspected, follow through and go for an early consult. It is imperative. For the patient, workup needs to be done for diagnosis and confirmation. Identifying from whom exposure occurred is vital, so there is an immediate need to screen close contacts. Failure to do all these has dire consequences. For the patient, he runs the risk of complications. Moreover, as a possible principal source, he ensures continued transmission and endangers those at high-risk and susceptible.
Are we all susceptible? TB is airborne and may be transmitted through talking, coughing, sneezing, or spitting. Transmission usually occurs from an adolescent or adult family or household member who either has unrecognized, partially treated, or untreated disease. The risk of acquiring infection is dependent on having significant close contact with the index case and a person’s state of immunity. How infectious an affected individual is determined by the amount of tubercle bacilli expelled. Populations that have been documented to be at high risk from close contact include the following:
In the pediatric age group, infants and postpubertal children once infected are the ones likely to rapidly progress to having the disease. Disseminated TB is more likely in those less than 5 years of age. Individuals who are smokes, with diabetes or immunosuppressive medical conditions such as end-stage renal disease, transplant recipients, or those on chemotherapy for cancer (to name a few), and health care workers are highly vulnerable as well. Having HIV is a “significant risk factor for progression of dormant TB to clinical disease.“ TB and HIV are a fatal partnership. TB remains to be a leading cause of death amongst affected adults with HIV. Think of our country where HIV is on the rise.
Is cure possible? If diagnosed early, TB infection may be given preventive therapy. If with pulmonary disease, a standard four-drug combination is given for a period of six months. In those with bone, joint, or central nervous system involvement treatment is longer. Management is also dependent on the susceptibility to the TB drug and the patient’s response to therapy.
Is treatment within reach? It is reassuring to know that anyone can avail of free treatment in designated public health facilities as part of the national TB program.
From 2015-2019, there was a reduction in annual mortality rates from TB. Though the pandemic has set us back significantly, knowing that we were able to achieve this feat is enough impetus to encourage everyone to keep working toward making TB history.
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