Loss of weight, loss of appetite, afternoon sweats, failure to respond to adequate antibiotics for a lower respiratory infection, unexplained fever of more than two weeks. These are but some of the more common signs that would raise a red flag for the diagnosis of tuberculosis. For the majority, common knowledge is that the lungs are the organ system most often commonly involved, but have you ever heard or seen those of the disseminated kind affecting the brain, the skin, the eyes, the ears, the bones of the skull, the spine, the gastrointestinal, urinary, or genital tract? In the last couple of years, we have seen a rise in the incidence of extrapulmonary tuberculosis. Personally, it never fails to incite an indescribable bundle of emotions from shock to disbelief, to being extremely sad most especially when witnessing the loss of function and faculties as a consequence of far advanced disease and worse, the loss of life from something that was entirely preventable.
Does it come as a surprise to know that the Philippines is considered a high-burden country? Based on the Global Tuberculosis Report 2022 of the World Health Organization, we are one of the 30 countries with a high disease burden for tuberculosis (TB), HIV-associated TB (TB/HIV), multidrug resistance and rifampicin resistance tuberculosis (MDR/RR-TB). Furthermore, we are in third place, behind India and Indonesia for having had a substantial reduction in the reporting of newly diagnosed cases between 2019 and 2020 with a slight improvement in 2021 when we slid to fourth place. All of us were involved in the battle against COVID-19. It does not take much to understand why. The pandemic severely affected health-care delivery and the prolonged lockdown greatly impacted access to services, reversing years of progress toward the goal of controlling TB. From the same report, the most severe aftermath globally was the increase in the estimated number of deaths in 2021 which was more than double compared to HIV/AIDS, and the possibility that TB may replace COVID-19 as the leading infectious agent causing death worldwide in the years to come.
TB briefer. Mycobacterium tuberculosis is a bacteria responsible for causing disease in humans. Primarily transmitted via the airborne route, it is acquired through inhalation of the bacilli from close interaction with a contagious source. To a large extent, the course is dependent on an individual’s immune response. Being immunocompromised, those at a young age, particularly children 5 years and below are known risk factors. Time from exposure to infection varies but ranges from three to 12 weeks. It is worthwhile to know that though anyone can get infected, not all will get sick. This is what you call a latent infection. In this category, a person is usually asymptomatic, has a negative chest radiograph and sputum smear, is noncontagious, and only has a positive skin or blood test. Latent infection also requires preventive treatment.
Management. For those diagnosed with the disease, meaning that the patient has signs and symptoms, is found to be positive on the skin for sputum smear or TB culture, and has an abnormal chest x-ray, in general, treatment involves four drugs over a four-to-six-month course, or longer for TB of the central nervous system and the bones/joints. It is important that aside from adhering to the prescribed regimen which is not an easy task, correct timing of intake or giving of medications must be observed to maximize absorption of the drugs to effect cure. The attending physician should also exert tremendous effort to perform contact tracing. Failure to identify and work up the primary source increases the risk for uninterrupted transmission for those exposed as well as increasing the chances of reinfection. Testing is extremely helpful in management, as findings of drug resistance necessitate a more complicated treatment regimen.
On a regular basis, we see more people coming to our institutions with far-advanced diseases. One shudders to think that there are more out there left untreated or undiagnosed. There needs to be a stronger push and collective action, the Philippines cannot afford to be labeled as the “sick man of Asia” in the health department as well.
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