THINK ON THESE: Waging war on TB

Last March, it was reported that the number of tuberculosis (TB) cases in Davao region was increasing. According to the regional office of the Department of Health (DOH), about 100 people died of TB and most of them were from Davao City.

It was indeed alarming, so to speak. But last July, a glimmer of hope was reported. From January to July this year, TB cases in the region have decreased by 50%. That’s a good news, indeed!

Last year, the region had 13,330 TB cases from January to July, reported Dr. Hansel Amoguis, the manager of the health department’s TB program. In comparison, only 6,000 cases has been reported from January to July this year.

Since time immemorial, TB has been a public health threat. As early as 460 BC, Hippocrates, the famous Greek physician, identified TB as a widespread and highly fatal disease. At that time, no one knew what caused TB and how to treat it. TB spread uncontrollably killing most of its victims.

Although it is a disease of the past, TB is still taking its toll. In the Philippines, it is the number six leading cause of death among Filipinos, according to Dr. Willie T. Ong, who writes a regular column for Philippine Star.

At least 60% of those who die of TB occur among the productive age group of 15-64 years old, DOH reports. Some P8 billion is lost annually from sickness and deaths due to TB, records show.

The Geneva-based World Health Organization has identified the Philippines as one of the countries in the world with “a high burden of this disease.” Currently, an estimated 200,000 to 600,000 Filipinos have active TB. “This is alarming since each person with active TB can spread the disease to 10 other Filipinos each year,” deplores Dr. Ong, who is an internist-cardiologist and author of several health books.

Multiply the number of Filipinos with active TB by 10, and you get the idea of how big the health problem is. “Just imagine how much TB is being spread yearly,” Dr. Ong points out. “Hence, if someone in the household has been diagnosed with TB, all the other members of the household should get tested for TB, too.”

An estimated 80% of Filipinos have latent TB, according to Dr. Ong. “In this condition, we already have the TB infection in our bodies, but the TB is still in the inactive state,” he explains. “Hence, we feel no symptoms and we are not contagious to other people.”

In industrialized countries like the United States, they treat people with latent TB with medicines. “But we can’t help it because we are born in the Philippines,” Dr. Ong says. “We just need to observe a healthy lifestyle, or else the TB infection might get reactivated.”

TB may belong to the past, but it is still with us until now. “Tuberculosis rose slowly, silently, seeping into the homes of millions, like an ageless miasma,” writes Dr. Frank Ryan, author of Tuberculosis: The Greatest Story Never Told. “Once arrived, TB stayed – a stealthy predator.”

Mycobacterium tuberculosis (MTB), the microorganism that causes TB, divides every 16 to 20 hours, an extremely slow rate compared with other bacteria, which usually divide in less than an hour.

MTB is transmitted almost entirely by the aerial route. “When infected individual coughs, sneezes, or spits, infectious particles are released into the air,” writes Dr. Maya Santos in her column which appeared in Vital Signs, a monthly health publication. “Anyone who inhales these particles is at risk of contracting TB.”

One of the reasons why TB still remains in the Philippines is due to poverty. “Studies show that there is a strong association between TB and poverty,” wrote Donn Miranda of Health Action Information Network (HAIN). Dr. Santos added: “Transmission is enhanced in overcrowded and poorly ventilated places.”

It is no wonder why the prevalence of TB inside jails and prisons in the Philippines is up to five times higher than among the general population.

With most infectious diseases, a person becomes sick right after the microorganisms enters the body. But such is not the case of TB. “Except for very young children, few people become sick immediately after MTB enter their body (called primary infection),” explained The Merck Manual of Medical Information. “Many MTB that enter the lungs are immediately killed by the body’s defenses.

“Those that survived are captured inside white blood cells called macrophages,” the Merck manual said. “The captured bacteria can remain alive inside these cells in a dormant state for many years, walled off inside tiny scars (latent infection).”

In 90-95% of cases, MTB never cause any further problem, but in about 5-10% of infected people they start to multiply (active disease). “It is in this active phase that an infected person actually becomes sick and can spread the disease,” the manual said.

More than half the time, activation of dormant MTB happens within the first 2 years, but it may not occur for a very long time. “Doctors do not always know why the dormant bacteria become active, but if often occurs when the person’s immune system becomes impaired – for example, from very advanced age, the use of corticosteroids, or AIDS,” the Merck manual said.

“People with HIV are many times more likely to be infected by TB,” Miranda wrote. “TB is the leading cause of death among people with HIV.” HIV stands for human immunodeficiency virus, the microorganism that causes Acquired Immune Deficiency Syndrome (AIDS).

The MTB usually attack the lungs, but it can also attack any part of the body such as the kidney, spine, and brain. A person with TB may demonstrate some or all of the following: persistent cough for at least two weeks; significant weight loss, with or without loss of appetite; fever and night sweats (persistent low grade fever of more than a month); chest pains (breathlessness) or back pains; and, hemoptysis (blood-tinged sputum).

“Symptoms depend on the organ affected,” says Dr. Ong. “TB of the spine causes severe back pain, while TB of the kidneys can cause bloody urine. Hence, TB should be checked and treated as early as possible.”