“A vaccine that prevented tuberculosis would merit a Nobel Prize, but it’s just very difficult to develop.” – Tom Frieden
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Since time immemorial, tuberculosis (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.
During the 19th century, TB was regarded “a romantic disease.” The reason: some of its famous victims include fiction writer Edward Bellamy, poet Elizabeth Barrett Browning, novelist Franz Kafka, composer Frederic Chopin, inventor Alexander Graham Bell, entertainer W.C. Fields, and nurse Florence Nightingale.
Brazilian poet Manuel Brandeira contracted TB in 1904 and expressed the effects of the disease in his life in many of his poems. American author Dashiell Hammet got the disease during World War II. American country composer Jimmie Rodgers sang about the woes of TB and ultimately died of the disease days after a New York City recording session.
World leaders were not spared from TB: Charles IX of France, Edward VI of England, American presidents Ulysses S. Grant and Andrew Jackson, Louis XII of France, Napoleon II of France, Pedro I of Brazil, and our very own Manuel L. Quezon.
In those days, TB was considered as the deadliest disease. “The ‘cure’ until the late 1940s was basically rest,” Andrea Barrett once wrote. “It was fresh, cold air, lots of food – five meals a day, lots of sleep, not very much talking, and for some people, complete stillness.”
Then, in 1944, 21-year-old “Patricia” with progressive, far-advanced pulmonary TB received the first injection of streptomycin. She improved dramatically during the ensuing five months and was discharged in 1947. She was evaluated in 1954 and found to be healthy and the happy mother of three children.
“This injection began the age of modern anti-TB treatment and led – until recently – to dramatic reductions in TB in industrialized countries,” says the Geneva-based World Health Organization (WHO).
Other anti-TB drugs were introduced in subsequent years: thioacetazone (first released in 1946), isoniazid and pyrazinamide (both first tried in 1952), and ethambutol (used for the first time in 1961). The most recent one, rifampicin, was released in 1966.
With all those drugs now available, TB can already be cured. “The usual treatment course for TB is between six and nine months of continuous medicines,” wrote Dr. Willie T. Ong in his column, “Mind Your Body.” “Once active TB is treated with the appropriate drugs, the person is no longer contagious after three weeks. That is why those who are being treated for TB are advised to rest during the first month.”
Because TB bacteria are very slow-growing, the antibiotics must be taken for the whole duration of the treatment. “Treatment must be continued long after the person feels completely well, otherwise, the disease tends to relapse because it was not fully eliminated,” warns Dr. Dominic Garcia, an infectious disease specialist.
Government health officials also admitted that many of those who are suffering from TB refuse to consult a doctor because of the stigma attached to the disease. “The problem is that most Filipinos ignore their symptoms, continue to roam around, and spread the infection,” says an official of the health department. “Oftentimes, they consult only when there is blood coming out when they cough.”
According to the United Nations health agency, TB prevalence in the Philippines is high among the elderly, urban poor, smokers, and those with compromised immune systems such as people living with human immunodeficiency virus (HIV), malnutrition and diabetes.
“Treatment of TB may not change a person’s chest x-ray results back to normal,” says Dr. Ong. Studies show that once treatment for TB is completed, a repeat chest x-ray may show the following results: 30 percent of chest x-rays will revert to normal (good news), 30 percent of chest x-rays will improve but will still show a scar (still can’t pass job test), 30 percent of chest x-rays will remain the same.
In the Philippines, TB treatment is coordinated through the National TB Program of the health department. Medications are said to be available at government health services and public hospitals around the country.
Disease of poverty
“Unfortunately, adhering to and completing treatment can sometimes be difficult, especially when the ones who are most vulnerable have little access to health care and no funds to support treatments,” writes Dr. Maya Santos in her column which appeared in Vital Signs.
Sixty-year-old Tina is very sick and her disease had been complicated by TB. Being poor, she was brought to a government hospital. Although TB medicines are free, she must pay for other antibiotics and vitamins prescribed. A few weeks ago, her only son received from a nurse a new list of medicines to buy.
The son said that he had to file leave of absence to take care of his mother. And if he doesn’t work, he won’t be able to buy the medicines which the doctor prescribed. “The impact on our finances is really big,” he lamented.
Resistant strains
Another challenge in combatting TB is the emergence of multidrug resistant TB (MDR-TB). “This new superbug probably arose because TB patients did not adhere to their drug regimen, which means that they didn’t take their medicines religiously for the usual six months,” laments Dr. Ong. “Because of this, the TB bacteria developed a resistance to the first-line drugs.”
MDR-TB is difficult and expensive to treat. “The world needs to acknowledge the serious threat of drug-resistant tuberculosis before it overwhelms health systems,” said Dr. Alimuddin Zumla, director of the Centre for Infectious Diseases and International Health at University College London Medical School.
If MDR-TB is bad enough, scientists have discovered a third more terrible strain of TB. These nasty bacteria are called “extensively drug-resistant TB” or XDR-TB. “This means that XDR-TB is resistant even to the special drugs developed for MDR-TB,” Dr. Ong says. Be forewarned: The WHO has reported that XDR-TB cases have been confirmed in 58 countries, including the Philippines.
Even today, TB is still considered as a disease of poverty. “The poor are not another race of creatures bound on other journeys,” Charles Dickens wrote. “They are fellow passengers to the grave.”
