by Maria Theresa R. Termulo, M.D.
Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis. The disease is an airborne infection acquired by breathing in contaminated air droplets coughed or sneezed by a person who has an active TB. The disease primarily affects the lungs but can also affect other organ systems such as lymphatic system, central nervous system, gastrointestinal, urogenital, and the skeletal system.
TB is also highly endemic in the Philippines and is considered a major public health concern. There are about 1 million Filipinos diagnosed with active TB and it is considered the third highest prevalence rate in the world, after South Africa and Lesotho. While it is infectious, it is also preventable and treatable. However, the Philippines is still among the few countries in the world with continually increasing number of TB cases, despite our extensive National Tuberculosis Control Program. This is why it is important that we focus on preventive measures, early recognition of the disease, and adequate treatment to prevent development of drug resistance.
Common symptoms (for patients 15 years old and above) of TB are:• Bloody sputum (also called hemoptysis)• Chest pains not referrable to any musculoskeletal disorders• Chest x-ray findings suggestive of Pulmonary Tuberculosis with or without symptoms• Cough of, at least, 2 weeks duration• Easy fatigability (or malaise)• Fever• Night sweats• Significant and unintentional weight loss• Shortness of breath or difficulty of breathing• Unexplained cough of any duration in a close contact of a known active TB case
There may also be people who have latent TB infection – patients infected with TB but not developing symptoms of the disease. Many of them will never show signs of the illness, and the bacteria will remain dormant for the rest of their lives. However, in certain people, particularly those who may eventually develop a weak immune system, the bacteria can become active, multiply, and cause TB.
Those at high risk for developing TB disease include:
• Babies and young children
• Elderly
• People living with HIV
• People who are sick with other diseases that weaken the immune system
• People who are not treated correctly for TB in the past• People who became infected with TB bacteria in the last 2 years
• People who inject illegal drugs
To reduce TB incidence and mortality, the country has a National Tuberculosis Control Program that has a nationwide coverage and targets Presumptive TB and TB affected households. It collaborates with government and non-government agencies to be able to enforce standards on TB care, integrate patient-centered TB services, and facilitate multi-sectoral implementation of TB elimination plan.
People are encouraged to visit and consult with their local health centers for diagnosis and treatment of TB. The usual TB treatment usually involves taking anti-TB medications for a minimum of 6 months and up to 12 months. However, a major health concern is the increasing number of people who were unable to continue with their medications for various reasons. Misuse or disuse of antibiotics can lead to multi-drug resistant tuberculosis (MDR-TB), which are treated with a second line of antibiotics. Although, there is also a risk that the second line may not be able to cure the disease due to the severity of drug resistance (extensively drug-resistant tuberculosis or XDR-TB). Thus, it is important that people are educated and reminded to complete the TB regimen they were prescribed.
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References:Centers for Disease Control and Prevention. TB Prevention.https://www.cdc.gov/tb/topic/basics/tbprevention.htmCenters for Disease Control and Prevention. Latent TB Infection and Disease.https://www.cdc.gov/tb/topic/basics/tbinfectiondisease.htmDOH National Tuberculosis Control Program.https://doh.gov.ph/national-tuberculosiscontrol-programWeiler, Gundo Aurel. It’s Time to End TB in the Philippines. March 24, 2019. WHO website.https://www.who.int/philippines/news/commentaries/detail/it-s-time-to-endtb-in-the-philippinesWHO Consolidated Guidelines on Tuberculosis. Module 1: Prevention:https://www.who.int/publications/i/item/9789240001503