TB still a deadly killer

WHILE fewer people fell ill and died from tuberculosis (TB) worldwide last year, such is not the case in the Philippines, according to a new report released by the World Health Organization (WHO).

The WHO’s 2018 Global TB Report said the number of TB cases in the country rose from 573,000 in 2016 to 581,000 in 2017. 

The report said there are still some countries that are not doing enough to end TB by 2030. “Although global efforts have averted an estimated 54 million TB deaths since 2000, TB remains the world’s deadliest infectious disease,” it said. 

The Philippines is among the 30 countries with the largest number of TB cases in the world.  In 2016 TB killed 73 Filipinos each day.

“Each person with active TB can spread the disease to 10 other Filipinos each year! This is alarming since there are between 200,000 and 600,000 Filipinos with active TB. Multiply this by 10, and just imagine how much TB is being spread yearly,” said Dr. Willie T. Ong, an internist-cardiologist who writes a regular column for a national daily. 

Even if new TB cases are treated immediately, it would not still be able to stop the spread of the disease, Dr. Aamir Khan told the audience who attended this year’s annual convention—Philippines Against Tuberculosis.

“People who are already infected will continue to become future TB disease cases and spread the disease further. Shrinking that reservoir of people who are infected with TB is the only way to stop the epidemic,” Khan, an epidemiologist and executive director of the Karachi-based Interactive Research and Development, was quoted as saying by the BusinessMirror in a recent news report.

All over the world, despite advance knowledge in science and recent discovery of sophisticated drug regimes, TB has continued its deadly progression. “Tuberculosis is perhaps the greatest killer of all time,” wrote Dr. Frank Ryan, author of Tuberculosis: The Greatest Story Never Told.

“Tuberculosis rose slowly, silently, seeping into the homes of millions, like an ageless miasma.  Once arrived, TB stayed [and became] a stealthy predator,” Ryan further wrote. 

The tenacious TB bacillus has preyed on people since antiquity. TB-induced skeletal deformities point to the disease’s existence as early as 8000 BC. “Year after year, century after century, it tightened its relentless grip, worsening with wars and famines that reduced people’s resistance, infecting virtually everyone but inexplicably sparing some while destroying others,” wrote Ryan in his book.

Ong, who coauthored the book with his wife, Dr. Liza Ong, Doctors’ Health Tips and Home Remedies, defined TB as “an infection caused by bacteria that usually affects the lungs.” These bacteria, called Mycobacterium tuberculosis, can transfer to another person through tiny droplets spread by coughing and sneezing.

This is how TB attacks the lungs: Airborne TB bacteria (bacilli) are inhaled into lungs’ small tubes. Macrophages, a kind of defensive cell, attack the particles, killing or surrounding them. Other immune cells surround particles in hard lumps called tubercles, making bacilli harmless.

 If the body’s immune system weakens, bacilli can escape from the tubercle.  Weakened immune system can’t neutralize the bacilli.  They multiply and penetrate blood vessels, spreading diseases throughout the body. 

In the Philippines, TB is common among the high-risk groups, such as the elderly, urban poor, smokers and those with compromised immune systems such as people living with HIV, malnutrition and diabetes.

In the past, TB was considered the world’s deadliest disease. 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 a 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,” the Geneva-based WHO pointed out.

TB can either be latent or active. In latent TB condition, the TB bacteria have already infected the patient’s body, yet they are still in their inactive state. There are no signs and symptoms and it is not contagious.

If you are diagnosed with active TB, then you must absolutely take anti-TB medicines.  “There are no ifs and buts,” Ong said. “It’s for your own good and for the good of the people around you. If you don’t take the medications, then you will be infecting an average of 10 persons in a year, including your loved ones and children.”

According to Ong, the treatment for TB is a bit more complicated compared to ordinary infections “since it will take approximately six months to completely eradicate the bacteria.” In cases where the infection is serious, it may take about nine months of treatment.

Only a doctor can give you a correct treatment so you better see one. “Never self-medicate,” Ong reminded. “This is the worst thing you can do. It will only strengthen the bacteria inside you and make you resistant to one tablet.”

Ong suggested those who are undergoing treatment to stay at home during the first three weeks of treatment. “Don’t go to school, work or come in close contact with people,” he said.  “Your saliva and phlegm can infect others.” 

He also recommended that they wear a facemask during the first three weeks of treatment. “Cover your mouth with a tissue when you cough, sneeze or laugh too hard,” Ong urged. “Then throw the tissue away in a sealed container.”

As a sort of reminder, all TB medications must be taken one hour before meals. “It is ideal not to break the dose of the drug,” Ong reminded. The patient needs to see his doctor to undergo blood tests to check for possible liver side effects of the drugs taken.

Side effects aren’t common but some TB medicines can occasionally be harmful to the liver, he said. In addition, the color of the urine will change from yellow to orange. But don’t worry; the change in color is “a normal reaction to the treatment course.”

Ong suggested that you need to consult your doctor once you experience any of the following: nausea, vomiting, loss of appetite, yellowing of the skin, or fever for more than three days. 

The most important thing: “Complete the six- to nine-month course of your medicines,” Ong declared. “Do not stop your medicines without your doctor’s permission. Doing so will cause the TB bacteria to mutate and come back in a stronger and more virulent form.”

In 2011 the WHO regional office reported that about 10,600 Filipinos have multidrug-resistant TB (MDR-TB).  By 2015 MDT-TB cases went up to 15,000.

Health experts said, “Treatment outcomes for MDR-TB are typically worse than those for patients with drug-sensitive TB, in significant part due to the length of treatment and the potential for adverse effects from second-line medications.”

Although TB cases in the Philippines are currently going down, there are still much to be done. “Many factors still need to be addressed, such as reducing the stigma of TB patients, and increasing the public’s awareness of the disease, especially the need for treatment,” Ong pointed out. “Some infected TB patients still refuse treatment and continue to pose a danger to people around them.”


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