Orolu: Overcrowding, poverty fuel tuberculosis infection
Ahead of World Tuberculosis Day coming up on Friday March 24, Dr. Ademola Olumide Orolu, a Consultant Family Physician told PAUL ADUNWOKE how to prevent, treat and manage the disease.
What is Tuberculosis?
Tuberculosis is an infectious disease, which can affect any organ of the body. However, the lung is the most commonly affected. The disease is as old as the existence of man, and has been a cause of morbidity and mortality for so many years. In countries with high prevalence of the disease, the perpetuating factors can be related to poor public health system, resulting in late presentation of the patient. Hence, delayed diagnosis, unavailability of medications, poor medication adherence, incomplete treatment, drug resistance, or a combination of these. Tuberculosis poses the highest burden in developing countries.
What are the causes of tuberculosis?
The commonest cause of tuberculosis is the bacterium Mycobacterium tuberculosis. Other causes include Mycobacterium bovis, transmitted through ingestion of unpasteurised milk, Mycobacterium africanum, Mycobacterium Canetti, and Mycobacterium microti.
What should the public know about tuberculosis?
Firstly, it is important for individuals to note that tuberculosis is a preventable disease. The mode of spread of the disease is through airborne transmission of droplets of the bacterium from infected patients to others. This is possible through repeated close contact with infected persons, who may cough or sneeze. Such close contact can be seen in households, boarding institutions, open office settings, and any circumstance, which brings people together for a long time. Therefore, a brief contact with a patient, who has tuberculosis, is not enough to infect people in most cases.
Tuberculosis can also be transmitted through consumption of unpasteurised milk, in which case, the disease is transferred from infected cows or dairy animals to man.
In developing nations, overcrowding is a major risk factor in the transmission of the disease from the patient to other unaffected persons. Hence, community planning and housing need to be done in such a way to prevent overcrowding. Conditions, which weaken the immune system, cancers, medications to treat cancers, Human Immunodeficiency Virus (HIV), and acquired immune deficiency syndrome (AIDS), poorly controlled diabetes mellitus, increase in the chance of an exposed individual having the active disease.
Hence, efforts should be made to ensure one has good immune system through regular medical evaluation. It should be noted that tuberculosis causes the patient loss of direct income, loss of days at work, loss of play, and also the risk of stigmatisation. Therefore, prevention cannot be over emphasised.
What are the symptoms and signs of tuberculosis?
The symptoms and signs of tuberculosis depend on the affected organs. Tuberculosis of the lungs, the commonest form of the disease manifests as a combination of any of these: persistent cough, at least two to three weeks, fever of more than three weeks, unusual night sweat of three weeks or more, and weight loss. Such individuals may appear sick. Among individuals with strong background nutrition and immunity, they may appear well.
This explains why such apparently well individuals would infect so many people before they report to the hospital for evaluation. Abdominal tuberculosis may manifest as abdominal pain, loss of appetite, weight loss, constipation or diarrhoea, depending on the specific type of abdominal tuberculosis.
Tuberculosis of the spine manifests as persistent back pain, difficulty with walking, prolonged fever, or weight loss. Other parts of the body that can be affected with tuberculosis include, the genitourinary system, genitourinary tuberculosis, the covering of the central nervous system, Tuberculous meningitis and the covering of the heart, Pericardial Tuberculosis, among others.
What are the next steps after noticing symptoms?
Any individual that experiences the above listed symptoms should consult a medical doctor immediately. Proper evaluation would assess the possibility of such complaints being caused by tuberculosis. A few investigations would be requested to confirm the clinical diagnosis of tuberculosis.
Thereafter, medications are commenced. Just as in some other chronic medical conditions, a combination of medications is used in the treatment of tuberculosis. Irrespective of the type of tuberculosis infection, the medications are used for at least six months.
Directly Observed Therapy (DOT) is a public health approach in which medical personnel confirm that the patient takes the medication. Appropriate treatment ensures recovery and helps prevent further spread to other individuals. Regular follow up clinical evaluation is essential to assess if the patient is making progress.
In terms of individual differences, any other medical condition, which can impair the immunity, is also screened in the work of a patient with tuberculosis. Such conditions are also treated to achieve optimal recovery.
In addition, other close contacts of every patient with the disease should be screened to rule out the active disease in them. For those who do not have active tuberculosis, Isoniazid therapy for six months is recommended. This has been proved to prevent progression to the active stage. Close contacts of the patient are treated accordingly.
How can tuberculosis be prevented?
Beginning from birth, children, especially, in countries with a high burden of the disease, are given the Bacillus Calmette Guerin (BCG), vaccine. The vaccine helps prevent having the active disease later in life among immunised individuals, who have the active disease, severe forms of the disease, tuberculous meningitis and tuberculous pericarditis, among others.
The higher the numbers of people immunised against tuberculosis, the higher the herd immunity, which helps protect the few unimmunised individuals because the disease is rarely present in the community. Unimmunised migrants from countries, with low prevalence of the disease, who desire to visit other countries, where the disease is highly prevalent should also get immunised prior to entry. Efforts to eradicate poverty and overcrowding are social measures to prevent tuberculosis.
What are the possible treatments and management of tuberculosis?
In all kinds of tuberculosis, a combination of very potent antibiotics is recommended for at least a period of six months. In some cases, the treatment may be extended to 12 to 18 months. In abdominal tuberculosis, genitourinary tuberculosis, tuberculosis of the spine, some surgery may be done in addition to medications.