Stop TB! By Datuk Dr Hj ABDUL RAZAK MUTTALIF World TB Day on March 24 reminds us to be ever vigilant against this ¡®hardy¡¯ disease. EVERY year, March 24 is celebrated as World TB Day. This is the date the germ causing tuberculosis was announced to the world by Dr. Robert Koch, in Berlin, Germany. To this day, the tuberculosis (TB) infection remains with us, and in Malaysia, the numbers affected by TB is growing, with new TB cases in Malaysia having reached 20,000 last year. There were about 1,600 deaths last year due to this infection. Though the TB germ was identified by Dr. Robert Koch in 1882, there was no treatment available until 1944, when the first antibiotic was discovered by Dr. Selman Walksman. (One antibiotic is not enough to kill the TB germ completely.) Over the next 20 years, more effective antibiotics were discovered, while the early 70s saw the introduction of the six-month treatment regimen for TB (18 months previously). This regimen consisted of four antibiotics given together for two months, and another four months of two antibiotics. The introduction of this treatment regimen resulted in the effective control of TB. The situation improved even further after the advent of a vaccine for TB ¨C the BCG vaccine (Bacilli Calmette and Guerine). In the mid-80s, a new infection emerged, the Human Immunodeficiency Virus, or the HIV infection. This infection became fuel for the TB infection. TB numbers which were well controlled became more frequent, and with the dual infection, there were more problems with the use of TB drugs and HIV drugs. Patients developed more severe side effects as they had to take more pills for the dual infections. Fortunately, the situation has improved, with better drugs and more compliance to drug-taking instructions. Symptoms There are also other reasons why TB is still not well controlled in Malaysia. One of the most important reasons, I feel, is the poor knowledge of the public regarding this infection. In the Institute of Respiratory Medicine and many other hospitals in Malaysia, patients come to seek treatment very late. These patients will be having the classical symptoms of TB, such as: Prolonged cough (more than two weeks) Loss of weight and loss of appetite Night sweats Coughing out blood (though not a common symptom) These symptoms are usually ignored and treated as a normal flu. However, the longer the patient is not treated with TB drugs, the worse the lung damage and the incessant coughing may spread the germs to others in his/her house or workplace. TB is an airborne disease; it spreads via the air infected by the bacilli, just like a common flu virus. For this reason, TB has to be diagnosed early and treated effectively. The most efficient way to diagnose a TB infection is by examining sputum through microscopy or doing a culture of the sputum. Doing an X-ray of the chest is also helpful as an investigation for anyone who has prolonged cough. TB and diabetes Some patients are more prone to get the TB infection, like the HIV infected person, or diabetic patients. I have done several studies in Malaysia; all these studies show that about 15% to 20% of TB patients have diabetes. The poorer the diabetes is controlled, the higher the chance of getting TB, and the worse the infection. It is thus very important for patients with diabetes to seek early medical advice in the event of any chronic or prolonged cough. Higher risk groups New studies have also showed that smokers are at a higher risk of getting infected by this germ. As smokers already have damaged lungs, they are not as capable of fighting the germs when they enter the lungs, compared to a healthy non-smoker, who can fight off these infections easily. There are several other people who are at higher risk of getting TB infections, apart from those mentioned above, like those on prolonged oral steroids, chronic kidney failure, patients on chemotherapy, the very young and the very old. There is also some concern of immigrants bringing in the TB infection to our country. The statistics over the past few years show that only about 10 to 15 % of the total TB infection in Malaysia is due to immigrants. Though this is a significant percentage, about 85% of TB is still in the local population. The Malaysian government has taken several steps to look at this issue of TB in immigrants. They are usually screened for infectious diseases at entry, and if found not fit, they will be sent back to their country of origin. Treatment As mentioned earlier, treatment of TB is a combination of at least three or four antibiotics, taken for about six months. Due to this long duration, a number of patients do not take their medications as instructed. As a result, drug-resistant TB ¨C called multi-drug resistant TB (MDRTB) ¨C has emerged. This form of TB is very difficult to treat, and the cost of treatment can be a hundred times more expensive, and more toxic. To prevent this from happening, it is advised that all patients take their medications at the nearest clinic, or someone responsible for them must observe them taking these medications at home, if they are not mobile. This is called directly observed treatment (DOT). This will ensure that treatment is adhered to and completed to prevent the emergence of MDRTB. In Malaysia, the incidence of this form of TB is still very low. With all these issues, World TB Day 2012 has an interesting theme ¨C ¡°Stop TB in my lifetime¡±. With this theme, today¡¯s children should expect to see a world where no one gets sick with TB, and women and men should expect to see a world where no one dies from TB. A curable disease TB is a curable disease, and it can be easily diagnosed in most cases. With the development of newer diagnostic tools, faster and more accurate diagnosis can be made. TB is not only a medical doctor¡¯s problem; it is a problem of society and the country. Every single person in Malaysia can play an important role in fighting this century-old infection. If you know of anyone with prolonged cough, loss of weight, loss of appetite and night sweats, please advise them to seek immediate medical advice. Normal antibiotics will not kill the TB germs; however with faster diagnosis, effective TB drugs will surely cure the infection. - Datuk Dr Hj Abdul Razak Muttalif is director of the Institute of Respiratory Medicine in Kuala Lumpur.
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