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					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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posted:4/12/2012
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