Dr. Aung Soe (a) Aung Kyaw Moe
Retired State Medical Superintendent
It sounds alarming that one-third of the entire global population is infected with Tuberculosis, a socio-economical disease. In Myanmar too T.B is a public health problem. To raise awareness among general public, World T.B. Day is held all over the world, including Myanmar on March 24 every year.
In my opinion, people should have some basic knowledge for Tuberculosis such as how it occurs, what the signs and symptoms are, how it spreads. There should also be general knowledge for TB not to be mistaken for some other similar diseases and how it is diagnosed, treated and what its possible outcome and clinical course are. Treatment, no doubt, is the task of care-givers such as doctors, nurses, laboratory technicians, assisted by social health workers, DOTS care providers and the family members.
– T.B is Airborne droplet transmission of Mycobacterium tuberculosis bacillus
– Organisms replicate within the alveoli
– The emergence of multidrug-resistant organisms is primarily due to failure to complete the required long courses of therapy
– Some positive PPDs are due to previous inoculation with BCG vaccine
– Most cases of active disease involve reactivation of a previous infection
– As such patient should live a healthy life style with proper rest, nutritious diet, suitable physical exercise, including playing Chin-Lon, avoidance of tobacco and excess liquor.
Tuberculosis should not be mistaken for –
– Bacterial pneumonia
– Lung cancer
– Congestive Heart Failure
– Fungal infection
– Lung abscess
One should be alart for such warning signs as –
– Night sweats
– Weight loss
– Pleuritic chest pain
– Dyspnea is uncommon
– Pleural effusion
– Extrapulmonary involvement: Lymph nodes, bones, joints, genitourinary, CNS, abdomen, pericardium, pleura; symptoms of organ dysfunction may be present.
As mentioned above, one-third of the world’s population is infected; fewer have active disease Groups who require screening PPDs: HIV, close contacts of active TB cases. IV drug users, DM, silicosis, immunosuppression, cancer cases. ESRD, health care workers, low-income and immigrant groups.
To diagnose TB:–
• Chest X-ray
– Primary TB: Lower lung infiltrates; adenopathy
– Latent TB: Nodules and fibrosis in upper lung
– Reactivation TB: Upper lung infiltrates, cavitation
– Miliary TB: Disseminated small nodules
– Gohn complex: Granuloma with bacilli in center plus calcified lymph node
• Sputum (need three samples): Shows acid-fast bacilli
• Tuberculin skin test (PPD): Most common screening test
– 15 mm of induration is positive if no risk factors
– 10 mm of induration is positive for patients at risk
– 5 mm is positive for patients with HIV, recent exposure, or suggestive CXR
• HIV testing should be done in all new TB patients
• Biopsy (node, liver, or bone marrow) to confirm diagnosis in extrapulmonary TB
Regarding Prognosis and Clinical Course:–
• Primary TB: Usually asymptomatic or a self-limited; noninfectious; leads to latent TB
• Active TB: Clinical symptoms; positive sputum, or CXR consistent with TB; 65% 5-year mortality if untreated; easily curable
• Latent TB infection: Positive PPD but no clinical, CXR, or culture proof of active infection; TB may reactivate when the immune system is weakened
• Disseminated TB: Inadequate host defenses (i.e., HIV) allow systemic spread (diffuse, multiple, small nodes of infection) with multiorgan symptoms
• 90% of cases remain latent; never become active
• Treatment cures more than > 95 per cent
• Report cases to public health authorities
• Respiratory isolation
• There are multipleguide lines of treatment with slight differences.
• Active TB: Isoniazid (INH) and rifampin (Rif) for 6 months plus pyrazinamide (PZA) for 2 months
– Add ethambutol in areas of INH resistance (most of the US) pending culture
– Multidrug-resistant TB is known
• Extrapulmonary TB: Same treatment as active TB
• Latent TB should be treated due to possibility of active transformation–especially in high-risk groups
– INH for 9 months or Rif for 4 months
– Rif/PZA for 2 months (caution in liver disease)
– Treat latent infection unless previously treated
• BCG vaccine is unreliable–disregard previous BCG exposure in evaluation of patients
Although treatment is mainly concerned with National Tuberculosis Program, Ministry of Health, co-operated with INGOs; NGOs, in the form of Public Private Partnership (PPP). Community participation is the key and all community members should be aware of this public health problem and socio-economic hazard.