The Rising Terror of TB

What is TB?

Tuberculosis is a curable and preventable disease caused by bacteria that affects the lungs of a person with low immunity. 

By Sarah Muiz
Tuberculosis, a disease caused by the bacteria commonly known as Mycobacterium Tuberculosis affects the lungs of a person with low immunity. The disease is currently on the rise countrywide due to various factors including a lack of awareness, low immunity and low nutritional levels.

Nevertheless, there is nothing to fear as long as one’s immunity is strong enough to battle the disease.The Global Tuberculosis Report 2016 released by the World Health Organization notes that there were an estimated 10.4 million new TB cases identified worldwide in 2015, of which 5.9 million were identified among the male population, 3.5 million among the female population and 1.0 million cases among children. The Report also indicates that there were an estimated 480,000 new cases of multidrug- resistant TB patients identified in 2015 and an estimated 1.4 million TB deaths recorded worldwide in the same year.   

What are the leading causes giving rise to TB?
In a candid interview with Daily Mirror, Chief Medical Officer of the Colombo Municipal Council Dr. Ruwan Wijayamuni highlighted several key features related to Tuberculosis, while underlining the factors that have led to an increase of Tuberculosis cases evident in Sri Lanka lately. “Most of us have inhaled the Mycobacterium Tuberculosis at some point in our lives. However, we will not contract the disease as long as our immunity is at an adequate level and is strong enough to fight and kill the bacteria. Comparatively, those with low or diminished immunity are vulnerable to the disease.   

The number of people with low immunity levels is gradually increasing in society due to the high prevalence of diabetes, which is steadily growing. Secondly, drug addicts drawn to drugs such as heroin and cannabis can also have a very low immunity level. People representing a marginal community from the lower economic strata are also vulnerable to Tuberculosis and various other diseases. Their immunity and nutritional levels are generally poor due to poverty. Very often, they cannot afford to consume nutritional food and medicine, thereby making their immune system more vulnerable to disease. These people, such as residents of shanties, are exposed to constant environment pollution  with little domestic facilities and very poor ventilation. These are the main reasons for the steady rise in Tuberculosis” Dr. Wijayamuni said.   

In the event a person in this environment has contracted Pulmonary Tuberculosis/ Tuberculosis of the Lungs, he or she can easily spread the disease to another. As pointed out by Dr. Wijayamuni, when Mycobacterium Tuberculosis attacks the lung tissues thereby dissolving the alveoli walls, cavities are formed within the lungs. These cavities are dense with the bacteria Mycobacterium Tuberculosis. Therefore, when a person infected with Tuberculosis coughs, millions of bacteria are released into the air and if someone in close proximity breathes this air, he or she can also contract the disease. This is generally known as Airborne Droplet Infection meaning the disease is spread through the air. The tiny droplets released into the air when coughed will contain thousands of micro bacteria. These droplets with bacteria can land in a healthy individual’s nasal cavity and find its way into the lungs. If the person’s immunity is low, the disease will thrive and conquer the lungs, causing the Tuberculosis disease.  

 
Symptoms of TB
Symptoms of TB include a prolonged cough that lasts for more than a week, perspiring during the night and loss of appetite. Occasional fever and cachectic conditions symbolizing wasting or extreme loss of weight could also reflect symptoms of Tuberculosis. In critical cases, symptoms may also include cough ensued with blood/ coughing up blood; a medical condition commonly known as ‘Haemoptysis’. This is an indication that the person is suffering from open type, Pulmonary Tuberculosis.   

There are different types of TBs including TB of the spinal cord, bones and kidney. According to Dr. Wijayamuni, this kind of TB is generally known as Extra Pulmonary Tuberculosis. In the case of Open Pulmonary Tuberculosis, the disease is open to the environment and can spread to others as well.   

Treatment
As part of the treatment process, Dr. Wijayamuini said patients are given a multi-drug treatment that should be continued until the disease is completely cured. Proper continuation of treatment is important to prevent the patient from developing drug resistance. It should be noted that Micro bacterium Tuberculosis can easily develop resistance to certain antibiotics. In Colombo, nearly ten percent of those diagnosed with the disease discontinue treatment at some point before the diseases is completely cured. Dr. Wijayamuni stressed that the TB treatment should be continued for six months until the disease is hundred percent cured.   

“A patient who discontinues treatment after a month is more like a TB terrorist because the disease can easily spread within society. In the event the treatment is taken only for a month or two and discontinued afterwards, the bacterium acquires resistance against the particular drug initially used for treatment. If an individual with weak immunity contracts the disease from such a patient, he or she will be diagnosed as a Multidrug Resistant TB patient.   

Multidrug Resistant TB patients eventually die because they are immune to the treatment that is generally prescribed for normal TB patients. This is mainly because there is no proper treatment available for drug-resistant TB patients. It should be noted that there aren’t very many drugs that can cure this particular TB type that is resistant to all other treatments available in the world. This is a very critical situation and nearly ten percent of our patients in this category have been thus named ‘Defaulters’. The defaulter rate in Colombo is nearly 9.8, while on a country’s scale, this rate is close to five percent” Dr. Wijayamuni said.   

Challenges in curtailing TB
The complexity Sri Lanka faces with regard to Tuberculosis is the difficulty in keeping track of patients’ whereabouts in order to curtail the disease from spreading further and help them continue with their treatment routinely. According to Dr. Wijayamuni, this is mainly because some patients are migrant workers from either neighboring countries or from distant parts of the country who do not stay in one place for long. Very often, such patients return to their homeland as half-treated patients hence carrying the risk of spreading Mycobacterium Tuberculosis within their community. “This is something similar to a terrorist who goes to a remote area and plants hand grenades that would result in a big explosion. This is the challenge we are currently facing in Sri Lanka with regard to Tuberculosis. TB is mainly rampant in areas within North Colombo where the living standards are generally poor such as in Mutwal, Mattakkuliya and Grandpass. This situation is also evident in areas surrounding Maligawatte. Out of the 47 municipal wards, there are four wards that have been identified as high-risk zones for Tuberculosis” he said.   “The Public Health Department of the Colombo Municipal Council in collaboration with the Ministry of Health is conducting Mobile Chest Clinics for the public and the publicity for this campaign is usually carried out in a public place of the chosen location. If anyone in the chosen location is suffering from a cough for more than one week, they will be advised to visit the Mobile Chest Clinic in the vicinity for a free medical checkup. People should be constantly reminded of the risk of contracting Tuberculosis. More importantly, if someone in the community is suffering from prolonged cough for more than ten days, people should encourage that person to seek immediate medical advice. If an individual is diagnosed with Tuberculosis, his or her immediate contacts should also go for a medical checkup as a safety measure. Tuberculosis is hundred percent curable if the disease is diagnosed early and the treatment is continued for six months properly.

Currently, we have launched house-to-house campaigns in high-risk areas to raise more awareness on Tuberculosis and on how to take necessary precautions against the disease” Dr. Wijayamuni added.