Consistently Among the Top: “Tuberculosis”

The Philippines hit the airwaves and social media with the villainous “tanim-bala (TB).” Perhaps not many in the international community and netizens know that we are also popular with another TB – Tuberculosis. TB has remained among the top ten causes of death and morbidity in the country from the time I entered medical school in 1981, up to the time I have gone through residency training in 1990, and up to the latest Department of Health statistics on the leading causes of death and sickness in the Philippines. If Tuberculosis were a hit song, the songwriter and composer would have raked-in royalties in the tune of millions of pesos by now.

Revisiting TB

TB is caused by Mycobacterium tuberculosis. The culprit bacteria are transmitted to an otherwise healthy or un-infected person by a person with infectious pulmonary TB. It is transmitted when said bacteria is aerosolized by coughing, sneezing, or speaking. There may be as many as 3000 tuberculosis bacteria per cough. The tiny droplets dry rapidly and may remain suspended in the air for several hours. They reach their destiny and fate to destroy air passages and lungs when inhaled. Multiplication of the bacteria occurs in the lungs. Although the main focus of infection is the respiratory system or the lungs, TB may also affect the liver, kidneys, bones, skin, intestines, and the brain.

Impact of TB

The World Health Organization (WHO) said in 2009 that 5.8 million new cases of TB were reported. Of this number, 95% of cases were reported from developing countries. That includes us. WHO also reported that Tuberculosis-related deaths mostly come from disadvantaged/marginalized populations. The WHO proclaimed that TB has reemerged as an important public health problem, mainly because of international travel, immigration, and the recent exodus of refugees to developed and first-world countries.

Diagnosis, signs and symptoms, and treatment

TB is classified as pulmonary (lung infection) or extrapulmonary (outside the lungs), or both. Before the advent of HIV, 80% of new cases of TB were limited to the lungs. Now, two-thirds of patients with HIV have both TB of the lungs and other organ involvement of the bacteria. Primary infection of TB occurs to a healthy person, most and often children, who are infected by adult with TB (Postprimary or reactivation type or adult type of TB). Diagnosis is made through chest x-rays, skin (Mantoux) test, sputum microscopic examination, and sputum culture for Mycobacterium tuberculosis. Biopsy of infected organ(s) is also possible. TB presents as cough of 3 weeks, or more or less a period of one month. Fever, body weakness, back pains, and weight loss may be present. Treatment: Don’t self-medicate. See your doctor if you have a nagging cough.