health talk:with Dr Johannes Marisa
I get troubled when I see patients dying of Tuberculosis, a disease that is treated for free in our country. Tuberculosis, commonly known as TB, is one of the top 10 causes of death worldwide. Last year in 2018, WHO estimated that 10 million people fell ill with TB and1,5 million died from the disease, majority of whom are from Africa, south of the Sahara Desert. Over the last five years, the number of TB cases detected annually in Zimbabwe has ranged between
40 000 and 50 000. A lot of other cases are not diagnosed till death.
TB is a potentially serious infectious disease that mainly affects your lungs. The bacteria that cause TB are spread from one person to another through tiny droplets released into the air via coughs and sneezes. Bacterium is usually Mycobacterium Tuberculosis although Mycobacterium Bovis, Avium Intracellulae used to be implicated in some cases. Other than the lungs, TB can affect the spine, joints, lymph nodes, brain, the liver, kidneys, heart or even the skin.
Although your body can harbour bacteria that cause TB, your immune system can protect you from sickness. It is thus imperative that a distinction is made between:
lLatent TB — Here there is TB infection but bacteria remain in your body in an inactive state and cause no symptoms. Latent TB is not contagious but can turn into active TB.
lActive TB — This makes you sick and in most cases can spread to others. It can occur in the first few weeks after infection with TB bacteria or might occur years later.
Therefore, signs and symptoms of active TB include:
lChronic cough (usually lasts 3 or more weeks)
lCoughing up blood
lDrenching night sweats
lUnintentional weight loss
lChest pains with breathing or coughing
lLoss of appetite
*NB Do not prescribe for yourself cough mixtures if such symptoms are present, instead, visit your doctor. We do not want to lose lives! Please note that TB can affect any part of the body and some symptoms can appear depending on what is affected. One can have TB Spine, TB Meningitis, TB Adenitis, TB of the Kidneys, TB of the Heart etc.
A healthy immune system often successfully fights TB bacteria. However, there are some conditions that predispose one to TB infection. It is unfortunate that about 30% of all HIV-related deaths come from TB alone. Lately in Africa, more than 80% of all TB cases have been linked to HIV/AIDS meaning less than 20% of all those who have TB are HIV negative.
Other immune suppressants that predispose to TB are:
lCancer treatment such as chemotherapy
lMalnutrition like Kwashiorkor, Marasmus
lThe very young ages or advanced ages
lSevere kidney disease
lDrugs to prevent rejection of transplanted organs
lDiagnosis comes from a combination of physical examination and tests. Examination finds such things as enlarged lymph nodes (mutochera) in such areas as the arm pits or the neck. Wasting of the body will be noted associated with a troublesome fever
lSputum tests — Usually three bottles are given to patients to put sputum inside so that TB bacteria can be looked for. This analysis is done by laboratory scientists. However, about 40% of TB bacteria can be missed from the sputum, giving a false negative answer. This is a serious cause for concern for some clinics and hospitals that have denied some patients treatment basing on sputum results. Clinical correlation should be done. Some council hospitals in Harare have been rejecting patients referred by doctors with obvious clinical TB and evident X-Rays citing sputum negativity.
lGenexpert test — This is a molecular TB test, which detects the presence of TB bacteria in the sputum, as well as testing for resistance to Rifampicin. This technology was launched in 2004.
lX-rays — Chest X-rays can show consolidation, cavitation or effusion which ought to be clinically correlated with symptoms. Please encourage your patients to go for X-rays.
lBiopsy — Masses or lumps can be removed for histology
Prevention and Treatment
Prevent contracting TB by observing some of the following:
lGet early HIV screening and treatment
lGet routine screening at high risk work places like mines
lStay in well-ventilated houses
lFinish your entire course of TB treatment to avoid a relapse
lBe sure your child is immunised at birth by getting Bacille Calmette Guerin (BCG).
Treatment is a minimum of six months where combination tablets are taken. It is sad to note that 25% of those who are started on TB treatment do not finish treatment because they feel it is not necessary. This has contributed to Drug resistant TB or Multi-Drug resistant TB. Even if you have improved to whatever level, please finish your course. The following drugs are used for TB treatment:
Please take as prescribed. Check for side effects of the drugs and visit your doctor for correction.
Till we meet again next week!
lJohannes Marisa is a private practitioner, who can be accessed on firstname.lastname@example.org.