By: Samuel Pimping
Tuberculosis (TB) remains prevalent among the marginalized, impoverished, and vulnerable communities despite being preventable and curable today. March 24, World Tuberculosis Day, commemorates the moment when the TB bacterium was discovered in 1882.
Tuberculosis in Numbers
Global statistics in 2021 indicate that 10.6 million people contracted TB, and 1.6 million (around 15%) died of it—an astonishing fact considering medical advancements, accessibility to antibiotics, and the ancient status of this centuries-old disease. It is still considered one of the world’s most lethal, infectious illnesses, taking almost 4,400 lives per day and revealing healthcare inequities as a consequence.
Majority of cases are concentrated in Southeast Asia (45%) and Africa (23%). The Philippines accounts for almost one million or 7% of cases worldwide, ranking fourth among the countries with the highest incidence rates of TB. International campaigns are being undertaken to eradicate the disease and mobilize the commitment of member states. Unfortunately, the additional burden placed on healthcare due to the COVID-19 pandemic led to a 4.5% relapse in the declining number of cases, disrupting years of progress and effort as services that manage TB were made unavailable for extended periods.
The most problematic aspect of TB is its extreme infectiousness. The reduced number of diagnostic reports further implies that more individuals have been left undiagnosed and hence untreated. This is the crux of the matter as it highly aggravates community transmission especially in dense populations. Incidence rates in terms of demographics demonstrate that adult males and females comprise 56.5% and 32.5% of cases, respectively.
How treatable is TB, exactly? Around 85% of individuals with the disease can be cured with a four-to-six–month regimen of antibiotics. The length of time for treatment and required medication poses a financial hurdle for the impoverished, and this is why universal healthcare is essential in addressing the socioeconomic inequities that impede the elimination of TB.
A Typical Case of Tuberculosis
In Japan during 2012, a 76-year-old woman complained of a persistent cough, phlegm, and week-long fever. No other family member in her residence had been diagnosed with TB at the time. Despite the absence of HIV and having no history of TB herself, she was diagnosed with active Mycobacterium tuberculosis. The specific strain was discovered to have originated from Manila, and this raised concerns as she had never traveled to the Philippines before. She was hospitalized for almost two weeks afterward.
It was found that her son had resided in the Philippines three years before staying at his mother’s home for days in 2011. While in Manila, he had been diagnosed with TB and received treatment until he tested negative for the illness. TB is an airborne disease commonly spread from person to person through coughing, sneezing, and talking, and the residue itself can still potentially infect individuals because the germs typically survive and remain suspended in the air for several hours. A smear test is a common
way of detecting TB in which the subject’s phlegm sample is smeared onto a glass panel and examined under a microscope to check for the presence of bacteria associated with TB.
Though he had already tested negative by the time he went home, he inadvertently infected his mother despite having shown absolutely no symptoms for many years. This illustrates the highly infectious and cloaked nature of TB as a silent killer. A person can contract the disease and hold it in their body for long periods of time without any complications. Such is called latent TB infection, a status which becomes active once the patient begins to show symptoms.
In this case, the subject probably had latent TB for several months until she started to feel its effects in 2012. Observations indicate that it likely became active because of her steroid therapy for asthma—making her more susceptible to suffering the symptoms of active TB. The incident highlighted the rapid spread of Manila-type TB and the elevated chance that patients diagnosed with active TB are actually experiencing the effects of old infections that had been left unchecked.
The Signs, Risk Factors, and Treatment of Tuberculosis
TB is a contagious lung infection that may remain dormant for a long time. Therefore, anyone with active TB most likely became infected at some point in the past (though some subjects show symptoms shortly after contracting the affliction). Patients who already overcame active TB might still have to endure a recurrence or reactivation in the future.
Older adults, infants, and those with compromised immune systems are at greater risk of active TB. In most cases, the latter includes individuals infected with HIV, people with inadequate nutrition, those taking medication for pre-existing lung issues, and patients who have undergone chemotherapy.
As for the external risk factors, these include residing in an unsanitary, densely populated environment, being exposed to drug-resistant TB strains, and simply being around people infected with the disease regardless if they show symptoms or not. Societal indicators such as homelessness are also relevant in the sense that an impoverished environment has less access to proper healthcare without government
support.
There are three stages to infection: primary, latent, and active. In primary infection, the immune system fights the bacteria within the body and little to no complications are experienced. Flu-like symptoms may manifest themselves such as coughing, feeling exhausted, and experiencing a low fever. The latent stage occurs once the infection is contained. In this stage, some germs survive, but they cannot cause further harm as long as the immune system successfully controls them.
Should the immune system be unable to keep the disease in check, the active stage begins while more advanced symptoms start to manifest such as bloody urination and coughs, chest pain, fatigue, fevers, and malaise. Pulmonary TB is isolated to the lungs, but the disease can progress to extrapulmonary TB by spreading to various body parts including, but not limited to, the kidneys, liver, heart, bones, and larynx. Pain near the site of infection is common in these cases.
Treatment generally demands controlled doses of antibiotics for around four to six months as prescribed by one’s doctor. Immediate consultation is needed should extreme complications such as labored breathing, chest pain, and blood expulsion occur.
Tuberculosis in the Philippines and Drug-Resistance
According to a study about social determinants of TB in the country, almost one million Filipinos have active TB and approximately 70 of them die every day from complications. Societal inequities are considered primary determinants as practically ten million of the urban poor reside in slums with dense, unsanitary conditions. Plus, the lack of education and awareness further increases the challenges in addressing TB. In an attempt to mitigate the spread, initiatives have been launched such as scaled-up screening for vulnerable communities. However, this proved insufficient because the measures are confined to detection. Social protection and healthcare accessibility for the marginalized must be instituted to execute a holistic approach in managing the disease.
Drug resistance can be caused by mismanaged partial treatment, inappropriate or substandard drugs, and the transmission of more durable strains. Typical medication becomes ineffective against these variants, and treatment costs skyrocket as they can pose more extreme complications such as hepatitis, kidney damage, depression, and even psychosis. Given the dangers, the spread of these drug-resistant strains would have a catastrophic effect in disrupting lives.
TB is a correctable problem that can potentially morph into a societal crisis if left unmanaged. In this light, the participation, intervention, and political commitment of all nations is necessary as it protects the very interests of humanity in the long run.
Whether developed or undeveloped, every nation’s collaborative effort is the only way to finally and fully eradicate this deadly, ancient disease.
