Dr. Mary Jean Loreche-Diao
( First of Two Parts )
Tuberculosis is one illness that may take years to eradicate.
Despite a lot of information dissemination, active education campaigns by experts and health authorities, TB , instead of losing ground in terms of number of cases, seem to stay in the spotlight. Worse, is the apparent increase of cases who are now afflicted with MDR TB ( Multi- Drug Resistant TB ). There was a time when Health In Focus discussed the problems encountered with Drug Resistant micro-organisms, how it would impact on treatment, cost, and prognosis. MDR TB is one classic example of a major public health concern.
Tuberculosis is caused by a bacillus, Mycobacterium tuberculosis, and is transmitted through air droplets. One can actually get the disease by breathing in air that contains particles of the micro-organisms that were released through coughing or sneezing, and is highly contagious. One though does not get the disease from holding or shaking of hands, sharing of food and water and even bed linens. There are instances when, even if one were already exposed to the illness, one may not manifest the signs and symptoms of active TB. This is what we may call as dormant stage of the disease.
It is when one’s immune system is down and out that the disease may become manifest or active. Those at high risk for TB are persons who are frequently in close contact with infected individuals like the health care providers, those who are under or malnourished. Persons living in crowded areas like inmates of prisons, families who crowd together in small spaces where sanitary conditions are far from ideal, and patients who are immune-compromised like those diagnosed with the big C and are undergoing chemotherapeutic treatment and persons diagnosed with HIV AIDS.
What is of utmost concern these days is not the usual , run of the mill Tuberculosis, but, the TB that is either drug resistant to multiple anti- tuberculous drugs or the extensively drug resistant TB ( XDR TB ). When one gets an MDR or XDR TB, the micro-organism do not respond to the standard 6 months treatment to the first line drugs. Treatment may take 2 years and will need the addition or combination of drugs that are more toxic ( meaning with more side effects ) and are a hundred times more expensive. Thus, treatment becomes very costly! With MDR TB, the mortality rate approaches 80%. And, with a global concern regarding the rising number of cases of HIV AIDS, MDR TB , one way or the other, is a factor that needs to be addressed, as it will further complicate matters in terms of prognosis, treatment and cost.
Who are at an increased risk of developing an MDR TB? Those patients who take their drugs, after diagnosis, irregularly or who fail to complete the treatment regimen. It is common practice among us, that, when one feels better after a few days’ intake, that the temptation to quit is so strong, not realizing that it will do more harm than good. Patients who develop Tuberculosis again, even after treatment, and those exposed to persons with MDR TB, and if one lives in a place that is endemic for MDR TB.
To be continued…..