Organised by the World Health Organization, the aim of World Tuberculosis Day is to raise public awareness about "the burden of tuberculosis worldwide". March 24, World TB Day, commemorates the day in 1882 when German physician Dr Robert Koch announced that he had found the cause of tuberculosis. At the time of the announcement, TB was killing one out of every seven people in Europe and the Americas.
"--- a dread disease, in which the struggle between soul and body is so gradual, quiet, and solemn, and the result so sure, that day by day, and grain by grain, the mortal part wastes and withers away, --- a disease which medicine never cured," [Nicholas Nickleby (1839) XLIX,]
This is how Charles Dickens describes the dreaded disease 'consumption' as tuberculosis (TB) was then known, named such to describe how the illness 'consumed' its victims. From the dawn of humanity, tuberculosis was a major killer. Hippocrates is said to have advised his students not to treat a patient who had sickened with the disease because it was inevitable that they would die. TB was responsible for 20% of the deaths in 17th century London and 30% of those in 19th century Paris. In Lisbon, 19th century travel guides describe the ancient Alfama quarter as being gloomy, dirty and overcrowded, with many cases of tuberculosis due to the unhealthy living conditions. Tuberculosis was not limited to a specific socio economic group. It affected all sectors of society. The 19th century English artist John Keats died of TB as did the Bronte sisters, George Orwell, Frederic Chopin, Anton Chekhov, Amedeo Modigliani, Franz Kafka amongst millions of others.
Tuberculosis transmission & symptoms
Tuberculosis is a bacterial infection that usually affects the lungs. According to WHO, it usually develops in poor countries where people live in crowded and unhygienic conditions.
When an infected person coughs, sneezes, spits or even talks, tiny droplets are propelled into the air. Infection occurs when a healthy person inhales these miniscule droplets. Often the immune system will protect the person from the bacteria, so prolonged contact with an infected person is usually needed for infection to occur.
TB outbreak in Italy
The following study, brought by the CDC's (Centers for Disease Control and Prevention) 'Emerging Infectious Diseases Journal' describes a recent outbreak of TB in Milan Italy which according to the evidence, spread because of prolonged contact with an infected person.
In November 2010, a 7 year old boy in Milan was diagnosed with TB. The contact investigation carried out by the local health authorities revealed that the boy’s family and friends were all free of infection but 20% of the students in his classroom and 20% and 14% of students in 2 other classrooms were diagnosed with Latent TB.
A month later, TB was confirmed in a secondary school pupil who had attended the same primary school as the 7 year old boy. Health authorities extended testing to all children who had attended the school during 2010. A total of 173 pupils were found to have Latent TB.
In February 2011, another case of TB was reported in a 17-year-old boy who was in the fifth year of primary school with younger children because of disabilities. He had been in the primary school for 3 years. The collected data suggest that this boy was the index case-patient for this outbreak: 90.9% of his classmates were infected, and a relevant ratio of TB infection was found among pupils of the other classrooms on the same floor.
The results of this investigation indicated that delay in diagnosing TB for the index case patient was the main cause for the transmission of the infection inside the school. The principal reason for this delay was the low degree of diagnostic suspicion toward the disease. As a result of this study experts have recommended that physicians should be aware of the signs and symptoms of early TB infection and should consider the diagnosis accordingly.
The symptoms of tuberculosis commonly include:
- A persistent cough which may progress to coughing up blood. This may last weeks or months.
- Sweating at night
- Loss of appetite
- Fatigue and tiredness
- Unexplained weight loss
- Chest pains or painful breathing
Tuberculosis is not limited to the lungs. There is TB of the central nervous system, gastrointestinal TB, skeletal TB, lymph node TB and others.
Most people who get infected with the TB bacteria develop what is known as latent TB, meaning that although the bacteria is alive in the body, it is inactive and the infection cannot be spread. Some of the infected will go on to develop active TB.
Normal antibiotics cannot cure TB. It has to be treated by taking different antibiotics for long periods of time, usually every day for about six months. The accepted treatment for tuberculosis is a combination of four antibiotics for two months and then two antibiotics for another four months. It is crucial that the patient completes the course of antibiotics to avoid the development of multi drug resistant tuberculosis.
Multi drug resistant tuberculosis
Multi drug resistant tuberculosis (MDR) is a growing problem that according to the WHO "threatens progress made in TB care and control worldwide". The WHO reports on worldwide TB trends reflect that there is race going on between deadly strains of this ancient killer disease and new drugs. MDR is the result of inappropriate or incorrect TB drug use that has enabled the TB bacteria to develop resistance to the most effective anti TB antibiotics and to relay the resistance to its offspring, thereby creating an antibiotic resistant strain of the illness. According to WHO figures for 2012, about 3.7% of new TB cases have an MDR strain of the illness. This percentage rises to 20% of patients who have been previously treated for the illness. In the UK for example, 431 TB cases did not respond to antibiotic treatment in 2011, compared to 342 in 2010. Most of the victims were foreign migrants with a weak immune system as a result of HIV or people with a history of TB.
A killer from the past?
Far from being a disease from the past, according to the WHO, TB is second only to HIV/Aids as the greatest killer worldwide. In 2011 8.7 million people fell ill with TB and 1.4 million died of the illness. In the UK, 8963 cases of TB were reported in 2011, with London accounting for the highest proportion of cases. 74% of those diagnosed with TB in the UK were born abroad, with 59% being born in South Asia and 24% in sub-Saharan Africa.
According to the Health Protection Agency, the majority of UK TB cases were likely to result from the reactivation of latent TB infection in people born outside the UK.
Parts of the world that have a high incidence of TB include:
- Sub-Saharan Africa
- Southeast Asia
- Russia and parts of Eastern Europe
- South America
- Vietnam, Cambodia and other countries in the region.
With the increasing popularity of holidaying in distant and exotic destinations it is now, more crucial than ever to consult a travel health specialist regarding immunization, especially for children. If you are staying in a quality hotel, your risk of infection should be minimal if however you might have prolonged contact with people who could be infected, make sure that your immune system remains healthy and know how to recognise the signs and symptoms of the disease. Experts agree that early detection is extremely important and as pointed out above, a full course of treatment is vital to prevent the development of MDR.