Tuberculosis, a double tragedy for community and patient

Each day at least 4,000 people lose their lives to tuberculosis. The World Health Organization places the principal burden on poor communities or those vulnerable and marginalised. However, no one is safe as TB spreads faster in crowded environments such as those in urban areas. Nathan Mugume, the head of communication at Rwanda Biomedical Center, says cough that lasts more than two weeks could be a sign of tuberculosis. “The coughing usually starts slowly but once it lasts more than two weeks, there is immediate need for medical checkup because it might actually be tuberculosis,” he says. But what is tuberculosis any way? Tuberculosis is spread by acid fast bacillus called mycobacterium tuberculosis. Once an infection occurs, the disease may take up two forms, which is the active disease or the latent infection. The most common form of active TB is lung disease or pulmonary tuberculosis, but if the bacteria invade other organs then it is extra pulmonary TB. In the active form, bacteria rapidly multiply and invade different organs of the body with typical symptoms such as cough, phlegm, chest pain, weakness, weight loss, fever, chills and sweating at night. On the other hand, miliary TB, a rare form of the active type that is rapidly fatal, occurs when TB bacteria find their way into the bloodstream and quickly spreads all over the body in tiny nodules to affect multiple organs at once. Unlike the active type, those infected with latent TB do not develop obvious disease. In addition, they rarely develop symptoms and their chest x-ray may be normal. The only manifestation of this encounter may be reaction to the tuberculin skin test or interferon-gamma release assay (IGRA) test. Tuberculosis is dangerous because a person with active pulmonary TB disease may spread TB to others through transmission of infectious particles coughed into the air. Dr Albert Ndata, a general practitioner in Kigali, explains that delaying treatment of tuberculosis only increases risks of spreading the disease to close friends and family members. “We all know that tuberculosis is highly infectious and in my practice as a doctor, the biggest problem I have witnessed is that people contract this infection but delay diagnosis. This makes the treatment process very difficult or worse generates other complications,” says Dr Ndata. Multi drug resistant tuberculosis (MDRTB) On initial treatment, tuberculosis is responsive to drugs but since treatment involves the use of a multi drug regime for long period of time, non-adherence to medication is common in patients. This, according to Dr Ndata, is responsible for the increase in cases of MDR TB. “Treatment is different with tuberculosis; remember you will be given a combination of drugs. Once some people start feeling well, they will stop the medication which has contributed to the increased resistance in TB cases,” he adds. According to the WHO, MDR TB requires a totally different drug combination to deal with the resistant bacteria making MDR TB a major problem globally. In 2014, an estimated 480,000 people developed the disease. Why resurgence after treatment is common Tuberculosis ranks alongside HIV/AIDS among the world’s top infectious killer diseases. Even after complete treatment, reoccurrence of the infection is a higher possibility especially in people whose immune systems are weakened by infections. In 2014, 9.6 million people fell ill with TB and 1.5 million died from the disease, including 380 000 among people living with HIV. An estimated 1 million children became ill with TB and 140 000 children succumbed to the disease the same year. Dr Ndata observes that tuberculosis resurgence is common among people with fragile immune systems. “Pregnant women, children and those infected with diseases such as HIV have high chances of reinfection even after complete treatment. That is the reason HIV patients are encouraged to always check for their TB status on visiting the hospital,” he says. Role of communities At least 6,000 TB cases were registered in Rwanda in 2013, and out of 100,000 patients 10 people die of TB, according to the 2013 World Health Organisation report. Prevention of TB therefore calls for both early treatment to reduce transmission and isolation of the infected persons until the level of infection is no longer contagious. However, most people believe that this is a role the public has to play right from the grassroots. Jean d’Amour Manirafasha, the director of health services in Rulindo District, explains that treatment of tuberculosis requires the involvement of every member at the community since everyone is at risk. “In a public place, you cannot know who has tuberculosis but at least sharing health information on how to deal with all infections is very important since TB itself affects individuals whose immune systems have been weakened, people should ensure that once signs are detected, medical attention is sought immediately,” says Manirafasha. A medic performing sputum smear test microscopy, the procedure is necessary in identifying acid fast bacilli that transmit tuberculosis. (Solomon Asaba) He also advises that after seeking appropriate diagnosis and treatment, individuals should adhere to practices which ensure completion of prescribed drug regimens. “It is very dangerous to take prescriptions half way, even when you feel a bit better. Treatments for tuberculosis should be taken up to the last dosage as recommended by the health professionals,” he adds. Also most people don’t complete the course of tuberculosis treatment because of the side effects that come at the inception of the treatment. However, Dr Ndata is fast to advise that this reasoning is bad since all drugs have side effects. “All drugs have side effects. Once diagnosed with tuberculosis, it is only safer that the course is completed,” he adds. Treatment fro children lasts six months, while that of adults takes eight months. In Rwanda, treatment for TB is free in public hospitals. While there has been significant progress in the fight against TB, with 43 million lives saved since 2000, the infection is still a threat to human kind. Experts therefore advise that early treatment and adherence to medication is crucial. There is also seemingly inconclusive evidence that since unhygienic foods such as fish spread zoonotic tuberculosis, cleanliness is vital during preparation. Coping and support Treatment for tuberculosis is a complicated and lengthy process. But the only way to cure the disease is to stick with your treatment. You may find it helpful to have your medication given by a nurse or other health care professional so that you don’t have to remember to take it on your own. In addition, try to maintain your normal activities and hobbies and stay connected with family and friends. Keep in mind that your physical health can affect your mental health. Denial, anger and frustration are normal when you must deal with something difficult and unexpected. At times, you may need more tools to deal with these or other emotions. Professionals, such as therapists or behavioral psychologists, can help you develop positive coping strategies. Prevention If you test positive for latent TB infection, your doctor may advise you to take medications to reduce your risk of developing active tuberculosis. The only type of tuberculosis that is contagious is the active variety, when it affects the lungs. So if you can prevent your latent tuberculosis from becoming active, you won’t transmit tuberculosis to anyone else. Protect family and friends If you have active TB, keep your germs to yourself. It generally takes a few weeks of treatment with TB medications before you’re not contagious anymore. Follow these tips to help keep your friends and family from getting sick: - Stay home. Don’t go to work or school or sleep in a room with other people during the first few weeks of treatment for active tuberculosis. - Ventilate the room. Tuberculosis germs spread more easily in small closed spaces where air doesn’t move. If it’s not too cold outdoors, open the windows and use a fan to blow indoor air outside. - Cover your mouth. Use a tissue to cover your mouth anytime you laugh, sneeze or cough. Put the dirty tissue in a bag, seal it and throw it away. - Wear a mask. Wearing a surgical mask when you’re around other people during the first three weeks of treatment may help lessen the risk of transmission. Finish your entire course of medication This is the most important step you can take to protect yourself and others from tuberculosis. When you stop treatment early or skip doses, TB bacteria have a chance to develop mutations that allow them to survive the most potent TB drugs. The resulting drug-resistant strains are much more deadly and difficult to treat. Vaccinations In countries where tuberculosis is more common, infants often are vaccinated with bacillus Calmette-Guerin (BCG) vaccine because it can prevent severe tuberculosis in children. The BCG vaccine isn’t recommended for general use in the United States because it isn’t very effective in adults. Dozens of new TB vaccines are in various stages of development and testing. Agencies