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Compliance to the treatment can cure Tuberculosis

Tuberculosis or TB is an infection caused by a bacteria. Globally, Pakistan ranks fifth as far as the burden of TB is concerned. In this interview, Dr Amer Saleem, a pulmonologist at Milton Keynes University Hospital England talks about causes, symptoms, treatment and prevention of this disease

SN: What is Tuberculosis (TB)?sni

Tuberculosis is an infection caused by a bacteria called Mycobacterium tuberculosis. This disease generally affects the lungs but can spread to lymph nodes, bones, brain, eyes, kidneys, liver and genitourinary organs through the blood stream. If not treated on time, it can be fatal. Moreover, we come across drug resistant cases in areas like Pakistan, which can be difficult to treat.sni

Globally, Pakistan ranks fifth as far as the burden of TB is concerned. In 2018, around 5,65,000 people developed TB here and about 80 percent of them had TB of the lungs. The actual figure can be higher due to the number of unregistered patients.sni

SN: Which other regions of the world is it common?sni

TB is one of the top 10 causes of death and number one cause of death by a single infectious agent worldwide. Its incidence is higher in South-East Asia. In 2019, 44 percent of the world’s new TB cases were diagnosed there.sni

SN: Is it a genetic disease?sni

No, it is an infection. Some individuals have genes to protect them against TB. Whereas some genetic illnesses can increase its risk.sni

SN: What is the difference between active and latent TB?sni

Patients with active TB show symptoms of the disease. While those who remain healthy and do not show any sign, have latent TB which is not infectious.sni

When a patient suffering from active TB of the lung coughs, sneezes or spits; tiny droplets are expelled into the air. These can enter the lungs and infect them in

SN: Who is more prone to this disease?sni

Those living with active TB patients, healthcare workers, individuals using immunosuppressants or suffering from HIV infection or any disease that can weaken body’s immunity are at risk. Smokers, homeless and malnourished individuals are also susceptible to this disease. Those living in overcrowded areas with reduced access to medical facilities are in danger too. Death rate due to TB is high among smokers. Therefore, smoking cessation is strongly recommended. Furthermore, in HIV patients latent TB can become active due to weakened immunity.sni

SN: In which age group is it more prevalent?sni

Anyone can contract this infection. However, normally people under the age of 12 and above the age of 70 are less affected by it.sni

SN: What are the common symptoms of this disease?sni

Some patients are asymptomatic and others have minor signs. Symptoms also differ depending on the site of infection. Most common signs are dry cough, difficulty breathing, cough with blood or mucus, chest pain, night sweats, weight loss, stunted growth, fatigue, malaise and gradual onset of fever (usually low grade) which rises in the evenings or at night. Some develop anorexia too.sni

SN: Can this infection spread from clothes and utensils?sni

It spreads through the air. When a patient suffering from active TB of the lung coughs, sneezes or spits; tiny droplets are expelled into the air. These can remain in the environment for eight or more hours based on air circulation. When inhaled they can enter the lungs and infect them. Two weeks of treatment can reduce the risk of transmission, provided the bacteria is not resistant. It does not spread from clothes, using same utensils or even shaking hands.sni

Some patients are asymptomatic and others have minor signs. Symptoms also differ depending on the site of infection

SN: How can it disturb a patient’s life?sni

TB being considered a stigma in our societies causes psychological concerns in the patients. Majority of which are related to social and cultural values of the areas they live in. Also leads to permanent disabilities in patients with TB of joints, bone, spine and brain.sni

SN: What are its complications?sni

Complications usually occur due to delay in seeking medical help, weak immunity, bacteria showing resistance to medicines and non-compliance to treatment. Depending on the part of the body involved in infection it can cause blindness, brain abscess, epileptic fits, weakness, joint destruction, intestinal obstruction and infertility. Contrastingly, TB of lungs can lead to coughing up of blood, damage to breathing tubes, cavities in lungs, chest pain, fluid accumulation in chest cavity and empyema (pus between tissue layers that protect and cushion the lungs).sni

SN: Can having comorbid diseases complicate things?sni

Yes, they significantly change the course of the disease. Any disease or medicine that weakens immune system can make the diagnosis and treatment difficult. Comorbidities related with high mortality rates are HIV infection, diabetes, chronic liver diseases (hepatitis or alcohol related), kidney failure, cancers and malnourishment.sni

SN: Can TB increase the chances of lung cancer?sni

Lung cancer can sometimes develop in old TB scars. But relation among them is complex as smoking is one of the common risk factors of this disease.sni

It is a curable disease. If bacteria are not resistant to medicines, it can be treated successfully with tablets

SN: Is TB curable? Can patients return to their routine work?sni

It is a curable disease. If bacteria are not resistant to medicines, it can be treated successfully with tablets. Combination of antibiotics are usually given in two stages for six months. This duration can sometimes exceed. As far as routine is concerned everyone responds differently to the treatment. Normally patients recover completely and are able to carry out routine activities.sni

SN: Can the disease reoccur?sni

Yes, it is a major problem in countries like Pakistan with high disease burden. International statistics show that chances of recurrence are high in the first three years of treatment.sni

SN: How important is it for an individual to complete the treatment?sni

It is a critical component in curing the disease. Besides it reduces the risk of drug resistant strains, complications, relapse and transmission of disease.sni

SN: How often are follow ups required after treatment?sni

After successful completion of treatment, patients do not need regular examinations. However, they should monitor their symptoms. Seek immediate help if you notice any sign or unusual change.sni

Anti-TB medications are antibiotics and mostly well tolerated. However, they do have side effects which include nausea, skin rashes, vomiting and diarrhea 

 SN: Are there any side effects of the treatment?sni

Anti-TB medications are antibiotics and mostly well tolerated. However, they do have side effects which include nausea, skin rashes, vomiting, diarrhea, abnormalities in liver functioning, low white blood cells and platelet count. They can also cause jaundice. Some medicines temporarily give reddish-orange discoloration to body secretions and fluids. Others can cause vision problems, nerve and kidney issues, high uric acid levels, reduced appetite, malaise, photosensitivity, hepatitis and joint pain.sni

SN: Does a patient need hospitalization during treatment?sni

Majority do not need hospitalization. But those who need continuous monitoring, have developed drug resistant TB or major medication side effects need hospitalization.sni

 SN: When does a patient become non-infectious?sni

If TB bacteria is not resistant to medication, then after 14 to 18 days of treatment the patient becomes non-infectious.sni

SN: Which vaccine is available for TB?sni

BCG vaccine is used against TB. It does not prevent a person from contracting the disease but can help avoid serious complications. It is given as one dose in left upper arm usually at 28 days of birth. However, in UK and some other countries healthcare workers aged 16 and above are at times given this shot too. It can leave behind a permanent scar. It is not offered during pregnancy. Individuals who are immunosuppressed should also avoid it.sni

Social media can raise voice about symptoms of active TB, factors limiting the spread of infection and stress on importance of seeking timely medical help

SN: Is there enough awareness regarding this disease among people?sni

About one third of the world’s population is currently infected with it. Roughly 10 percent has active disease and 90 percent has latent which can turn into active. WHO has designed “Stop TB Strategy” to raise awareness worldwide. “National TB Program” also aims to achieve a TB free Pakistan. But we still need to reinforce the message. We should continue our efforts in creating awareness on available forums for better prevention, treatment and control of the disease.sni

SN: What role can media play in creating awareness?sni

Media campaigns can change public perception, knowledge and behavior towards an issue. Social media can raise voice about symptoms of active TB, factors limiting the spread of infection and stress on importance of seeking timely medical help. Public awareness material and programs in local languages should be available too.sni

SN: How can it be prevented?sni

Vaccination at the time of birth in endemic areas, contact tracing and screening, access to sufficient healthcare facilities at primary level and availability of information on the subject can help prevent the disease.sni

SN: How can infected individuals protect their family and friends?sni

They should observe hygienic practices while coughing and sneezing, wear mask inside the house and avoid going to gatherings. Their rooms must be properly ventilated to prevent droplet infection.sni

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