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.
