Despite the advances in the treatment of tuberculosis, patient compliance remains an issue.
IN most cases, tuberculosis will first present itself as a cough and cold episode inflicting an otherwise healthy person. There is not even a strong fever with a high temperature, although coughs are persistent, along with night sweating as the person sleeps.
It is cause for concern if symptoms continue for the second week, and if there is no improvement by the third week, doctors should check for TB, says Dr Loo Chee Yean from Sri Kota Medical Centre in Klang.
“If the patient is undiagnosed and untreated after one month, there’s a chance the TB bacteria has affected the lungs,” says Dr Loo, who is a nephrology and internal medicine specialist. “The patient will cough up blood, which is when they become concerned and come to see us.”
Like most diseases, the faster it is diagnosed the higher the chances of recovery. But even those who worry about their health may end up worsening the condition through some unsubstantiated notion.
“Instead of a follow-up, they go to a different clinic thinking the first clinic is no good because they didn’t get better,” says Dr Loo. “But the new clinic doesn’t have their medical history and the new medicine will not cure TB.”
Diagnosis is quite simple, adds Dr Loo. When two weeks have passed with no improvement on the cough, the doctor should order a chest X-ray. Signs of TB infection in the lungs will show up in the x-ray, and there may be follow-up tests on skin, sputum or blood to confirm the diagnosis.
COUGH ETIQUETTE
But how does one get infected with TB in the first place?
The easiest explanation is that they get it from an infected person. TB bacteria are released into the air through tiny droplets from coughs and sneezes – hence the importance of covering one’s mouth when coughing and sneezing – and the infection risk is higher when there is inadequate ventilation.
But some people may develop TB disease because of a latent TB infection. Dr Loo explains: “All of us may have the TB bacteria without knowing it. Perhaps we came in contact with a person with active TB but the exposure was small and we had a strong immune system, so it didn’t affect us.
“For many years the TB bacteria lay dormant. But when our immune system weakened, we became affected by the bacteria. We didn’t even need to be exposed again to a TB infection to develop the disease.”
In either case, people with a compromised immune system will need to take care. This includes people with diabetes who don’t have the disease under control, people with HIV, and those on long-term steroid medication.
That said, Malaysians are vaccinated against TB through BCG injections at birth. “This leaves a scar and if you don’t have it, you probably need to check,” says Dr Loo. “The vaccination keeps our TB rate low and incidents will be higher without it.
“So while there are TB cases, there’re no large outbreaks. In people who are vaccinated but still get the disease, it is probably due to the amount of TB they’re exposed to,” he explains, adding that he’s worried about irresponsible parents who don’t vaccinate their children due to their misguided beliefs on vaccines.
MEDS FOR SIX MONTHS
People with TB disease will need to take a cocktail of antibiotics, which nowadays, comes in the form of a single pill. But they will need to take it every day for six months.
Says Dr Loo, “TB is a slow-going bacteria so you need multiple antibiotics to attack it and stop it from becoming resistant. But the current treatment is effective with a 90 per cent response rate, and patients can see massive improvements after the first week.
“There’s no need to stay in hospital for long and patients can go home in a week or two when they are no longer infectious. But the challenge is compliance, where the patient feels better and they stop taking the meds.”
Dr Loo mentions a programme in government hospitals where nurses observe the patient taking their meds. Follow-up appointments with the doctor are also important to ensure treatment is going according to plan.
“When a TB patient goes home, they need to understand the disease so they don’t endanger other people. They must learn to dispose of their sputum properly, and cover their mouth and nose when sneezing or coughing,” says Dr Loo.
Patients who lapse and do not complete treatment will require a different medication when they get sick again because the bacteria is now resistant. It is much harder to treat and the response rate is lower at 40 per cent. These patients more dangerous to people, and the meds are more expensive too.
“After recovery, TB-affected lungs will form scars. No new lung tissue will develop,” says Dr Loo. “This is called lung fibrosis and patients with a lot of scarring will feel the difference. But from my experience, patients who are treated quickly and are compliant will not suffer much lung damage.”