In Africa, Nigeria is the most populous country. So also is Nigeria the number one country with people living with tuberculosis, the acronym is TB. And in Nigeria, because of its dense population as a megacity, Lagos State has the highest number of tuberculosis cases. Despite these high numbers, tuberculosis is not discussed in everyday conversation.
In this write up; we have simplified the information on TB for ease of understanding by the reader. The message is that TB should be taken seriously and should become part of the health dialogue and conversations.
TB can come to light in 2 ways:
- First by the screening of a person without symptoms of TB for immigration or employment purposes (Domestic or health workers).
- The second way TB comes to light is the diagnosis of a person presenting with symptoms that suggest tuberculosis.
People emigrating outside of Nigeria are often asked to be screened for tuberculosis before their travel visa will be issued.
This screening takes the form of a PPD or Tuberculin skin test or Quantiferon gold blood test, if positive; a Chest x-ray (CXR) is obtained.
People who have had BCG vaccine, may or may not have a reaction to the tuberculin skin test and so the blood test, Quantiferon gold may be preferred for screening.
If the Quantiferon gold test is positive, while the Chest x-ray is normal, the person is diagnosed with latent tuberculosis infection (LTBI).
This means exposure to TB has occurred but the person has not yet developed any symptoms. A decision for prophylactic treatment may be recommended using Isoniazid and pyridoxine for 9 months or alternative shorter treatments depending on the severity of tuberculin skin test and consideration for other risk factors.
If on screening, the person has evidence of TB then treatment is recommended with 3 or 4 antimycobacterial agents typically in TB clinics that provide daily treatment as daily observed treatment (DOT).
The second way to find TB is by screening a person who presents with a cough of 2 weeks duration. The person could have chest pain, coughing up sputum or phlegm, weight loss, night sweats, coughing up blood, enlarged or infected lymph nodes, fever, abdominal swelling, internal heat, weakness, or chronic headaches.
Testing for TB is done by collecting sputum (phlegm) sample and testing using gene Xpert machine. This is a new test that gives the result of TB testing in just 2 hours as well as testing for Multi-Drug resistant TB (MDR-TB).
MDR-TB is TB that is resistant to both isoniazid (INH) and Rifampicin. In such a case, different medication is required for treatment.
The more serious resistant TB is called drug-resistant TB (XDR-TB). This is difficult to treat.
TB is caused by a bacteria called mycobacterium tuberculosis. This is an airborne infection spread by air droplets from a cough or sneeze of someone with Active TB. To prevent the spread of TB, people with active TB should wear a mask. People who cough or sneeze should use a tissue or paper napkin to cover their mouth.
TB is common in overcrowded spaces without cross ventilation. Household contacts of a person with TB should be screened for TB.
What TB can do
TB is airborne, it first affects the lungs, then it spreads to other organs. TB usually affects the lungs where it eats up the lung tissue. If untreated a person with TB will die from the destruction of the lungs.
TB can spread outside of the lungs to the abdomen, kidney, brain, lymph nodes, spine (Pott’s disease, causing hunchback), joints, and heart
People with HIV/AIDS have a higher risk of TB because their immune system is weakened. Therefore, they should be monitored closely for signs of TB.
TB can be reduced by giving BCG at birth. However, BCG vaccine should not be given to babies who have HIV.
TB can present with a cough that has lasted more than 2 weeks. Early check-up and treatment at a TB center will reduce the complications of TB.
We can see that TB is not a condition to play with. Therefore we must all take responsibility to seek care for any of the above-mentioned symptoms especially a cough that has lasted for 2 weeks if you live in an area with a high prevalence of TB. Please go to your nearest TB control clinic for free testing.
The good news is that TB is curable and treatable!
Written by Dr. Ngozi Onuoha.