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Tuberculosis

Tuberculosis (TB) is an infectious disease that most commonly affects the lungs and is caused by a bacteria known as Mycobacterium tuberculosis. Still, it can also affect other body parts such as guts, bones, lymph nodes, brain, and kidneys.

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Signs and Symptoms of TB

It is crucial to educate ourselves regarding the common symptoms of TB to catch and cure it as early as possible. The common symptoms of TB include,

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Chronic cough/

coughing out of blood

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Weight loss

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Chest pain

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Night sweats

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Fatigue

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Fever

The symptoms of TB depend on the site of infection. For instance, one with bone TB might have severe back pain and difficulty moving, while the other with gut TB might present with abdominal pain.

How does TB spread?

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TB can spread through the air when people with the bacteria in their throat cough, sneeze, sing, or spit, which means TB is airborne. It can also affect people from all age groups, making TB even more intimidating, but remember, TB is curable and preventable.


On the other hand, TB is not spread through hand-shaking, sharing food or drink, sharing toothbrushes, kissing, contact with bed linens or toilet seats, et cetera.

The Global and Local Landscape of TB

According to the Global Tuberculosis Report 2022, it is estimated that 10.6 million people will be ill with TB in 2021, with the highest incidence in South-East Asia (45%). Locally in Malaysia, our Health Minister, Dr. Zaliha, said that Malaysia recorded 25,391 TB cases in 2022, a 17% increase compared to 2021.

Diagnosis, treatment, and prevention of TB

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Diagnosis: 

Mantoux tuberculin skin test (TST)

Most commonly, people with TB infection could be detected by the Mantoux tuberculin skin test (TST), in which a small amount of fluid called tuberculin will be injected into the lower arm's skin. 2-3 days after the injections, that person needs to return to where he/she received the injection to check for the reaction, to be more specific, the size of the swelling (but NOT the redness) around the injection site.

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Other than TST, the World Health Organization (WHO) also recommends rapid molecular diagnostic tests, which confirm TB's presence by detecting bacterial genetic material.

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Treatment:

Antibiotics

Since tuberculosis is a bacterial infection, it is treated with antibiotics. Normally, four different antibiotics (isoniazid, rifampin, pyrazinamide, ethambutol) are given to be taken daily for 4 to 6 months.

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Prevention: 

TB vaccination

The only effective TB vaccine is the Bacillus Calmette-Guérin (BCG) vaccine. It is also part of the immunization schedule in Malaysia in which infants will be given a dose of BCG at birth and later at 7 years of age (Sabah) or 12 years of age (other states). However, the primary benefit of the BCG vaccine is protecting against early childhood deaths caused by TB. Essentially, BCG has minimal effects in preventing transmission of TB. It may also cause a false positive TST.

Myth debunking: How have you misunderstood TB?

Myth 1:
The most prominent feature of someone with TB is coughing

Fact 1:

False. You can have TB without a cough, especially if you have TB in your bone, or a latent TB.

Myth 2:
TB must be spread through coughing

Fact 2:

False. TB can still be spread if the infected person does not cough. The prerequisite for TB transmission is the presence of the bacteria in the throat and lungs, but not the act of coughing itself. Hence, singing, sneezing, or even talking to those with active TB in the throat or lungs will transmit the bacteria to its next victim. People with latent TB are not infectious.

Myth 3:
TB has ended and walked into history; there are no more new TB cases nowadays

Fact 3:

False. As mentioned above, TB still poses a serious public health threat to mankind, with 1.6 million people dying from TB and 10.6 million with TB infection worldwide in 2021. Interestingly, International Union Against Tuberculosis and Lung Disease proposed three possible grounds for that, first, near-elimination of TB in certain countries, including Northern and Western Europe, North America; second, the introduction of effective TB treatment; and third, underdiagnosis and underreporting due to stigma.

In a nutshell, tuberculosis is not a story that is unimaginably far away from us. It is still a big concern, especially in the impoverished and underprivileged marginal populations. Hence, it requires everyone’s understanding and effort collectively to make Malaysia a safer and healthier place to live to end TB in Malaysia under the WHO End TB Strategy goals.

Written by:
Oh Hui Xin
2nd-year Medical Student
Faculty of Medicine, National University of Malaysia (UKM)

Reviewed by: 
Prof. Dr. Shamsul Azhar Shah
Department of Public Health Medicine
Faculty of Medicine, National University of Malaysia (UKM)

Reference:

  1. https://www.cdc.gov/tb/topic/basics/default.htm#:~:text=The%20bacteria%20usually%20attack%20the,kidney%2C%20spine%2C%20and%20brain. 

  2. https://www.cdc.gov/tb/topic/basics/howtbspreads.htm

  3. https://my.clevelandclinic.org/-/scassets/images/org/health/articles/11301-tuberculosis

  4. https://www.webmd.com/lung/what-is-skeletal-tuberculosis

  5. https://emedicine.medscape.com/article/376015-overview#:~:text=Clinical%20features%20of%20intestinal%20TB,in%20the%20right%20iliac%20fossa. 

  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6688829/#:~:text=Coughing%20does%20not%20appear%20to%20be%20a%20necessary%20prerequisite%20for%20TB%20transmission.  

  7. https://theunion.org/news/myths-misconceptions-and-half-truths-about-tb

  8. Global tuberculosis report 2022. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO.

  9. https://www.nhs.uk/conditions/tuberculosis-tb/  

  10. https://www.who.int/news-room/fact-sheets/detail/tuberculosis  

  11. https://www.cdc.gov/tb/publications/factsheets/general/tb.htm#:~:text=What%20is%20TB%3F,they%20do%20not%20get%20treatment.  

  12. https://www.thestar.com.my/news/nation/2023/03/24/tb-cases-in-malaysia-up-by-17-last-year-says-health-minister#:~:text=The%20Health%20Minister%20said%20Malaysia,63.5%20cases%20per%20100%2C000%20people).

  13. https://ckbirlahospitals.com/cmri/blog/common-myths-and-facts-about-tuberculosis 

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