by Work the World

Clinical Features

Most of us will only really have come into contact with tuberculosis during school vaccination programmes. It may be a surprise to find out that this only really protects against the childhood form of the disease and that many people are still diagnosed across the Western world each year.

But while for us it is just a case of a trip to the doctor and a round of antibiotics, in Africa and Asia it is a bit more complicated. Each year, an estimated eight million to 10 million people contract the disease and two to three million people die from it. 80% of these are from sub-saharan Africa and Asia.

The TB alert website comments "TB has been on the rise since the 1980s, with its spread concentrated in Southeast Asia and sub-Saharan Africa. Much of TB's resurgence is directly connected to the HIV/AIDS pandemic - especially in Africa, where two-thirds of those living with HIV also carry TB."

Disease profile

WHO define it as: "Tuberculosis, or TB, is an infectious bacterial disease caused by Mycobacterium tuberculosis, which most commonly affects the lungs. It is transmitted from person to person via droplets from the throat and lungs of people with the active respiratory disease".

The most common symptoms of pulmonary tuberculosis are a cough with profuse amounts of phlegm. Blood can often be coughed up (the classic sign you always see on films as heroes and heroines produce blood splattered hankies!), fever, weight loss, night sweats and a loss of appetite.

A lack of education means that even in hospitals staff are not aware of how contagious the disease is - and if they are not clued up, how will patients ever be?

Who does it affect?

Tuberculosis is an infectious disease and is passed from one person to another by bacteria in airborne droplets. These are produced as bacteria and coughed into the air by a patient just like the common cold. It can affect anyone who comes into contact with the bacteria, but is more prevalent in Africa and Asia because it is more likely to affect people whose immune systems are already weakened. Malnutrition - as we discussed recently - is often the trigger for other diseases, and TB is a real threat when already suffering from food deprivation. It also poses a massive threat to those who have HIV -  25% of HIV deaths are attributed to TB as the two diseases seem to speed each other up.

Another problem is disease control. A lack of education means that even in hospitals staff are not aware of how contagious the disease is - and if they are not clued up, how will patients ever be?

In 2010, the largest number of new TB cases occurred in Asia, accounting for 60% of new cases globally. However, Sub-Saharan Africa carried the greatest proportion of new cases per population with over 270 cases per 100,000 population in 2010.

Treatment

In almost every case TB can be cured without a stay in hospital - just a combination course of antibiotics. The problem in many developing countries is that the disease is now becoming resistant to drugs. This is largely because of incomplete treatment, either because the drugs were not prescribed or not taken correctly or because treatment was interrupted. A lot of this is to do with educating both patients and staff about the importance of completing the full course.

Once treatment has started, people normally become non-infectious after about two weeks and begin to feel better after two to four weeks, but at least six months treatment is required to cure the disease. In some cases it can take a couple of years of treatment.

Recent stories in the news

Groundbreaking trials were reported in the Telegraph,  using a cocktail of three drugs - one not actually licensed for use yet - to tackle TB. The result was amazing - 99% of patient's bacteria was killed after a fortnight of treatment. It was more complicated for HIV patients, with drug combinations needing to be slightly different because of HIV medication, but it's a good start.

What experience have our students gained?

"We saw numerous patients that had HIV, tuberculosis and malaria, conditions that are not common in Australia. There were also patients with advanced disease due to late presentation, disease states that I had read about in textbooks but not seen with my own eyes.  This exposure, in conjunction with further experience in managing more common conditions such as hypertension and diabetes, was very beneficial."
Hugh Le Lievre, Australian medical student.

"There were, however, some more unusual cases that I would not be likely to observe in the UK, such as Pott’s disease (tuberculosis of the spine)"
Sian Henderson, physiotherapy student.

"I was able to be more hands-on as I progressed through the placement however, and was involved in many interesting cases, including malaria and tuberculosis in pregnancy" Kelly Silk, midwifery student.

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