The Road to Better Health

Dr. Cynthia de la Cruz

MEDICAL FACTS: Tuberculosis

Tuberculosis infection is the 6th leading cause of death and illness in the Philippines with majority of cases between ages 15 - 54 years old. The Philippines is 9th on the world list with high cases of this infection. Tuberculosis remains a major cause of morbidity throughout the world because of persistent overcrowding, antimicrobial resistance, and immunodeficiency states such as AIDS.

Recently, USAID LINC (Linking Initiatives and Networking to Control Tuberculosis Project, a program of USAID in support of the Phil DOH TB Control Initiatives (TB LINC) is updating/ training government, private doctors and allied health professionals with the aim of reducing TB prevalence and mortality . TB LINC promotes utilization of DOTS (Directly Observe Treatment Short Course) in 17 provinces and three cities in the country. In the nine provinces not covered by TB LINC, Health Government implements the USAID-assisted TB programs, in particular advocacy support for TB contro.

What is tuberculosis? Tuberculosis (TB) is an infection caused by Mycobacterium Tuberculosis, an anaerobic acid-fast bacillus. Spread of infection is through aerosolized sputum as in coughing and sneezing. Because children usually do not have productive coughs, infections in children typically arise after exposure to an adult with active disease.

Clinical Manifestations. Whereas adults commonly experience a chronic cough, fever, night sweats, and unexplained fever and weight loss, children with TB typically are asymptomatic. Other children may show failure to grow aside from weight loss and chronic cough. On examination these affected children will have enlarged non tender lymph node on neck, fluid on one side of the chest on x-ray. Some cases may present as deformity on bones. Others may have signs of meningitis and others may have abdominal swelling.

Recent recommended approach by WHO in the diagnosis of TB in Children are:

1. Careful history (including history of TB contact and symptoms consistent with TB
2. Clinical examination (including growth assessment)
3. Tuberculin skin testing (or interferon-gamma release assay)
4. Bacteriologic evaluation

Investigations relevant for suspected pulmonary TB and suspected extra-pulmonary TB

Prevention. All children should be skin tested for TB (1) prior to receiving measles-mumps- rubella vaccine, (2) at school entry, and (3) in adolescence. Children who live in areas with a high prevalence of TB should be skin tested more frequently, perhaps as often as every 1-2 yr. Children who have been exposed to persons with TB should be skin tested soon after the time exposure. Children should avoid close contact with untreated person. Infected persons at home should be treated soon.

Treatment relies on long term use of antituberculous agents: Isoniazid, Rifampicin, and Pyrazinamide and or Ethambutol. Please visit your health providers who will give you instructions on proper dosage, timing and duration of intake on those anti tuberculosis medications./TE