March 24, 1882 was a historic day in the medical world, a day in which the beginning to the end of the then so-called “white plague”, now known as tuberculosis. Dr Robert Koch, on this day announced the discovery of Mycobacterium Tuberculosis, the biological agent that has been found guilty of causing tuberculosis infection across the globe. The day now designates a time wherein the world is sensitized about the existence of tuberculosis, taught and educated on the health concerns with regards to Tuberculosis and the means of stopping it’s spread.
Tuberculosis commonly known as TB is an infection of the lungs caused by a bacterium called Mycobacterium Tuberculosis. It enters the lungs via inhalation of respiratory droplets containing the bacteria, which must have been gotten from an infected person. Here it grows and causes damage to the lungs (intrapulmonary TB). However, this smart bacterium does not limit its action to the lungs alone, it gains access to the blood stream where it establishes infection in other organs as the brain (extrapulmonary TB), kidney, and spine. This makes the bacteria very deadly.
In The Gambia, the mortality rate of tuberculosis infection in 2019 was 19 deaths per 100,000 people. The incidence in this period was 158 cases per 100,000. These values appear to be small or an insignificant, but doing the math in relative to the total population makes you realize that quite a number of people are dying annually from this disease in our beloved nation, The Gambia.
Modes of transmission of tuberculosis
Any means that allow or permit the entry of the Mycobacterium Tuberculosis into the lungs or respiratory tract. These include:
Inhalation of respiratory droplet containing Mycobacterium Tuberculosis when an infected person;
Coughs: people are fond of poor hygienic practices when it comes to coughing, and this leads to the occurrence of tuberculosis in many places.
Other modes of transmission include when the droplets containing TB fall on surfaces and contaminate them. When an uninfected person comes in contact with such contaminated surface or object or material and inoculates the bacteria into the respiratory tract probably because they haven’t washed their hands.
Types of tuberculosis infection
When Mycobacterium Tuberculosis enters the body, it may or may not cause the manifestations or the signs of a disease. This is dependent on the Integrity of the system that fights against the bacteria, the immune system. A potent immune system can engage the bacteria to battle, subdue the bacteria and stop or avoid the onset of signs and symptoms of the disease even if the Mycobacterium Tuberculosis is present in the body. Others times the immune system is compromised and the bacteria can defeat this system leading to the manifestations of disease through signs and symptoms. This dependence of the tuberculosis infection on the immune system’s potency causes the existence of two types of Tuberculosis Infection;
1) latent tuberculosis infection: This is the type of Tuberculosis Infection that causes no appearance of signs and symptoms of the disease even with the inoculation of the Mycobacterium Tuberculosis, however when there is immune suppression or recurrent mycobacterium infection (increase in load of mycobacterium tuberculosis), a person with latent tuberculosis may show signs and symptoms of the disease. People with such Infection are unable to transmit the Mycobacterium Tuberculosis.
2) tuberculosis disease: this is type of infection that shows signs and symptoms of the tuberculosis infection after the entry of the mycobacterium tuberculosis into the body. This usually occurs in people with a weak immune system.
Signs and symptoms
The signs and symptoms of TB infection are dependent on the organ affected, as it corresponds to damage to infected organ. These manifestations are:
∑ A bad cough greater than 3weeks of onset
∑ A chest pain
∑ Coughing up of blood or sputum
∑ Fever & chills
∑ Night sweats
∑ Weight loss
∑ Dysuria, hematuria (bloody urine) and pyuria (pus in the urine)
∑ Stiff neck as seen in meningitis.
Remember that there are no manifestations for a latent TB infection
Risk factors: These are conditions that increase the susceptibility of a person to acquire a disease. In The Gambia, the stand out risk factor for TB disease is household crowding and exposure to a known TB case. Most homes in The Gambia are overcrowded with many people living in a small space, this increases the risk of acquiring the disease. However other risk factors of TB are;
∑ Substance abuse
∑ Organ transplant
∑ Medical treatment such as use of corticosteroids
Prevention & control
∑ Protection against exposure to TB (use of face mask when talking to an infected person)
∑ BCG vaccination: TB vaccination that makes the immune system ready to fight off future TB infections.
∑ Preventive treatment, use of drugs recommended by the doctor as prophylaxis if you suspect you have been exposed to the TB infected person.
∑ Avoid overcrowding.
∑ Report suspected cases of TB according to signs and symptoms and report to the nearest health if you experience signs and symptoms.
∑ Eat fruits, vegetables, protein rich foods and perform regular exercises to boost your immune system
Correcting misconceptions of TB
Kissing, hugging and sexual intercourse does not spread TB. Shaking hands, sharing of tooth brush and using a toilet seat does not spread TB.
TB is not hereditary and cannot be transmitted from parents to children.
Sometimes all a TB patient needs is assurance that he or she is loved and cared for, this can help improve the prognosis of the disease, however stigmatization of TB patients has an incredible effect on worsening the disease prognosis and prevalence in a place because:
∑ They become stressed. Stress increases a substance called cortisol in the body, this substance then decreases the potency of the immune system leading to worsening of the disease
∑ Fear of reporting a case to the health centre due to societal treatment of TB patients may ensue, leading to the increased transmission of the disease.
The immune system not only thrives to fight against Mycobacterium tuberculosis but also fight off any foreign agent that can cause a disease therefore the strengthening of the immune system is of great benefit to our health.
Tuberculosis was once known as “the captain of all these men of death”, because of a novel describing the lethalness of TB, but now its mortality rate has been greatly reduced and recovery is very possible. With more cooperative effort we can put an end to TB infection.
Let’s prevent and control TB and also end the stigmatization of TB infected people. Together, we can drastically reduce TB infection and mortality in The Gambia, our home land.