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Script 32.3

Notes to broadcasters

The following additional information about tuberculosis was sent to us by Dr. Helen Gordon, Toronto, Canada.

Background on tuberculosis

Tuberculosis is an infectious disease caused by a special category of bacteria called mycobacteria. The other disease caused by a mycobacterium is leprosy. These mycobacteria can attack humans as an acute and rapidly progressing disease or as a chronic, very slowly developing disease that progresses over a number of years.

M. tuberculosis comes in three types human, bovine, and avian. Therefore humans can become infected in three ways. Avian TB is most frequently spread by birds of the parrot family. People inhale dried feces, or eat food contaminated by the infected birds. Bovine TB has become rare where most milk is pasteurized, but it is still common where milk is not treated and there are cows with the infection. Bovine TB affects the digestive tract in humans as well as frequently causing TB of the bone. Finally the most common form of TB is the human TB usually spread by inhalation of infected droplets from an infected person, or by eating or drinking infected material.

So the most common form of TB is caused by the human form. It usually affects the lungs, and is called the “terrible chest”. It is most serious, possibly lethal, in persons who are in poor health, who are undernourished and who lack adequate shelter. It is also more serious in people who have no immunity to the disease, such as infants, young children, and young people with other health problems. Many adults have been exposed to the disease and have developed a sort of immunity. I will explain about this immunity later as it is different from the type of immunity that the body develops to childhood diseases, where one attack makes a person immune for life.

In the natural progression of the disease in humans, the bacillus enters the lungs and implants there, usually near the pleura or chest wall part of the lung. It causes an area of infection there with the exuding of fluid. Then the centre of this area dissolves and liquifies the lung tissue in it. This is called caseation. At the same time the irritant fluid and some of the bacillus are carried by the lymphatic system (the body’s scavenger system) to lymph nodes in the centre of the chest and these nodes enlarge a little. In many people the disease is arrested at this stage and the caseated area and the lymph nodes heal by forming a scar which later becomes hard. These healed scars show on an X ray and are evidence that the person has been exposed and has overcome the infection.

In some cases the body defences are not able to stop the infection, and the infected area continues to dissolve lung tissue and produce cavities in the lung. If a cavity erodes into a bronchus then the person develops a cough with infected sputum and often blood. This person is then highly infectious. They are also increasingly sick and in danger of dying unless treated.

Symptoms

There are frequently no symptoms in the primary phase. The body deals with the bacillus and nothing shows to indicate it except that an X ray may show a shadow in the future. (Often there is no shadow until after the scarring phase has been completed.) In this phase, small children may have a flu like illness with a mild fever, fatigue, and loss of weight and appetite. This phase lasts two to three weeks. During that time the child may seem quite happy and normal at times. As the child overcomes the infection, the appetite and weight return and the fever goes. The child has then recovered.

Symptoms of progressing disease start gradually and considerable time may pass before the person feels ill. The most common symptoms are fatigue, loss of appetite and weight, and a recurring low fever especially at night. This fever accounts for the night sweats so often associated with the early stages of the disease. A cough is a relatively late symptom. It occurs only after the infected area in the lung has eroded into a bronchus and the irritating secretions and blood are in the bronchus. A lesion that is only in the lung tissue does not cause a cough.

The first recognized symptom is often coughing up some blood. Of course, as the disease progresses and lung tissue is destroyed, people become short of breath and the amount of sputum increases. Sometimes the lesion at the chest wall portion of the lung may cause irritation of the lining over the lung. In that case the person may develop chest pain associated with breathing. This is called pleuritic pain and may be the first indication that something is wrong.

Preventing the spread of TB depends on an active public health program combined with mass chest X rays and TB testing. Early diagnosis and treatment usually cures the disease.

Treatment is prolonged, and it is essential that it be continued until the person is healed. This is usually 18 to 24 months. For that reason, TB patients are often kept under the daily supervision of a doctor or clinic. Any patient with open TB, whether it is of the lungs or any other area, should be isolated from the rest of the community as much as possible until the treatment has made them non infective.

There is disagreement about how much protection the vaccine BCG actually gives. Some think that it changes the TB test from negative to positive in the way an allergy test shows a sensitivity to a substance. But the BCG vaccine can be helpful for children. It gives children a safe, mild infection. It does not make them completely immune but it can help them handle exposure without producing a rapidly advancing infection.

Script

In China they call the disease the “terrible chest”. Doctors call it tuberculosis, or TB for short. By any name, it is a killer.

Tuberculosis is an infection, which means that a germ, in this case the TB germ, invades your body and makes you sick. The germ is too small to see with your eye, but even though it is small it is as powerful as a lightning bolt. That’s because it multiplies inside you and makes you ill.

Without treatment, tuberculosis can kill you. Usually we think of TB as a breathing disease, because we get the germs for TB by breathing them in. But TB isn’t that simple. For one thing, many people who breathe in the TB germs manage to fight them off. That means, the germs get in the lungs but the body isolates them so they can’t cause disease. They just sit there, as if they were asleep.

Unfortunately, TB germs don’t always just sit there. Many times they become active, and you get sick. This sickness is usually in the chest, because that’s how the TB germs got into your body in the first place. When TB becomes active in the lungs, it grows and you cough until you have trouble breathing. But TB can travel beyond your lungs and become active in other parts of your body, including the bone, or the kidneys and other organs. Wherever it occurs, the effect is the same. You run a chronic fever, you lose weight and you become weaker and weaker. Tuberculosis is a terrible problem, especially because it spreads so easily. It moves around through water droplets too small to see.

That means people who show symptoms of the disease spread the germ simply by coughing in the presence of other people. And as they get sicker, and have to cough and spit all the time, they spread the germ even more. And you catch it when you breathe in.

How do you know if someone has tuberculosis?
Here are things to look for, although not everyone who has TB will have all the symptoms on the list:

  1. A cough that won’t go away, especially after waking, and sometimes what is coughed up has blood in it
  2. A mild fever in the afternoon and sweating at night
  3. No appetite for food
  4. Weight loss and weakness
  5. Pain in the chest or upper back that doesn’t go away
  6. Shortness of breath

There is a vaccination called “BCG” available against tuberculosis. Get your doctor’s advice about vaccination. It is important to have children vaccinated to protect them against tuberculosis.

Older people, and people with AIDS, are more likely to get sick if they carry the tuberculosis germ.

If someone in your house has active tuberculosis, there are several things you can do:

  1. Have the children vaccinated against TB.
  2. Make sure everyone, especially the children, eats nutritious food.
  3. If possible, have the whole family tested for TB.
  4. Arrange for the person with TB to eat and sleep separately from the children until the person with TB has no cough at all and is getting correct treatment. The person with TB should not prepare food or care for babies until free from infection.
  5. Alert a health worker so the sick person can start getting the right medicine.
  6. Make sure the person with TB covers their mouth when coughing and does not spit on the floor. Have the sick person spit into tissues, and then burn the tissues. You could also have them spit into a container of disinfectant.
  7. Take children to a health centre at the first sign of TB or if their cough lasts more than two weeks.

Remember that good food and fresh air are the best healers we have and can make people resistant to infection.

In China they have a saying about tuberculosis. They say, “Ten get it, nine die.” But do people with TB have to die? No. That is the good news. There are cures for TB. The trouble is, they are not simple cures. It takes several medicines working together over many months before people with tuberculosis feel better, and even then they are not cured. They must continue taking all of their medicine until the health worker says the TB is completely gone. If not, the TB will come back, but the medicine won’t work any more. Curing tuberculosis takes months.

Chances are you will be cured of tuberculosis if you do these things.
Act quickly. Get in touch with the health worker as soon as you recognize the symptoms, and keep taking your medicine. If you keep taking it even when you start feeling better there’s a good chance you will be cured.

That means you won’t die of tuberculosis. And there is a wonderful bonus. When you had active TB, you couldn’t help spreading it when you coughed or even talked. When you are cured, you are no longer spreading it. That means, you are no longer a danger to your spouse, your children, your parents. You have not only acted to help yourself, you have acted to protect your family.

It is vital that we cure TB in everyone who has it, even people who are dying of another disease. Some people may question that. Why waste good medicine on people who are dying? Even if you are not hard hearted, you may wonder at precious medicine going to someone who can’t live long enough to enjoy a cure.

But there is an answer to that. Because even though these people are dying, they are still breathing, they are still coughing, they are still spitting. And every time they cough, and every time they spit, they are spreading the TB germ.

Curing them has two benefits. It eases their pain, so they may die a more peaceful death, which is only right and proper. And it protects you and me from exposure to more tuberculosis. It may someday be possible to wipe out TB entirely. In the meantime, we have to work toward that day. We can do that by acting quickly when we recognize the symptoms of TB the cough, the fever, the weight loss, and weakness and by taking the right medicine for as long as the health worker says, and by vaccinating children the day they are born, or as soon as possible.

Acknowledgements

  • This script was prepared by Katie Gillmor Ellis, Toronto, Canada.
  • Thank you to our medical advisors Dr. Elizabeth Hillman, Dr. Helen Gordon and Catherine Fergusson, R.N., for reviewing this script.

Information Sources

  • “Communities can challenge tuberculosis”, World Neighbors in Action Newsletter, Volume 13, Number 4E, published by World Neighbors, International Headquarters, 5116 North Portland Avenue, Oklahoma City, Oklahoma 73112, U.S.A.
  • “TB: A global emergency” in World Health, No. 4, July August 1993, published by World Health Organization, CH 1211 Geneva 27, Switzerland.
  • Where there is no doctor, (1992, 446 pages) by David Werner, published by the Hesperian Foundation, P.O. Box 1692, Palo Alto, California 94302, U.S.A.