Three years ago, Marianne received an e-mail from her mother. She was petitioned of going to the United States.
The 32-year-old single teacher from Davao City was ecstatic to hear the news. After all, she had been dreaming of going to the land of milk and honey.
Unfortunately, it has been more than a year now but her visa application is still pending. She wondered why. It all started when, after having a medical check-up, she was found to have pulmonary tuberculosis (TB).
Like in other parts of the country, TB cases remain a health issue in the city. “TB is the number six leading cause of death in the Philippines, with 73 Filipinos dying everyday of it,” wrote Dr. Willie T. Ong in his column, ‘Mind Your Body.’
Aside from writing, he is an active consultant in cardiology at the Manila Doctors Hospital and Makati Medical Center.
“As another result of this high infection rate, visa applications are delayed for more than fifteen percent of Filipinos applying to immigrate to the United States,” says the US Embassy in Manila. “(TB) is the number one medical-related refusal for immigrant visa applicants.”
TB infection is transmitted almost entirely by the aerial route. “When an infected individual coughs, sneezes, or spits, infectious particles are released into the air,” writes Dr. Maya Santos in her column which appeared in Vital Signs. “Anyone who inhales these particles is at risk of contracting TB.
Transmission is enhanced in overcrowded and poorly ventilated places.” This is the reason why TB is more prevalent among those living in squatter communities and correctional institutions.
A less common route of TB transmission is through the skin. Pathologists and laboratory technicians who handle TB specimens may contract the disease through skin wounds.
TB has also been reported in people who have received tattoos and people who have been circumcised.
A person may become infected with TB bacteria and not develop the disease. His or her immune system may destroy the bacteria completely. In fact, only 5-10 percent of those infected with TB actually become sick.
The four most familiar signs of TB, according to health experts, are chronic cough, mild fever in the afternoon and sweating at night, chest and back pain, and progressive weight loss. In more serious or advanced cases, the symptoms are spitting blood, pale and waxy skin, and a hoarse voice.
The disease can occur in two stages: primary and secondary. “In primary TB,” explains Maria Luisa Padilla in Encarta Encyclopedia Padilla, “a person has become infected with the TB bacteria but often is not aware of it, since this stage of the disease does not produce noticeable symptoms.
Macrophages, immune cells that detect and destroy foreign matter, ingest the TB bacteria and transport them to the lymph nodes where they may be destroyed or inhibited.”
TB is not contagious in the early stage. “About three weeks after initial infection," Padilla continues, “bacteria may be inhibited, destroyed, or allowed to multiply. If the bacteria multiply, active primary TB will develop.”
Symptoms of carriers include coughing, night sweats, weight loss, and fever. A chest X-ray may show shadows or fluid collection between the lung and its lining.
At the primary stage of TB, the disease does not progress, but bacterial may remain dormant in the body for many years. If the immune system becomes weakened, the tubercle opens, releasing the bacteria, and the infection may develop into active disease, known as secondary TB.
In the secondary TB, the formerly dormant bacteria multiply and destroy tissue in the lungs. They also may spread to the rest of the body via the bloodstream.
Fluid or air may collect between the lungs and the lining of the lungs, while tubercles continue to develop in the lung, progressively destroying lung tissue.
Coughing of blood or phlegm may occur. At this secondary stage, carriers of TB can infect others.
“Each person with active TB can spread the disease to 10 other Filipinos each year,” Dr. Ong deplores. “This is alarming since there are between 200,000 and 600,000 Filipinos with active TB. Multiply this by 10, and just imagine how much TB is being spread yearly.”
According to the US Center for Disease Control and Prevention (CDC), there are two tests that can be used to help detect TB infection: a skin test or TB blood test.
The Mantoux tuberculin skin test is performed by injecting a small amount of fluid (called tuberculin) into the skin in the lower part of the arm. A person given the tuberculin skin test must return within 48 to 72 hours to have a trained health care worker look for a reaction on the arm.
The TB blood tests measure how the patient’s immune system reacts to the germs that cause TB.
“A positive test for TB infection only tells that a person has been infected with TB germs. It does not tell whether or not the person has progressed to TB disease,” the CDC explains.
“Other tests, such as a chest x-ray and a sample of sputum, are needed to see whether the person has TB disease.”
TB disease can be treated by taking several drugs for 6 to 12 months. “It is very important that people who have TB disease finish the medicine, and take the drugs exactly as prescribed,” the CDC reminds.
“If they stop taking the drugs too soon, they can become sick again; if they do not take the drugs correctly, the germs that are still alive may become resistant to those drugs.”
In the Philippines, TB treatment is coordinated through the National TB Program of the Department of Health.
Medications are said to be available at government health services and public hospitals around the country.
“Unfortunately, adhering to and completing treatment can sometimes be difficult, especially when the ones who are most vulnerable have little access to health care and no funds to support treatments,” laments Dr. Santos, who considered TB as a disease of poverty.
World leaders were not spared from TB: Charles IX of France, Edward VI of England, American presidents Ulysses S. Grant and Andrew Jackson, Louis XII of France, Napoleon II of France, Pedro I of Brazil , and our very own Manuel L. Quezon.
