March 29, 2009
When it's not just a cough
With TB on the rise, a stubborn cough coupled with fever, weight loss and blood in sputum call for a visit to the doctor
By Cheryl Tan
If you have a cough that will not go away, go and see a doctor as you might have tuberculosis.
But before you start getting anxious the moment you break into a coughing fit, check for other telling symptoms such as prolonged fever, sudden weight loss and/or blood in the sputum.
While some of TB's symptoms, such as cough and fever, are similar to flu, doctors say the flu virus usually lasts only five to seven days. The body will either recover by itself or respond to medication.
For those with the active TB bacteria, the symptoms will persist. Often, sufferers can cough for many months without knowing they have the disease, says Dr Cynthia Chee, senior consultant at Tan Tock Seng Hospital's tuberculosis control unit.
A delayed diagnosis means the unsuspecting person can spread the airborne disease through infected respiratory droplets. The bacteria can also spread to the brain, kidneys, lymph nodes and bones.
According to an update by the Health Ministry on Monday last week, the number of TB patients in Singapore grew by 15 per cent to 1,451 last year, from 1,256 in 2007.
The report, which was released a day before World Tuberculosis Day, also highlighted the increase in younger people aged below 30 getting infected. Nevertheless, sufferers in that age group remain a minority among TB patients, say doctors.
The bulk of patients still comprise the elderly who have a weakened immune system or suffer from other medical conditions that allow the bacteria to multiply.
Explaining the spike in numbers, Dr Chee says 'urbanisation and overcrowding' help to spread the infectious disease.
Dr Philip Eng, senior consultant respiratory physician at Mount Elizabeth Medical Centre, also attributes the rise in the number of TB cases to the 'increased numbers of foreigners in Singapore for holiday and work'.
He says: 'This is especially so for people who come from countries with high incidence rates of TB, including parts of India, China, the Philippines, Thailand and Myanmar.' He says the rise could also be due to more Singaporeans travelling to more exotic locations such as South Africa and Cambodia, which have a high prevalence of the disease.
However, experts say the increase in TB cases should not get one so paranoid as to visit a doctor each time someone nearby starts hacking uncontrollably.
The disease is more likely to spread if there has been prolonged close contact of up to nine hours with someone with infectious TB in a poorly ventilated space.
Ultraviolet light, which is found in sunlight, kills the germs.
According to the Singapore Anti-Tuberculosis Association, individuals become non-infectious after two to three weeks of proper treatment. After six months, they will be cured. The disease is almost 100 per cent curable, it says.
If TB is suspected, patients have to undergo a chest X-ray, sputum tests, blood tests and a skin test. Those diagnosed with the disease have to undergo the six-month Directly Observed Therapy, an international standard of care for treating TB.
In the first two months of treatment, the programme requires patients to make daily trips to the nearest polyclinic to ensure that they take their pills dutifully. Over the next four months, they need to visit the clinic three times a week.
'Compliance with medication is of crucial importance and should not be discontinued just because patients feel better,' says Dr Constance Lo, senior consultant at the department of respiratory and critical care medicine at Singapore General Hospital (SGH). 'Premature discontinuation of medication can lead to a relapse and cause the TB bacteria to resist medication.'
This results in a multi-drug resistant form of TB that carries 40 to 50 per cent risk of fatality, says Dr Eng. This strain of TB accounts for less than 1 per cent of the patients here. Those with this strain need 18 months to two years to get better and they need stronger and more toxic drugs.
Dr Low Su Ying, a consultant at SGH, advises seeking prompt treatment as delay can lead to 'destroyed lungs or orthopaedic problems', affecting one's quality of life.
She blames 'general complacency' as a catalyst fuelling the recent rise in numbers. Many people, she adds, 'believe TB is a disease of the past and is no longer a problem'.
Truth about TB
§ More than two billion people, or one-third of the world, are infected with the tuberculosis germ.
§ TB is the seventh leading cause of death worldwide (World Health Organisation, 2004).
§ In Singapore, 2.2 deaths per 100,000 a year are caused by TB. The disease is also the No.1 cause of death among people infected with HIV (WHO, 2006).
§ If left untreated, each person with active TB infects 10 to 15 people every year.
§ The vast majority of TB deaths are in the developing world. More than half of all deaths occur in Asia.
§ Every year, there are about 1,000 patients in Singapore treated under the Directly Observed Therapy. Those who fail to turn up will be given reminders through phonecalls and home visits. As a last resort, he or she will be referred to the Ministry of Health and forced to seek treatment under the Infectious Disease Act.