World Tuberculosis (TB) Day was observed last month in nations with tuberculosis. It was enthusiastically observed in Pakistan through press releases, seminars, talk shows, and awareness walks. Pakistan is one of eight countries that accounts for two-thirds of new cases of tuberculosis and has a plethora of infectious diseases (ID). It also has the dubious distinction of ranking fifth in the world in terms of TB burden.
While incidence rates in developed nations are less than 10 per 100,000 people, they are alarming in Pakistan: Dr. G.N. Kazi, a specialist in public health, estimates that 580,000 people develop TB annually, or 263 per 100,000 people. More than half of the patients we see in the crowded ID clinic at The Indus Hospital in Karachi every day have tuberculosis; The remainder have a number of other IDs. Numbers in the community are also rising, according to reports from other medical facilities.
TB is brought about by a bacterium called Mycobacterium tuberculosis (MTB)and has been found in DNA examination of Egyptian mummies from a long time back. The spread of tuberculosis (TB) is unabated in low- and middle-income nations and is concerningly uncontrollable among our population, despite extensive scientific research on its cause, diagnostics, treatment, and prevention. Similar to other bacteria, MTB is like a moving target. Although anti-TB medications that were introduced in the 1950s were effective for several decades, the dreaded situation of drug resistance has been brought about by prescriptions written by inexperienced doctors or non-compliance by patients; The patient no longer responds to standard medical care. The new drugs work well, but they are also very expensive and toxic.
The TB bacterium is a persistent organism. Unless it is blown away by the wind, it can remain suspended in the air for many hours, and it can survive for days even in extremes of temperature or humidity. The quantity of microorganisms showered by a tainted individual while hacking, sniffling or in any event, talking differs from two or three thousand to a couple million. The duration of an individual's exposure to the bacterial load and their level of exposure determine whether they contract the infection. It goes without saying that people are more likely to inhale more bacteria in smaller living areas.
Brave doctors attempt to save the failing organs, but 200 people per day die.
The statistic that only one out of every three people who are exposed will contract the disease is encouraging. Within two years, one third of these individuals will exhibit disease symptoms; One third of people will breathe in the bacteria, but the germs will stay dormant in their bodies until the person's immunity deteriorates due to age, stress, or other illnesses. Sadly, the bacteria may return even after decades. The leftover 33% of contaminated people might very well never manifest TB.
The bad news is that Pakistan is ripe for a rapid escalation of tuberculosis due to the substandard living conditions, malnutrition, and poor hygiene, particularly among women who have multiple pregnancies. We are further entangled in the muck of incurable diseases as a result of the country's faltering economy. Unfortunately, kids presented to relatives are the most horrendously terrible impacted, and if undiscovered or treated late may kick the bucket, or get by with harmed lungs.
A particular element of TB is that the microorganisms can head out to any organ of the body: when the microbes take a traction in the lungs, they might duplicate gradually over years, crawling through blood and lymph course to any piece of the body — organs in the neck or chest, the skin, bones, joints, kidneys, cerebrum, eyes, stomach, heart — similar as woodworm, harming the impacted organs.
While lung TB can be easily diagnosed in the laboratory by testing the sputum, when a deep organ is affected, the diagnosis is difficult to make. The disease can be controlled and cured if diagnosed early and properly managed; then again, assuming the determination is deferred or the patient is erroneously treated, the impacted organ might be unsalvageable harmed. Additionally, the clever bacteria respond to erratic treatment by mutating and developing drug resistance. Drug-safe TB is the doctor's and the patient's bad dream on the grounds that poisonous and costly medications should then be endorsed for a very long time; A third of the drug-resistant patients may never be cured even in that scenario.
TB must be viewed as a social condition as well as a unique identification. Clean water, food, and air are essential for good health, but our population is severely lacking in these things. Most people with tuberculosis who live in urban slums are generally malnourished; Small apartments without windows block sunlight; the air is contaminated with residue and smoke; frequently at least 10 people share a room. When a person with lung TB breathes in the same air as another, the bacteria are inhaled. Diabetes, hepatitis, AIDS, kidney failure, and damaged lung structure from polluted air or cigarette smoke predispose individuals to tuberculosis in Pakistan's population. Worse still, liars pretending to be doctors mess up prescriptions and diagnoses.
The prognosis remains extremely bleak despite the government's commitment to improving the situation with TB through the globally funded National TB Programme, which raises awareness, provides diagnostics, builds capacity, and promptly distributes effective anti-TB medications. On any given day, a patient who has stopped breathing, burst intestines, or is unconscious from TB of the brain is brought to the hospital. Others might have hindered kidneys, bones or joints, or barrenness from TB-impacted organs. Brave doctors attempt to save the failing organs, but 200 people per day die.
This horrendous situation will stay irreversible insofar as congestion in inappropriately ventilated homes, work environments, schools and madrassas wins. A poorly supported individual with exhausted protein stores can scarcely be anticipated to battle contaminations. Except if neediness returns, consistently will be TB Day in Pakistan.
In Karachi, the author is a specialist in infectious diseases.
Published on April 20, 2023, in Dawn
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