31 Mar 2011
By JONATHAN LIAUTRAKUL
As communities marked World Tuberculosis (TB) Day last Thursday, new statistics showed that there has been a slight rise in the number of cases in Singapore.
It underlies a cause for concern: Without proper treatment, a TB sufferer could risk a relapse of the disease.
According to the Health Ministry, there were 1,478 new cases of TB diagnosed here last year – 36 more than in 2009.
In addition, there were 126 repeat patients last year.
A relapse of the disease can occur when TB sufferers do not complete their medication properly and especially if they are vulnerable patients. These include cancer patients, chronic alcoholics and the elderly.
“Patients who do not complete their treatments may get better initially but once the bacteria multiplies or builds up resistance, the disease will relapse,” said DrJim Teo, a respiratory physician at Nobel Chest and Internal Medicine Centre at Mount Alvernia Medical Centre.
Dr Low Su Ying, a consultant with the department of respiratory and critical care medicine at Singapore General Hospital, said a relapse could occur even for patients who comply fully with treatment.
“Patients who have previously contracted TB and completed treatment may suffer a relapse because their immune systems are weakened and the traces of TB bacteria in their bodies, which have been dormant, begin to multiply and cause TB disease again,” she said.
TB can be spread through the air when a person who is infected with the disease coughs, sneezes or spits.
It is important that the disease is diagnosed early and the patient stays with his treatment over six to nine months until he is fully cured. Otherwise, there is a risk he could infect others.
Usually, a relapse is of the same strain, so doctors may prescribe the same drug that was originally used, or a drug-resistant one, as there is always the worry that the bacteria may have become resistant.
Treatment for a drug-resistant strain would then take at least 18 months, instead of six.
Another type of TB recurrence, known as latent or “sleeping TB”, happens when one contracts the bacteria from a TB patient in close proximity, like a family member in the house.
The bacteria then stays dormant in his body and has a 10 per cent chance of multiplying and causing full-blown TB in his lifetime. Unless he has a Mantoux test (a diagnostic test for TB) or a blood test, the person will not know he has TB or show symptoms of the disease until his immune system is weakened.
This could be 10 to 30 years from when he first contracted TB.
Some causes that lead to a weakened immune system include ageing, chronic diseases like diabetes or cancer and the effects of steroids or immunosuppressant drugs taken after organ transplants.
The stigma of getting TB and the prolonged treatment may be barriers that prevent people from coming forward for diagnosis and treatment, said a spokesman from the Health Ministry.
In the end, prevention is still better than cure.
TB patients should comply with the initial treatment regimen and maintain a healthy lifestyle and diet after its completion, said DrLow.
“If you have a prolonged cough for three to four weeks, blood in your phlegm, unexplained fever and weight loss, you should see a doctor immediately to exclude the possibility of TB,” advised Dr Teo.
Email: jonliau@sph.com.sg
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