Experts from Taylor’s University Explain How We Can End the Threat of Tuberculosis

WORDS DR SAPNA SHRIDHAR PATIL, DR AMEYA ASHOK HASAMNIS & PROFESSOR DR WEE LEI HUM

FEATURED EXPERTS

DR SAPNA SHRIDHAR PATIL
Senior Lecturer
School of Medicine
Faculty of Health & Medical Sciences
Taylor’s University
DR AMEYA ASHOK HASAMNIS
Senior Lecturer
School of Medicine
Faculty of Health & Medical Sciences
Taylor’s University
PROFESSOR DR WEE LEI HUM
School of Medicine
Faculty of Health & Medical Sciences
Taylor’s University

Tuberculosis remains a significant global health challenge, with an estimated 10.6 million people falling ill and 1.3 million people dying from the disease in 2022 alone—making it the second largest infectious disease killer after COVID-19.

In 2023, tuberculosis cases in Malaysia were recorded at 26,781 cases, a five percent increase from the previous year.

PREVENTABLE & CURABLE, YET IT REMAINS A DEADLY THREAT

Despite being preventable and curable, tuberculosis has remained a leading cause of death from infectious diseases for decades. The 2022 numbers were the highest since the World Health Organization (WHO) began global monitoring in 1995, and above the pre-COVID baseline.

However, after two years of the COVID-19 pandemic-related disruptions, there has also been a major global recovery in the number of people diagnosed with tuberculosis and treated in 2022. These figures likely suggest a sizeable backlog of people who developed tuberculosis in previous years, but whose diagnosis and treatment were delayed due to COVID-19 that affected access to and provision of health services.

HOW TUBERCULOSIS SPREADS COMMON SYMPTOMS OF TUBERCULOSIS
The bacteria causing tuberculosis spread through tiny droplets released from the nose and mouth into the air during sneezing, coughing, or talking.
  • Persistent coughing
  • Fever
  • Chills
  • Night sweats
  • Weight loss
  • Lack of appetite
  • Fatigue
  • Coughing blood

The disease thrives in crowded environments and typically affects the lungs (pulmonary tuberculosis), but it can also affect other sites (extrapulmonary tuberculosis).

MALAYSIA’S COMMITMENT TO ENDING THE DISEASE

In Malaysia, the National TB Control Programme and the National Strategic Plan align with the WHO targets to combat tuberculosis, reflecting the country’s commitment to ending the disease, supported by three key pillars.

  • The first pillar emphasizes integrated, patient-centered care and prevention, including early case detection, and successful implementation of the BCG vaccination programme. Screening of high-risk populations, such as prison inmates and substance abuse victims, is an important strategy in early detection and enabling of timely intervention.
  • The second pillar promotes government stewardship and accountability, ensuring quality-assured anti-tuberculosis drug supply, and reducing treatment costs to alleviate patient burden.
  • The third pillar focuses on research and innovation to improve detection, treatment, and control, focusing on developing new drugs and vaccines.
INDIVIDUAL AWARENESS OF PREVENTIVE METHODS IS VITAL

These methods include practicing hand hygiene, proper cough etiquette, and wearing masks in crowded places.

Quitting smoking, maintaining a balanced diet to strengthen the immune system, and avoiding close contact with active tuberculosis cases can greatly reduce risks.

Anyone who shows symptoms of tuberculosis must consult a doctor immediately.

IN CLOSING

Challenges in addressing tuberculosis, including disrupted access to diagnosis and treatment, call for continuous strengthening of current policies and health systems. Aligning national tuberculosis response with regional and global strategies is imperative for effective management.

In Malaysia, tuberculosis initiatives not only contribute to ending the disease, but also to bolster primary health care, achieving universal health coverage and advancing the UN Sustainable Development Goals.

Tuberculosis Cases Are Rising in Malaysia. An Expert Shares What You Should Know & Do About This

WORDS LIM TECK CHOON

FEATURED EXPERT
DR ROSMADI ISMAIL
Consultant Interventional Pulmonologist and Internal Medicine Specialist
Sunway Medical Centre

Quite recently, our Minister of Health Dr Zaliha Mustafa revealed at the United Nations General Assembly High-Level Meeting that there was a concerning increase of 17% in tuberculosis cases in 2022 compared to 2021, along with a 12% increase in tuberculosis-related deaths during that time period.

In light of this development, Dr Rosmadi Ismail shares his thoughts with us about tuberculosis, its detection, treatment, and prevention.

Tuberculosis is an infectious disease that is caused by the bacteria Mycobacterium tuberculosis (MTB) infecting the lungs as well as certain other parts of the body.

An overview of the symptoms and preventive measures of tuberculosis. Click on the image for a larger, clearer view.

IS DETECTION OF TUBERCULOSIS GETTING BETTER?

Dr Rosmadi reveals that there are several innovative techniques currently undergoing clinical trials in a few countries.

These techniques, which include biosensing technologies and nano-diagnostics, promise quicker and more accurate results.

He shares: “Ongoing research focuses on innovative methods like computer-aided detection (CAD) through artificial intelligence, aerosol capture technologies, and antigen-based skin tests. They are poised to revolutionise TB diagnosis, enhancing efficiency and effectiveness in the future.”

In Malaysia, there are diverse methods employed to ensure accurate and timely detection of tuberculosis, such as:

  • Sputum smear microscopy, typically the first test for tuberculosis.
  • Culture and sensitivity testing to diagnose tuberculosis.
  • Nucleic acid amplification tests (NAATs) to facilitate the identification of tuberculosis cases.
  • Chest radiography and clinical tests like the Tuberculin Skin Test (TST) to confirming the infection.
TREATMENT OF TUBERCULOSIS

Treatment of tuberculosis in Malaysia follows the World Health Organization guidelines, which is the global standard.

Dr Rosmadi tells us, “The standard treatment for drug-susceptible tuberculosis in Malaysia involves a combination of four drugs administered for a duration of 6 to 8 months.”

Treatment utilizes the Directly Observed Treatment (DOT) strategy, which sees the patients receiving close supervision from healthcare workers to ensure that they complete their medication intake.

Currently, there are no new medications or treatments that show superior results over current ones when it comes to treating tuberculosis. Dr Rosmadi notes that treatment for drug-resistant TB involves a distinct medication regimen and extended treatment duration.

“This tailored approach has proven effective even in cases of drug-resistant TB, reinforcing our commitment to comprehensive patient care,” he says.

DR ROSMADI’S TUBERCULOSIS TIPS 
  • Stay clear of crowded places. It’s best to avoid crowds, especially if they’re poorly ventilated.
  • If you’re experiencing a persistent cough, fever, or unexpected weight loss, seek medical help promptly. This will help you get better and stop the disease from spreading.
  • Get checked if you’re at risk. If you have a weak immune system or have been around people with tuberculosis, consider getting tested. It’s a simple step that can catch the disease early if exposed.
  • If you’re diagnosed with tuberculosis, completing your treatment is essential. P
  • Preventive measures such as wearing a mask, covering your mouth and nose when you cough or sneeze, and disposing of tissues properly can help protect yourself and those around you.
  • If your job puts you in contact with many people, wear the proper protective gear as an added layer of safety.
  • Think about getting vaccinated. The current vaccine, Bacillus Calmette Guérin (BCG), offers partial protection to infants and young children against severe forms of tuberculosis. It doesn’t protect adolescents and adults that are the primary carriers of the tuberculosis bacteria, but it could help in the long run.

Is Tuberculosis Still a Disease That We Should Be Worried About?

WORDS LIM TECK CHOON

FEATURED EXPERT
PROFESSOR DR JAMES KOH KWEE CHOY
Head of Division of Medicine
School of Medicine
International Medical University (IMU)

Tuberculosis, often abbreviated as TB, has been around for a long time. In fact, it was known as “consumption” back in the 1800s.

Perhaps this is what many of us rarely spare this disease a thought unlike, say, dengue and COVID-19.

WHAT CAUSES TUBERCULOSIS

It is caused by the bacteria Mycobacterium tuberculosis.

TUBERCULOSIS CAN ATTACK DIFFERENT PARTS OF THE BODY

“It can attack different parts of the body, with the lungs–referred to as pulmonary tuberculosis– being the most common,” says Professor Dr James Koh Kwee Choy,

These different parts of the body include the lymph nodes and bones (usually the spine), in rare cases in the gut. The bacteria can also attack the brains of people with suppressed immune system, such as those living with HIV. Such cases of tuberculosis are called extrapulmonary tuberculosis (EPTB for short).

Symptoms and prevention of tuberculosis. Click on the image to view a larger, clearer version.
WHO IS AT RISK OF CATCHING THIS DISEASE?

According to Prof James, the most susceptible groups of people are:

  • The elderly
  • People with lowered immunity, including young children whose immune system is still developing
  • People with suppressed immune system, such as those on chronic steroid therapy and people living with HIV
  • People living in overcrowded living spaces, such as the poor and migrant workers, as this close proximity makes it easy for the bacteria to be passed on from person to person
HOW EASILY DOES TUBERCULOSIS SPREAD?

Similarly to all respiratory diseases, it is spread by water droplets that come from coughing or spitting.

However, the bacteria responsible for this disease need to be in significant amount in water droplets for the disease to spread.

“You have to be in quite close contact and in a situation where there’s prolonged exposure. Generally, more than eight hours a day,” says Prof James.

It is also worth noting that the bacteria can become dormant in the body of the host, and someone with dormant bacteria will not pass the bacteria on to others.

Similarly, people with only extrapulmonary tuberculosis—the infection doesn’t affect their lungs—will not spread the bacteria to other people.

THE SYMPTOMS OF TUBERCULOSIS

Detecting tuberculosis at its early stage can be challenging because the symptoms may not show immediately.

“You could have been exposed long ago, and the bacteria will stay latent or dormant in the body and hibernate. Symptoms can come up months or even years later,” says Prof James.

SYMPTOMS OF PULMONARY TUBERCULOSIS (TUBERCULOSIS IN THE LUNGS)
  • Chronic cough
  • Profuse sweating at night
  • Unexplained weight loss
  • Recurrent rise in body temperature in the evenings
SYMPTOMS OF EXTRAPULMONARY TUBERCULOSIS (TUBERCULOSIS IN OTHER PARTS OF THE BODY)
  • Swollen lymph nodes
  • Chronic back pain and fragile bones
  • A sensitive gut and
  • Seizures, headaches, confusion and even alterations in personality if the brain is infected
WHAT TO DO IF YOU BELIEVE THAT YOU HAVE TUBERCULOSIS

“Don’t wait to cough up blood,” says Prof James. “See a doctor if you have had a persistent cough for two weeks!”

Also see a doctor if you have unexplained night sweats and weight loss together with swollen lymph nodes or chronic back pain.

“If you are aware that you’ve been exposed to someone with TB, someone you share a working or living space with, then you might also want to see a doctor to be screened,” Prof James adds.

HOW IS THIS DISEASE TREATED?

Treatment is straightforward, but can take place over a long period of time.

Once the treatment is started, a person will be non-infective in ten to 14 days. In hospitals, a patient will be put in isolation but there is no prescribed quarantine period. “The most important thing is to wear a mask and wash your hands frequently,” Prof James says.

Antibiotics to overcome tuberculosis

“A combination of 4 antibiotics will be prescribed for a period of 6 months to a year, depending on which part of the body is affected,” explains Prof James.

There are newer medications can potentially treat tuberculosis within 3 months, but Prof James shares that, unfortunately, they are not yet available in Malaysia. “At the moment, we’re still using the old regime,” he says.

It is crucial to take these antibiotics on time and as prescribed by the doctor

Otherwise, the bacteria can become resistant to the antibiotics. “This can escalate into extensively drug-resistant TB (XDR TB) and multidrug-resistant TB (MDR TB) – or what is commonly known as superbugs!” Prof James warns.

“Those with MDR/XDR TB can spread it to others and unfortunately for that someone, because the bacteria is already resistant, it becomes very hard to treat. These cases will need a lot of alternative medications involving injections and much longer therapy for up to 2 years. It gets very, very complicated,” he further explains.

WHY ARE WE STILL CONCERNED ABOUT TUBERCULOSIS? WE ALREADY HAVE THE BCG VACCINE TO PROTECT US FROM IT

The Bacille Calmette-Guerin (BCG for short) vaccine is given to Malaysians when they are babies and at primary school.

While the vaccine confers protection against tuberculosis, its effectiveness decreases over the years,

“By the time we are adults, many of us no longer have immunity against the disease,” says Prof James.

Tuberculosis cases in Malaysia are on the rise

Malaysia is still considered a country with a high incidence rate, estimated at 92 per 100,000 population. Prof James reveals that we have about 20,000 to 25,000 new cases every year, with an average of 1,500 to 2,000 resulting deaths.

Interestingly, the number of cases went down during the lock down, when we were wearing masks and practicing social distancing as well as movement control orders. It is when the SOPs are relaxed that the number of cases is up again.

CAN’T WE JUST GET A BOOSTER SHOT?

Sadly, there is no such booster shot currently in existence!

Prof James advises that the best way to keep tuberculosis at bay is to ensure a healthy lifestyle. “Generally, a person who is healthy with a good immune system should be able to fight off TB on their own.”

It is also important to be aware of the symptoms and seek early treatment. “If left for too long, even after recovery, tuberculosis can leave scarring on the lungs that will forever curb a person’s lung capacity,” Prof James states.

Also, it is equally important to stay healthy after recovering from tuberculosis. “Maintain a good diet, exercise, don’t smoke. You can get re-infected with TB and that can be quite bad,” says Prof James.