by
Nick Nunes
What do all the Brontë sisters, John Keats, Chopin, Desmond Tutu, Nelson Mandela, Simón Bolívar, and famed cowboy John Henry “Doc” Holliday have in common? They all suffered from an infectious disease that we rarely hear about today—consumption (as they would know it), tuberculosis or TB to the 21st century.
Even though it’s rarely talked about in Barbados these days, this interesting illness is still a major cause of death around the world. According to the World Health Organisation (WHO), “Every year, ten million people fall ill with tuberculosis (TB). Despite being a preventable and curable disease, 1.5 million people die from TB each year – making it the world's top infectious killer. TB is the leading cause of death of people with HIV and also a major contributor to antimicrobial resistance.”
TB can literally affect almost everywhere in the body. In medical school students can pretty much always add it to the bottom of almost all differential lists. It can always be thought of as a cause (differential diagnosis) for pretty much any rash. Luckily, the highest incidences of TB in Barbados, in recent years, occurred in 2004 when the country saw eight cases per 100,000.
“In 2019, incidence of tuberculosis for Barbados was zero cases per 100,000 people. Though Barbados’ incidence of tuberculosis fluctuated substantially in recent years, it tended to decrease through 2000 – 2019 period ending at zero cases per 100,000 people in 2019,” according to World Data Atlas.
According to WHO,“About one-quarter of the world’s population is estimated to be infected by TB bacteria. Only 5-15% of these people will fall ill with active TB disease.
The rest have TB infection but are not ill and cannot transmit the disease. Both TB infection and disease are curable using antibiotics.”
WHO further asserts that,“Tuberculosis (TB) and COVID-19 are both infectious diseases that attack primarily the lungs. Both diseases have similar symptoms such as cough, fever and difficulty breathing. TB, however, has a longer incubation period with a slower onset of disease.”
Most cases of TB exhibit no symptoms, but about 10% of latent infections progress to active disease which, if left untreated, kills about half of those affected. The classic symptoms of TB are generally chronic cough with bloodcontaining mucus, fever, night sweats, and weight loss.
TB is spread through the air when someone with an active form of the disease coughs, spits, speaks, or sneezes. There is a vaccine for TB which reduces the chance of infection by 20 per cent but other vaccines are still being developed.
Though 90 per cent of active cases of TB affect the lungs, extrapulmonary TB infections do occur. The main sites of extrapulmonary TB are in the central nervous system (meningitis), lymphatics (scrofula of the neck), pleura (TB pleurisy), disseminated (miliary TB of the blood), bones and joints of spine (Pott’s disease), and genito-urinary (urogenital TB).
In 2019, Minister of Health and Wellness, Lt. Col. Jeffrey Bostic, noted that “the world had become so dependent on antibiotics to cover everything from surgery to childbirth, as well as animal husbandry and food production, that with increasing antimicrobial resistance, countries now faced a number of threats”.
He outlined some of these as “the return to unsafe childbirth, increased illness and death with surgical procedures, reemerging diseases such as tuberculosis, threats to food security and food safety, as well as economic losses to countries and developmental regression,” Barbados Government Information Service (GIS) has archived on their webpage.
This came a year after the Best-dos Santos Public Health Laboratory at Enmore, Collymore Rock, St Michael, was officially opened by Health Minister John Boyce in 2018.
On the occasion of its opening, the former Health Minister said that the facility, which is an amalgamation of the Public Health Laboratory, the Leptospira Laboratory and the Ladymeade Reference Unit Laboratory, was state-of-the-art with bio-safety level three capacity, improved lab safety and the capability for an enhanced range and quality of tests. These tests include haematology, serology, molecular biology, tuberculosis bacteriology, chemistry and pathology, according to the GIS.
It would seem providence that a facility was created just in time for the current pandemic even if the proportions could never have been known. Though causes of this infectious disease have been rare in the island of late, it is important to keep in mind the potential, especially with an extraordinarily stressed medical system due to the ongoing COVID-19 pandemic.
Especially in the context of the dire global and local medical dilemma, WHO has asserted,“While experience on COVID-19 infection in TB patients remains limited, it is anticipated that people ill with both TB and COVID-19 may have poorer treatment outcomes, especially if TB treatment is interrupted. TB patients should take precautions as advised by health authorities to be protected from COVID-19 and continue their TB treatment as prescribed.”
