Tuberculosis: A local, global problem

Friday, March 28, 2014

A new study published in the journal Lancet found that drug-resistant tuberculosis (TB) infects as many as 32,000 children globally.

"Overall, as many as 1 million children become sick with TB each year, about twice the number previously thought, and of these, only a third of the cases are ever diagnosed, the study found," Reuters reported.

The study was published World Tuberculosis Day, which aims to raise awareness of the issue and the status of prevention.

The World Health Organization estimates “that half a million people caught drug-resistant ‘superbug’ strains of TB in 2012, and that about 2 million people could contract it by 2015,” Time magazine reported. A study by  researchers from Brigham and Women’s Hospital’s Division of Global Health Equity stated,  “The researchers went through several databases to determine a more accurate number of children with TB, since the disease in kids is known to be underreported.”

Recent TB Scare In Local High School 

Possible exposure to TB prompted health and school officials to make TB testing available earlier this week for more than 100 students and staff members at a Gaithersburg, Md., high school. The Washington Post reported that 126 people at Watkins Mill High School “were in classes or after-school activities with the infected person from October 2013 to January, officials said.”

Once a leading cause of death in the United States, TB is curable and preventable. Caused by bacteria called Mycobacterium tuberculosis, TB targets the lungs, but may spread to other organs such as the kidney, spine, and brain.

It is spread from person to person through the air, according to Children’s National Health System infectious disease specialist David Hyun, MD. It can be transmitted by droplets from infected people when they cough, sneeze, speak or sing, for example.

“For most children older than 4 years of age and adults, there can be a considerable lag time between time of infection of TB  and development of disease, which can be anywhere from months to years,” Dr. Hyun said. The period between exposure and the disease development is referred to as the latent period.

“In younger children, this interval can be a lot shorter, which is why it's all the more important to identify potentially exposed subjects early so that preventive measures can be put in place to prevent TB disease,” said Dr. Hyun.

Stages of TB 

Exposure occurs when someone is exposed to or comes into contact with a person who may be infected.

Latent TB infection means they have the bacteria in their body, but it doesn’t make them sick; they may have a positive skin test, but a normal chest X-ray, and no illness.

Most people fight TB before it grows and becomes TB disease.  Having the disease means bacteria are active or multiplying in the body. Someone with the active infection will have a positive skin test, a positive chest X-ray detecting TB, and they might become sick.

“Latent infections are asymptomatic and usually treated with a single antibiotic to prevent development of symptomatic TB disease. If latent infections progress without treatment it can lead to most commonly pulmonary TB which exhibits as chronic coughing, fevers, night sweats, and weight loss,” Dr. Hyun said.

Symptoms of TB 

The symptoms may resemble other lung conditions or medical problems and they differ depending on the child’s age, so consult your child's doctor for a diagnosis.

In children, common symptoms are:

  • Fever
  • Decrease in weight
  • Night sweats
  • Cough
  • Chills
  • Enlarged lymph nodes

In adolescents, common symptoms are:

  • Cough that lasts greater than three weeks
  • Cough
  • Chest pain
  • Blood in their sputum (phlegm)
  • Fatigue
  • Weight loss
  • Decrease in appetite
  • Fever
  • Night sweats

“For anyone who has been exposed to a documented case of TB disease, it is important to have either a PPD skin testing (all age groups) or an interferon-gamma release assays from the blood (for children older than 4 years),” Dr. Hyun said.

“The most important steps for families to take is if they have been notified of a exposure in the household or school, to make sure to follow the public health agency's (health department) instructions on obtaining the screening tests or contacting their pediatrician,” Dr. Hyun said.


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