It is more difficult to diagnose a disease if people are not aware it is in the population. I was 2 weeks in hospital at end of February while the doctors tried to figure out what was going on. 4 weeks following release from hospital there came the confirmed diagnosis of tuberculosis.
That was a bit of a shocker! … Who? Me? Are you sure those results don’t belong to someone else?!
The Mycobacterium tuberculosis (Mtb) bacillus has the ability to lie dormant in the human body for decades, only progressing to active disease in 5–10% of immunocompetent individuals. The organism is transmitted through aerosols, and enters the pulmonary system through inhalation. Within the lung, the bacillus can take up residence inside an alveolar macrophage triggering the aggregation of immune cells and the formation of a granuloma. During the course of infection, granulomas play a dual role – serving as a niche for the invading bacteria, whilst, protecting the host from active disease.
(Sorry – I lost the source document)
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TB is known to be on the rise world-wide.
“It is the top infectious disease in the world”. http://www.wsws.org/articles/2001/mar2001/tb-m22.shtml
A google search using “tuberculosis, rise in” throws up headings such as
- “Rise in TB rates in Washington”
- “…in Sacramento”
- “… Africa shows alarming rise”
- ” …TB rise in Florida”
- “in Columbus (Ohio)”
- “TB cases rose in California, Texas, New York and 16 other states in 2003, but fell in the nation as a whole.”, March 2004 http://www.planetark.com/dailynewsstory.cfm/newsid/24349/newsDate/19-Mar-2004/story.htm.
- Dr. Eileen Schneider, an epidemiologist with the CDC’s (Centre for Disease Control) tuberculosis elimination division, said the 1.9 percent drop in the U.S. infection rate last year was the smallest decline since 1992, when the disease peaked. “We’re not sure if this is just a plateau or a resurgence,”
- published in October 2004 by the Chief Medical Health Officer in England, “This action plan sets out steps which the Government, health services and local communities need to take to reverse the rise in Tuberculosis (TB)”;
- from (link no longer valid – www.eubusiness.com) “Europe fights new TB on the rise in former Soviet Union. Europe’s first anti-tuberculosis centre, aimed at combating the spread of a new multi-drug resistant strain of the disease, opened in Riga, Latvia on 22 November (2004). … According to the WHO (World Health Organization), cases of multiple-drug-resistant TB are rising at an alarming rate in many parts of the world, and especially in the former Soviet Union. Estonia, Kazakhstan, Latvia, Lithuania, the Russian Federation, and Uzbekistan are now among the top ten global ‘hot spots’ for the disease, says the WHO.”
- on the rise in Papua New Guinea
- on the rise in the Marshall Islands.
- And so on.
Hart Haidn has been very good at finding recent events (appended). The news stories are about occurrences in a Miami Beach High School, 41 people infected at a Tyson chicken processing plant in Oklahoma, a high school in Kentucky, and today there is the story of 3 patients and 16 staffers at a cosmetic surgery hospital in Sapporo, Japan who have been infected with tuberculosis, and one has died. …
There is a lovely description in an appended article – the micro organism dissolves your tissues!
The medical profession would normally think of people who are already weakened by diseases such as AIDS as the most likely to contract TB; it is found among addicts and homeless people. In Canada it has been in northern native communities and is a problem at homeless shelters in Toronto and Ottawa.
I don’t fit the profile but I have TB. I don’t live on the street (yet! although this activism work may put me there!), am not a drug user, am not an immigrant, don’t have AIDS/HIV, nor do I work with high-risk populations.
I eat well, exercise, and the biggest stress in my life is Monsanto and the Government – these issues we deal with day in and day out! The workers in the Tyson plant don’t fit the profile. I was talking to a middle-aged white fellow at the TB Control Centre in Saskatoon a couple of weeks ago. His case I can understand. … My introductory line: “I have tuberculosis. What brings you here?” He works at an addiction rehabilitation centre in Saskatoon. Half of the employees tested positive for TB. (Which does NOT mean that half have active TB.) This fellow tested positive and had his x-ray in hand, waiting to hear whether he has an active case or not. Today I talked with a woman who works at the Salvation Army.
The Health Authority has been there in the last couple of days, testing for TB.
I speculated as to where I might have picked up the micro-organism (which the Doctor said is neither bacteria nor fungus but something in between). It may seem a somewhat fruitless attempt. You can carry the micro-organism in a dormant state for years, although I was told that 80% of the cases develop within a few months of exposure. I was in an enclosed space (a car) in November with a person who had a bad smoker’s cough But it turned out to be more than a smoker’s cough. I was in hospital by February.
In response to my many questions, the Head of TB Control here in Saskatchewan, Dr. V. H. Hoeppner (UPDATE: now retired) (Royal University Hospital, 306-933-6347) said that relatively little is known about tuberculosis.
I am reminded that it is in our interests to see that the emotional, physical, mental and spiritual health of EVERYONE in the society is looked after, from the time before they are conceived. We are indeed inter-connected. Disease (and crime which is a form of disease) will slowly but stealthily travel from the unhealthy to the healthy, inevitably, if we don’t care for those “others” in our society. We need to make opportunities to walk and work in the “bad” side of town regularly. It does not make sense to sit and watch disease and crime spread to “our” side of town. High fences, more police and more drugs can’t protect us ultimately. We protect ourselves by protecting especially the children who will otherwise grow up in conditions that would warp my being and yours if we had been raised in a similar environment. That said, it is acknowledged that population growth which has tripled world wide since I was born (except in Saskatchewan!) contributes to the spread of disease. In the U.S. the Centre for Disease Control identifies that almost half the cases are brought in from other countries.
Ha! you will know that it is a hard pill for me to swallow, to be prescribed drugs! Fortunately I am able to decline. The TB is outside my lungs in the pleura which is the lining between the lungs and the rib cage.
I don’t have the classic symptom of coughing. And the TB is at an early stage. It is not yet contagious. You can’t catch TB from me, so don’t run away!
Some of the info in the appended articles could be better. The TB micro organism does not lodge in only the lungs. It can develop in other places (liver, etc.) in which case the symptoms will be different from a lung infection. One thing that seems to be consistent with TB, no matter where it is located in the body is “the sweats”, most noticeable at night. (Men get to experience a symptom of menopause!) Weight loss is another consistent symptom. Tiredness. And flu-like symptoms. Before I went to hospital that’s what I thought I had – a bad flu that made my bones and joints ache, fever – I holed up in bed for 2 days. Had the TB been inside my lung I might have been coughing which would make it seem even more like virulent cold and flu. The cough would not have gone away, I would have continued to feel real tired, and would have complained that I just couldn’t seem to shake the bug. As it was, because the micro organism lodged outside the lung there was a build-up of fluid “ON the lung” which eventually caused sharp pains in my side, especially if I breathed too deeply. After 3 days I decided the pains weren’t going away and warranted a visit to the doctor. Someone with TB inside the lung would not experience pains in the side?? as I did? Their symptoms, if dismissed as the flu, may not have taken them to the hospital and diagnosis.
From conversations I have had, the drug route to “cure” the TB isn’t necessarily the most efficacious – depends on a few factors, one being whether
or not the patient is contagious. You will see in the newspaper reports below that if people test positive and only have “latent” but not active TB (are not contagious), they are being put on the drug protocol.
… makes me cringe. To me it is better, if you can, to let your body do the healing so it becomes strong in its ability to combat the micro organism. The drugs have side effects and I highly doubt that the long term effects of the drugs have been studied. In addition, the indiscriminate use of drugs causes the development of resistant strains of TB.
The drug protocol is 8 or 9 months long. For the first month they deliver pills to your door every day. For the remaining time they deliver them twice a week. They have side effects (of course!). One fellow I know of, stopped taking the drugs because he became so nauseated by them. The drugs are potent, they check your liver every 3 weeks to ensure it is not being damaged. It is not good to stop or even miss taking one dose of the drugs once you’ve started – you will have killed the weakest of the TB micro organisms and left the most virulent ones – which is how TB that is resistant to drugs develops. There is a real problem treating people that are in the high-risk population, addicts, etc. They are often itinerant and lack discipline, which is the reason the Health Authority delivers the pills to your door daily, and watches to see that you take the pill – an attempted safeguard against the development of resistant strains (which are now found in different parts of the world).
TB is a problem in the homeless shelters in Toronto and Ottawa, as mentioned. The shelters are crowded which enhances the risk of catching TB. Some homeless people are now refusing to use the shelters because they are afraid of contracting the disease. (Thanks to Jim for this input.)
I think of my former Grandmother-in-law (Dot) Kelleher who had TB. She spent two years in the sanatorium in the Qu’Appelle Valley and overcame the disease through good food, lots of rest, sunshine = = low stress and let your immune system do its curing work. That was the standard treatment protocol back then.
There is a cottage remaining from the sanatorium that was on the banks of the Saskatchewan River here in Saskatoon. It is a little museum, I believe.
I was able to decline the drug protocol, with the okay from Dr. Hoeppner – I’m working jointly with him and with a naturopath. With good results so far. As I see it, the TB makes you tired, so more rest is required. If you do the drug route, you have to lay down anyway because of the nausea and your body is under
high stress from the drugs. I would rather be tired, than both nauseated AND tired for 8 months! Hardly know you have the disease if you take care of yourself, until it has been successfully combated. Each successive x-ray I have had shows improvement all of which has been brought about without drugs. Take responsibility and have faith in your own body and the supportive thoughtfulness of family and friends. (Not for EVERYONE – remember, my case was not yet contagious.)
A “history of tuberculosis” and “laws” regarding TB are appended, also thanks to Hart.
Take care of your self (I say with sincerity!) /Sandra
The TB Control Centre (Dr. Hoeppner) has a data base. If, for example, you name a place, they can do a search and tell if there have been identified cases of TB at that location.
Latent TB (not infectious) – if a person has latent TB, there is no risk of infectimg others.
What is latent TB infection? In most people who breathe in TB bacteria and become infected, the body is able to fight the bacteria to stop them from growing. The bacteria become inactive, but they remain alive in the body and can become active later. This is called latent TB infection.
People with latent TB infection
- have no symptoms
- don’t feel sick
- can’t spread TB to others
- usually have a positive skin test reaction
- can develop active TB disease if they do not receive treatment for latent TB infection or maintain the immune system.
- Many people who have latent TB infection never develop active TB disease. In these people, the TB bacteria remain inactive for a lifetime without causing disease.
- But in other people, especially people who have weak immune systems, the bacteria can become active and cause TB disease.
TB in Miami Beach, plus references
Several Students At High School Test Positive For TB
POSTED: May 6, 2005
MIAMI BEACH, Fla. — Health officials confirmed that nearly a dozen students at Miami Beach Senior High School have tested positive for tuberculosis.
What Is It?
Different Types Fact Sheet TB Glossary
Officials tested 98 students at the school after a student from the school tested positive for the disease.
Health officials announced Friday that 11 more students also tested positive for tuberculosis. A positive test can either indicate an active case of the disease or just an exposure. Those who test positive will need to go to a doctor or to the health department for more testing. Either way, they will be put on medication.
Officials said there is no way to determine if those who tested positive picked up the tuberculosis from the student who had tested positive or from another source.
Letters were sent home with all of the students who attend the school to alert parents to the situation. Health officials said that there is no quarantine at the high school.
For more information about tuberculosis, its symptoms, and how it is spread, click here.
Copyright 2005 by Local10.com. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
North Hardin student tests positive for TB Health department to test possible carriers
By SARAH BAKER
Lincoln Trail District Health Department officials are working with North Hardin High School to identify potential carriers of tuberculosis after one student at the school tested positive for the disease.
“We’re basically in the process of identifying those who might need to be tested,” said principal Bill Dennison.
Health department personnel notified the school of the case after school Friday. Dennison sent letters to parents Monday, informing them of the situation. Health department officials are unsure how many people will be recommended for testing. Considering the close quarters of a school
setting, the number could be higher than in other cases, said Rick Molohon, the department’s environmental health director. The tuberculosis bacteria travels through the air. When a carrier coughs or sneezes, others can inhale the bacteria.
Once those who might be infected are identified, the health department plans to return to the school and test those people for free, Molohon said. A tuberculosis skin test is also available at the health department for $8.
Nurses from the health department also will host informational meetings in the school’s cafeteria at 6:30 p.m. Wednesday and Thursday. Molohon said they will discuss the disease, testing and treatment. “A case like this is treatable. There’s medicine that takes care of this,” he said.
According to the Centers for Disease Control, tuberculosis can almost always be treated with medicine. After a few weeks on medication, patients feel better and may no longer be contagious.
Last year, the Kentucky Department for Public Health reported an all-time low of 127 tuberculosis cases in the state. Molohon said two or three cases were reported in Hardin County.
The bacteria enters the lungs and, if able to grow, destroys tissue, starting with the lungs and possibly spreading to the kidneys, spine and brain.
Most immune systems can prevent the bacteria’s growth, leaving it inactive but alive. This is known as a latent infection. The tuberculosis skin test usually identifies latent infections, which should be treated, according to the CDC.
Symptoms of active tuberculosis include a bad cough that lasts longer than two weeks, chest pain, coughing up blood or phlegm, fatigue, weight loss, chills and fever.
Sarah Baker can be reached at 769 1200, Ext. 428, or e-mail her at sjbaker AT thenewsenterprise.com.
Copyright © 2005 The News-Enterprise http://www.thenewsenterprise.com
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Workers in Processing Plant Being Infected with Tuberculosis USAgNet – 05/03/2005
A screening of 222 workers at a Tyson chicken processing plant in Broken Bow, Oklahoma, revealed that 41 were infected with tuberculosis, the Oklahoma State Health Department said. The health department saif the infections did not poise any danger to consumers.
Health workers began testing workers at the plant after a worker there was diagnosed with the tuberculosis. “Initially, I think they selected 18 individuals to test that had the closest amount of contact with the infected individual and they found about half of those to be infected,” Oklahoma’s Tuberculosis Control Officer Dr. Jon Tillinghast commented. “So they expanded the numbers of individuals to be screened.”
Health workers said it was possible that some of the infected workers were exposed years ago from unrelated cases, and were not diagnosed until now. Tillinghast said that tuberculosis is generally treated with six-months of antibiotic treatment.
One dies; 18 infected with tuberculosis in Sapporo hospital
Friday, May 27, 2005
SAPPORO — Three patients and 16 staffers at a cosmetic surgery hospital in Sapporo have been infected with tuberculosis since March 15, and one of them has died, Sapporo city health center officials said Thursday.
One of the infected patients at the Seikei Geka Memorial Hospital, a man in his 60s, died in late March. The patients shared a room at hospital. (Kyodo News)
(note: this is an earlier reporting of the Miami High School event:)
Miami Beach High Student Diagnosed With Tuberculosis
POSTED: May 4, 2005
MIAMI BEACH, Fla. —
Students and teachers at Miami Beach Senior High School will be tested for possible exposure to tuberculosis after a 17-year-old sophomore was diagnosed with the disease.
Testing will begin Wednesday at the school to make sure no one was exposed to the airborne TB germ.
Health officials will test 149 students and eight teachers who had prolonged, repeated contact with the infected student.
“We’ve been seeing recently cases that are in adolescents because they’re more dramatic, because they’re in school and we highly encourage those that have been identified to get their PPD testing and to work with the public health officials at the school so they could then be properly handled,” said Lillian Rivera, with the Miami-Dade County health department.
This is the second case of TB in a Miami-Dade high school in the past month.
Previous Stories: April 6, 2005: Miami Central High Students Tested For TB After Classmate Diagnosed
Copyright 2005 by NBC6.net. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
History of Tuberculosis
(as written by Margaret Tulloch and edited by Richard Sucre)
Prior to the discovery of the tubercle bacillus, consumption, as tuberculosis was then known, was treated primarily in the home, though some consumptives traveled to salubrious climates in places such as the Adirondacks or the Rockies to recover. Consumption in the early 1800s, for
instance, was regarded as a wasting disease which produced in its victims a refinement of the body, heightened artistic sensibilities and ennoblement of the soul. At this time, notions regarding diagnosis and treatment varied widely.
According to the historian Katherine Ott in her work entitled Fevered Lives: Tuberculosis in American Culture since 1870, “The illness itself was
characterized by a fluid group of behaviors, signs, and symptoms, with shifting connotations. Diagnosis depended largely upon a patient’s temperament, which could be sanguinous, lymphatic, bilious, or nervous.
However, as in other areas of medicine, there was no consensus upon what each signified.” Doctors in the 1870s and 1880s offered often conflicting diagnoses and cures, prescribing all manner of “snake oil” patent remedies.
One physician even espoused the belief that by wearing a beard, a man could effectively ward off consumption. The Romantic perception of
consumptives as the tragically beautiful victims of a wasting disease was replaced with a stigmatized view of “lungers” as the infectious carriers of a devastating illness, as fear of contagion spread in the late 1800s with the emergence of new theories regarding bacteriology.
Towards the turn of the century this escalating terror, coupled with optimism regarding the institutionalized treatments first pioneered at the German “closed institutions” run by Drs. Hermann Brehmer and Peter Detweiler, led to the construction of tuberculosis sanatoria across the United States. According to Sheila M. Rothman, author of Living in the Shadow of Death: Tuberculosis and the Social Experience of Illness in American History, “A generation of physicians, social reformers, and philanthropists were convinced that confining the tubercular in these facilities would promote not only societal well-being by isolation those with the disease but also individual well-being by implementing a therapeutic regimen. The sanatorium satisfied both the drive to coerce and cure.” As concepts of bacteriology gained acceptance, the idea of caring for patients in a setting removed from the general populace was considered wise and necessary for preventing the spread of the disease. Not only would such a location ensure the public welfare, but the siting of sanatoria in the countryside was also considered to aid the patients in their recovery. At the time, cities were considered by many to be pestilential and insalubrious places so the notion of patients taking in the fresh air and sunshine of healthful and preferably mountainous, rural settings was persuasive. Even in the early 1800s when notions regarding diagnosis and treatment were far from standardized, fresh air, along with nourishing sustenance, was one of the few antidotes upon which most physicians and patients agreed, especially given society’s reluctance to embrace urban life and pandemic fears regarding immigrants, tenements and the physical and moral “evils” of the city. It is not surprising, then, that pastoral settings, often former farms, were viewed as the ideal locations for sanatoria and that many maintained their own agricultural operations, particularly dairies, in order to supply the patients with fresh and healthful alimentation.
Nonetheless as treatments progressed and the responsibility for recovery was subtly shifted away from the patients themselves to their doctors, these sanatoria with their agrarian healing landscapes were closed and converted to geriatric, psychiatric or other such facilities. Their dairy herds were sold at auction, as their fields and pastures were often parcelized and sold for development. According to historian Katherine Ott, today “therapy relies completely upon chemotherapy. There is no need for a change in lifestyle, personal habit or mental adjustment.” Tuberculosis today is treated in clinical, modern settings where efficiency and technology are of primary importance and the mantra of “fresh air, rest and good food” is accepted as intuitively, rather programmatically, important. The outpatient clinics and hospitals of today are often found in urban settings, as tuberculosis has increasingly become a disease of AIDS patients and the homeless – ironically, the very settings which in the early part of this century were believed to cause the disease. As Ott astutely observes, “The history of tuberculosis chronicles how a romantic, ambiguous affliction became first a dreaded and mighty social truncheon, and finally an entity bound up in the public health and civic order.” Thus, the evolution of medical and popular notions regarding tuberculosis is reflected in the changes of the settings in which the disease was treated, ranging from the early sanatoria with their pastoral healing landscapes and agricultural operations to the more antiseptic and clinical, from both a physical and metaphorical standpoint, modern hospitals of today.
It is in this larger context that the history of tuberculosis sanatoria in Virginia unfolds and is best understood. Blue Ridge Sanatorium, for instance, is representative of many of the early sanatoria in Virginia and beautifully embodies this complex evolution of theories regarding tuberculosis. By examining its current physical form and looking back through its archives to see how the site has changed over time, as well as by researching the institution’s shifting attitudes toward the treatment of tuberculosis and resultant transformations in the way of life at Blue Ridge, we can begin to comprehend this history. As we have seen, agriculture and nutrition played an important interrelated role in the treatment of tuberculosis at such institutions and it is through this particular lens that we will regard the history of the disease at Virginia sanatoria such as Blue Ridge Sanatorium.
The Law regarding TB (Communicable diseases) Federally,
12(1) Notwithstanding subclause 33(4)(c)(i) of the Act, a person who is diagnosed as being infected with tuberculosis or as being a carrier of tuberculosis shall request a physician, a clinic nurse or the tuberculosis investigator to communicate with the person’s contacts.
(2) A physician or clinic nurse who receives a request pursuant to subsection (1) shall refer the request to the tuberculosis investigator and forward to the tuberculosis investigator the information provided by the person pursuant to clause 33(4)(b) of the Act within 72 hours if possible, but not later than 128 hours after receiving the request.
For Saskatchewan the requirements for informing and reporting of communicable diseases are set out in this regulation: (link no longer valid)http://www.qp.gov.sk.ca/documents/english/Regulations/Regulations/p37-1r11.pdf (see sec. 12 for tuberculosis).
I’m sending along some information on the Federal level as well. There appears to be an effort to coordinate information under the aegis of the Public Health Agency of Canada and something called the Advisory Committee on Epidemiology. Here is a link to some information about what
they are doing: http://dsol-smed.phac-aspc.gc.ca/dsol-smed/ndis/list_e.html (note in the Glossary section a definition of “notifiable”).
Tim Schobert Library of Parliament/ Bibliothèque du Parlement Ottawa, ON K1A 0A9 Tel: 947-6795 email: schobt AT parl.gc.ca