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Re-Emergence of Tuberculosis in Peel

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Article published on page 25 in the March 28, 2012 issue of
The Mississauga News under the feature: Health & Beauty, Medicine Matters.
Portrait of Dr. Peter W. Kujtan, supplied 2005
Dr. Peter W. Kujtan

Tuberculosis (TB) is a respiratory disease that affects one third of the world’s population. By the time you finish reading this column, three more people will have succumbed to the disease.

There has been a re-emergence of Tuberculosis in the Peel Region. In the 19th century it was referred to as “consumption”, and was a common cause of death in Peel.

Peel has twice the Provincial rate of TB, despite the fact that it is the only disease that our government provides free care and medicinal treatment for everyone.

We are more diverse now, and half of our population is made up of immigrants born elsewhere. Many arrive from TB hotspots such as India, Pakistan and the Philippines, where there exists a great degree of social stigma towards the mention of the disease. Of the 130 cases discovered in Peel last year, more than 90% can be traced to a world hot spot. The active form of the disease causes a lot of symptoms and can be tracked down easily.

The problem arises from latent TB, where there are few or no symptoms. The patient has been infected with the bacterium at some point and it lays dormant in the body with a potential to flare up and cause disease. It is important to find these people and offer treatment to stop the spread which occurs through coughing.

To test for TB, we usually start with a skin test, in which some non-active antigen is inserted with a fine needle into the skin, and the reaction of the body observed 48 hours later. If the T-cells of your immune system have been sensitized to TB by previous exposure, a raised area of reaction may occur. If the first test is negative, it is often repeated 1-2 weeks later, a method which enhances detection.

Many false positives occur especially if you received the BCG (Bacillus Calmette-Guérin) vaccine in childhood.

People with persistent coughs, night sweats and fever are offered a chest x-ray and their sputum is examined directly for the presence of TB. Our detection rates remain fair and newer tests have emerged. One such test is the QuantiFERON blood test which is more sensitive, but not covered by OHIP. The detection of latent TB is a clinical judgment that requires experience and detailed information.

If you are found to be infected, you receive fully funded treatment and medical supervision.

TB is still a very treatable disease, despite the slow emergence of resistant strains. Treatment involves taking medications for many months, and many of our elderly patients feel fine and cannot see any reason to take the medications. This is further compounded when people travel back to their homelands for visits and the potential for silent re-infection arises. The active form of TB often will emerge in the presence of other infections such as HIV or when people's immune systems are weakened by cancer.

See Disease Control: Tuberculosis (TB) from Peel Public Health, Region of Peel website: www.peel-stoptb.ca for more answers.

Related resources:

Tuberculosis from Wikipedia. Tuberculosis, MTB, or TB (short for tubercle bacillus) is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis.
Tuberculosis (TB) from MedicineNet. Symptoms, Signs, History, Treatment, Causes. How does a person get TB?
Tuberculosis from Canadian Lung Association.
Tuberculosis Prevention and Control in Canada: A Federal Framework for Action from Public Health Agency of Canada.
Tuberculosis from American Lung Association. Understanding Tuberculosis. Symptoms, Diagnosis and Treatment. Preventing Tuberculosis. Living with Tuberculosis. In-Depth Resources. Take Action.
Tuberculosis from World Health Organization (WHO).
Tuberculosis from MedlinePlus. Symptoms of TB in the lungs may include:
    A bad cough that lasts 3 weeks or longer
    Weight loss
    Coughing up blood or mucus
    Weakness or fatigue
    Fever and chills
    Night sweats.

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