Tuberculosis

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A disease that has existed since prehistoric times is making news in today’s West Coast. Long Beach, California seems to be the epicenter of an outbreak of tuberculosis (TB), leading to a public health emergency in the area.

Tuberculosis (TB), known in the past as “consumption” because it appeared to gradually “consume” the body, is an infectious disease caused by the microbe Mycobacterium tuberculosis. One quarter of the population in Africa and Asia is believed to have tested positive for the disease, which resulted in 1.3 million deaths in 2022.

At this time, Long Beach’s health department has identified 14 cases so far, with nine hospitalizations and one death. They have also found about 170 others with probable exposure. The cases seem to be centered around an unnamed hotel frequented by substance abusers, homeless, and the mentally ill.

TB has infected humans and certain animals for thousands of years. Evidence of the disease has been found in fossils of bison living in Wyoming 17,000 years ago. In Egypt, human skeletal remains with signs of tuberculosis have been dated to 4000 BC. TB has been shown to exist in the Americas for at least 2000 years. It should be noted, however, that there is no factual reason to believe that animals passed it to humans, as was previously thought.

SIGNS AND SYMPTOMS OF TUBERCULOSIS

Tuberculosis on Xray

Tuberculosis usually affects the respiratory system, but can also involve other parts of the body. Most cases are asymptomatic and are known as “latent.” Perhaps ten percent of latent infections activate into significant disease; if left untreated, TB kills about fifty percent of victims.

Symptoms include:

  • Chronic cough
  • Bloody phlegm
  • Fever
  • Night sweats
  • Weight loss

Once TB travels to other organs, symptoms relating to those organs may be seen.

HOW TUBERCULOSIS SPREADS

Tuberculosis is a contagious disease. It’s spread from person to person through the air. Only actively infected individuals spread the disease. Those considered “latent” don’t. Airborne droplets emanate from coughs, sneezes, spit, and even just speaking. Those with weakened immune system are most likely to develop active TB.

(ASIDE: I was working the emergency room in 1980 at a major inner city hospital in Miami when Fidel Castro shipped 125,000 refugees, many from Cuban prisons, to our area from a place called Mariel. As you can imagine, many were ill, and I was one of the physicians on the front line. This was before mask mandates, and sure enough, I turned positive for tuberculosis via skin test during the crisis. Luckily for me, it was a latent case and remains so to this day.)

DIAGNOSIS AND TREATMENT OF TUBERCULOSIS

TB is usually diagnosable by chest X-ray or lab examination of body fluids. Without modern lab studies, the diagnosis is made by the signs and symptoms, especially cough with bloody mucus. As many people have taken the TB skin test in the past, medics should include that information in patients’ medical histories.

Treatment requires a four-to-six-month course of combinations of antibiotics (which I took). Resistance is an issue in some areas, with increased cases of multiple drug-resistant TB reported.

TUBERCULOSIS IN THE U.S.

In the 19th century, TB killed one out of seven people living in the United States and Europe. The advent of antibiotics and improved public health measures markedly decreased the disease in the U.S. The current outbreak in California, however, is noteworthy in that it comes after the number of 2023 cases in the U.S. were the highest in ten years.

Forty states reported an increase among all age groups. Most cases were diagnosed in people born in other countries. Although not proven with hard data, undocumented immigrants probably comprise the majority of the increase in the states. Despite this, the U.S. has less TB cases than many other nations.

PREVENTION OF TUBERCULOSIS

Mask use is suggested for those caring for the actively infected. N95 masks, recently reported to be of little use against COVID-19, should be effective as they are 95 percent effective against airborne droplets larger than 1.3 microns. Mycobacterium tuberculosis measures an average of 2-4 microns.

Standard respiratory precautions are appropriate to help prevent Tuberculosis:

-Practice good hand hygiene; wash hands thoroughly and often during the day.

-Clean countertops, doorknobs, and other common-area items to reduce the viral load. A dilute bleach solution will work.

-Avoid social situations where someone is sick. Coughs and sneezes can reach others several feet away.

-Sick persons should cover their mouth and nose with tissues or other barrier when coughing or sneezing. Don’t have tissue? Sneeze or cough into your elbow or sleeve.

-Seriously ill individuals should be quarantined in an area away from high-traffic spots in the home. N95 masks provide some measure of protection.

Remember that staying indoors is not particularly protective against respiratory infections. The viral load in a closed and crowded room is probably much higher than the air outside!

Joe Alton MD

Dr. Joe Alton

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