The death of a maid from tuberculosis has raised awareness of the infectious disease
Since antiquity, it has gone by many names: consumption, the wasting disease and Koch’s Disease – the last after the German doctor who discovered the bacteria that causes it. But is tuberculosis, or TB for short, on the rise here?
Nine days ago, the body of Filipina domestic worker Jennifer Pioquinto Dignos, 31, was found in River Valley Road. She is believed to have died of the infectious, airborne – and sometimes deadly – disease. Contact tracing to identify individuals who may have been put at risk due to prolonged contact with her is currently being carried out.
According to Ministry of Health (MOH) statistics, the first six months of last year saw 745 new cases of TB among Singapore residents. In 2009, the ministry was notified of a total of 1,442 TB cases. Of these, 66 ended in death. The number of TB related deaths last year is currently unavailable. Several factors may account for this increase, such as the reactivation of latent TB infection among the rapidly ageing population here, and increased global travel.
An MOH spokesman notes that TB was fairly common in Singapore in the 1960s and earlier. Adults living in Singapore then may have contracted latent TB but are only now developing active TB in their later years because of a weakened immune system. That said, 92 of last year’s cases came from the five to 29 age bracket. In addition, five patients were under the age of four. People with latent infection have TB germs in their bodies but do not display symptoms because the germs are not active. The disease develops only in about 10 per cent of those infected.
Classic symptoms include fever, sweating at night, a persistent cough lasting more than three weeks and coughing up of blood or sputum. Diagnosis usually involves, among other means, a chest X-ray and laboratory tests of sputum. Not everybody who gets infected falls sick: The body’s immune system “walls off” the bacteria, which can lie dormant in the body for years. About 20 per cent of individuals with active TB do not show any symptoms.
One of them is Veron (not her real name), a 28-year-old executive. The disease was discovered during a chest X-ray for a routine health screening at her company last year. “I had taken up long-distance running and I don’t smoke or drink. I felt very healthy, so I was pretty shocked,” she recalls, adding that she had experienced no symptoms before being diagnosed. She was subsequently quarantined for two weeks at Tan Tock Seng Hospital’s Tuberculosis Control Unit and given a six-month course of drug treatment. Although she experienced headaches initially, she was able to continue leading a normal life. She was given the all-clear earlier this month.
While the disease can be treated and cured with a cocktail of drugs, MOH stresses the need for early diagnosis and complete treatment, which takes six to nine months. Patients who fail to adhere to treatment may continue to be infectious or even experience a relapse. Its spokesman says: “The tuberculosis bacteria may mutate into a drug-resistant form, which will be more difficult to treat.”
Mr Myca Tan, Singapore Anti-Tuberculosis Association (Sata) CommHealth’s spokesman, adds: “While it is likely that a patient’s condition could improve a few weeks after treatment, it is important to complete the full course of the treatment in order for all the TB bacteria to be killed.” More than 85 per cent of those infected are cured, says Dr Cynthia Chee of the unit. But this is provided the patient does not have drug resistant TB, receives the correct medication and takes the medicine faithfully. While the disease is spread when an infected person coughs or sneezes, Dr Chee stresses: “It usually requires many hours of exposure to the germ to be transmitted to close contacts. Only a minority of those who inhale the germ will develop active tuberculosis.”