Thinking of the world's kids on World TB Day

"Tuberculosis is as old as mankind." I quoted this 1974 article the other day when I was describing the challenges with diagnosing TB in children. Today is World TB Day. On this day in 1882, Dr. Robert Koch discovered the cause of TB, the tubercle bacillus. A lot of people think of TB as a disease of the distant past, a disease we don't need to worry about any more. TB makes you think of "consumption" and of the tragic stories of poets like Keats -- romantic young figures wasting away while coughing up blood. (Or maybe it's just us English majors who think of TB that way.)

Unfortunately, TB is not just a disease of the past. I suspect most people in the United States would be shocked to know that one third of the world's population has been infected with TB. Even worse, there are more than nine million new cases of TB each year.  TB is still common in places with poor health care systems, places where people live in crowded conditions, and places where many people have weakened immune systems.  Unfortunately, most of the world's poorest countries have all of those problems at once. And so TB causes lots of deaths in countries already suffering from poverty, poor infrastructure, and HIV.

Our HIV clinics see a lot of patients with TB. In fact, TB is the biggest killer of people who are HIV-infected. During my last AMPATH clinic day in Kenya, a thin mother came into my exam room with a pair of adorable 15-month-old identical twins. The two boys looked exactly alike, but they could not have reacted more differently to seeing me. One wailed and screamed from the time his mother carried him into the room, while the other quickly warmed up to me with some stickers and hand-shaking. (He kept looking at his twin brother like "what is wrong with you?") As it turns out, the identical twins did not have identical medical issues; the wailer is HIV-infected and was hospitalized with a bad pneumonia just 2 weeks before I saw him (hence the wailing at the sight of a doctor), while the quieter twin looks like he is going to be HIV-negative (he'll have his final text to be sure in another 3 months). They do share one medical problems though; they both have been coughing for weeks, running fevers, and not gaining any weight over the past few months.  That is exactly what TB usually looks like in our HIV-infected kids. I sent them off to get x-rays of their chests, suspecting I would see at least one x-ray picture that would make me decide to start these two on TB treatment as well.

Along The Field

TB is tough on kids. Their immune systems are not fully developed, and it is especially hard to make a clear diagnosis of whether or not they have this infection. Usually, an adult in the house will get TB first, and then the children are soon to follow. TB is spread when you are in close contact with someone who has TB and who is coughing. Because you can hold small children close to you, they are more likely to get infected by someone who is sick with TB. 20-50% of children who live in households where an adult has active TB become infected. Children with TB do not grow well. TB can put their lives in danger with serious pneumonias, and the infections can spread to other parts of the body, or pop up in places like the brain, where it can cause meningitis.

Normally, TB can be treated easily and cheaply, but if your doctor does not realize that it is TB or if you do not have access to a doctor, TB can be missed. And then TB continues to spread.

While most of my work focuses on HIV, I'm actually involved in a number of TB projects right now as well. We are working on an analysis of how to best use clinical symptoms and scoring systems to predict which children need to be treated for TB. And I work on another project to try to develop new formulations of anti-TB medicines that are much easier for babies and young children to swallow. The geniuses at Purdue are working to put it in a little wafer that dissolves almost instantly in babies' mouths.

I know TB is one of those far-off, doesn't-affect-me diseases for most of my friends and family (Thank God). But TB is an every day problem in Kenya, and it's an every day problem in many parts of the world.  An every day problem, but one that causes huge amounts of suffering, sickness, and grief. I'm hoping that "World TB Day" will make lots and lots of people think about TB for a few seconds today. Maybe read something about TB, maybe say a prayer, maybe make a visit to the Stop TB partnership, maybe even give some money. On behalf of the rambunctious toddlers of my present and future, I would appreciate it. 

Posted at 09:45

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