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Tuberculosis in Developed Countries - A Review

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TB persists in developed countries. Advances in diagnostic and treatment methods are required to control its spread.

Written by

Dr. Suhaila

Medically reviewed by

Dr. Kaushal Bhavsar

Published At April 24, 2024
Reviewed AtApril 25, 2024

Introduction

Tuberculosis (TB) is a contagious disease caused by certain bacteria, commonly affecting the lungs. Currently, it is preventable and curable, but without treatment, it can lead to death. This disease is commonly associated with developing countries, but it is still a concern in developed countries. This article plans to explore tuberculosis (TB) in developed countries, stating the challenges and preventive measures.

What Is Tuberculosis?

Tuberculosis (TB) is a bacterial infection commonly caused by Mycobacterium tuberculosis. It has been a global health concern for decades. This disease is mainly associated with the lung tissue, but it is not unusual to affect other parts like the spine, kidney, and brain. It is a potentially serious and contagious condition. The bacterium causing tuberculosis, Mycobacterium, is primarily airborne; it spreads through the air when an infected person sneezes or coughs. Inhalation of these infected droplets helps transmit them to other individuals. The symptoms of the disease include persistent cough, sometimes with blood, fatigue, chest pain, and significant unexplained sudden weight loss. However, like other respiratory disorders, the symptoms are nonspecific and can be mistaken for other disorders. Diagnosis involves taking chest X-rays and performing laboratory tests like tuberculin skin tests. Confirmation is usually done by culture.

What Is the Epidemiology of TB?

In developed countries, TB rates have undergone a drastic decrease with the advent of medicines and vaccines. However, certain groups of people are still facing a higher risk of TB infection. The various factors that lead to this prevalence of TB, even in developed countries, include:

Social and Economic Factors

  1. Immigration: It has been noticed that there is a rise in traveling between countries as a result of comparatively easy travel procedures. This leads to an increase in the movement of people from areas of high prevalence; they could be carrying the infection and develop TB after arriving in the new country.

  2. Overpopulation: Crowded areas can facilitate the spread of disease. Overcrowded living conditions lead to inadequate access to healthcare facilities, which can also increase transmission.

Health-related Risk Factors

  1. Resistant Strains: Multidrug-resistant strains have emerged, posing a serious threat. These strains cause diseases that cannot be cured with a normal regimen of medications and need added complex antibiotic dosages.

  2. Undernutrition: Poor nutrition or consuming foods of less nutritional value (junk food) weakens the immune system. When the immune system weakens, the body becomes more susceptible to diseases, including TB.

  3. Human Immunodeficiency Virus (HIV): It has a close association with TB.

  4. Alcohol and Drug Abuse: These weaken the immune system and make the patient less adhere to the treatment schedule, making them more prone to disease.

  5. Smoking: Smoking contributes significantly to damaging the lungs and respiratory system, thereby making them more prone to TB infection.

  6. Prior TB Infection: TB infection significantly lowers immunity, and even after successful treatment and recovery, the patient seems to be at a higher risk.

What Are the Challenges Faced by Developed Countries Concerning TB?

  1. Aging Population: With advancing age, the immunity of the individual decreases. In developed countries, the elderly contribute to a major TB population.

  2. Underdiagnosis: As the symptoms are largely nonspecific, they are not diagnosed early. Especially in developing countries where the incidence of disease is low, doctors do not consider this a potential threat.

  3. Co-morbidities and Immunocompromised Individuals: The use of medications that suppress the immune system, such as autoimmune disorders are more susceptible to disease occurrence.

  4. Treatment Adherence: Ensuring the patient adheres to the full course of the treatment regimen is very important to reducing the disease burden. However, it is challenging as all medications have side effects, and many mental and social factors come into play.

  5. Coordinating Care: Coordinating patient with the healthcare provider is challenging in both developed and developing countries.

What Are the Recent Progress and Initiatives Taken in This Regard?

  1. Improvement in Diagnostics Used: Advanced diagnostic aids utilizing molecular methods and rapid testing methods allow the clinician to make an easy, quick, and accurate diagnosis. Compared to older times, there are fewer chances of false positives.

  2. Treatment: Shorter patient-friendly regimens are introduced with the intent to prove adherence. Continuous research is ongoing in this field.

  3. Global Efforts: Countries participate in global initiatives with the intent to eradicate TB globally.

What Are the Treatment Considerations?

  1. Surveillance: Larger investment should be made by countries to investigate and research interventions for TB.

  2. Strong Healthcare: Prompt diagnosis treatment and support groups are needed further to help the patient.

  3. Integrated Approach: Collaborating TB prevention with other health initiatives and policies can significantly contribute to effective control.

The most commonly used drugs for treating include Isoniazid, Rifampicin, Ethambutol, and Pyrazinamide. These are considered first-line drugs. The treatment regimen is extensive, with the initial phase lasting around two months, during which all four drugs are combined. Following this phase is the continuation phase, which mainly involves Isoniazid and Rifampicin. The treatment duration can range from seven months to seven years. The duration is decided by the physician based on the severity. To simplify treatment, fixed-dose combinations are used, combining multiple drugs into a single pill.

  • DOT (Directly Observed Therapy): This means the healthcare worker ensures that the patient takes the medication. This is adapted to improve patient adherence and reduce missing dosages.

  • Regular Follow-up: Regular monitoring is to be done to assess the response to treatment and document any side effects. Progress is documented, and treatment is adjusted if needed.

Preventive care includes using these drugs, monotherapy, and regular screening assessment. As a prevention mode, the Bacille Calmetter-Guerin (BCG) vaccine is given to babies as early as the first week of birth. This helps prevent TB outside of the lungs.

Conclusion

Though TB cases have significantly decreased in developed countries, they still represent a public health challenge among the population there. This makes further investigating the diagnostic, preventive, and treatment fields necessary. While a lot of efforts are being made in this regard, factors such as overpopulation, migration,and the emergence of drug-resistant strains still necessitate a further detailed approach. In this regard, global collaboration, research advancements, and adopting a supportive approach considering the social and mental components of the disease are key to achieving considerable progress in TB control in developed nations. Through collective efforts, it can be controlled and eradicated.

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Dr. Kaushal Bhavsar
Dr. Kaushal Bhavsar

Pulmonology (Asthma Doctors)

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