T.b.

[plachonubon]

HI ,

I'd like to know about contracting TB i see or hear about many people with TB in Thailand.

How easy is it to catch? I've been here 5 yearsmostly in Bangkok but spend alot of time in Issan.

Is there some precautions we should be taking against getting this?

THNX for any advice.....

[FBN]

HI ,

I'd like to know about contracting TB i see or hear about many people with TB in Thailand.

How easy is it to catch? I've been here 5 yearsmostly in Bangkok but spend alot of time in Issan.

Is there some precautions we should be taking against getting this?

THNX for any advice.....

Transmission of TB requires fairly direct and prolonged contact with an active carrier. The latest, more resistant strains seem to be more infective (hence the huge hoo haa a while ago about the US guy who flew on a commercial airline) but healthy, immune competent people has relatively low risk. It is usually recommended to have household staff (especially nannies) screened in endemic countries.

[seonai]

As someone with TB and particularly damaged lungs - also white, middle class and previously a nurse - I'd say that TB is quite easy these days to catch and that people ought to be aware of it. You have to be in prolonged contact with a person who is coughing to get it but air travel and close living quarters mean this is more likely. I am one of those kind of people who thinks that a disease like this will never happen to me... but it did... and it is causing all sorts of probs with my life

[Mossfinn]

How easy is it to catch?

Is there some precautions we should be taking against getting this?

Neither rhyme nor reason, I am afraid.

As others have said, it can be caught by prolonged contact with infected carriers, but once treatment has started, the risk of infection reduces substantially.

However, you can catch the infection quite easily as well, just by walking through an infected sneeze or cough, although having a compromised immune system will strengthen the possibility.

Remember that approx 25%/30% of people are latent carriers of TB in the first place, you just need something to drop the gate and let the little buggers in.

TB some Info

Moss

[seonai]

Good comments Moss,

Don't know where FBN is getting his info and I'm not going to jump as it's probably not his fault ... Grrrrrrr ... but this is typical of the world's perception - having the maid checked - TB can and does affect every type of human it has nothing to do with class/culture/race/economic background. In fact, in the past in Britain it was very common amongst the literary upper classes

[Prakanong]

Good comments Moss,

Don't know where FBN is getting his info and I'm not going to jump as it's probably not his fault ... Grrrrrrr ... but this is typical of the world's perception - having the maid checked - TB can and does affect every type of human it has nothing to do with class/culture/race/economic background. I fact, in the past in Britain it was very common amongst the literary upper classes

Totally agree it is not a class based disease but maid or nanny screening is not a bad idea if you are employing someone from a TB endemic area - in fact it is a requirement in many countries as a condition of maid employment.

There are a few companies working on new vaccines for the new strains so there may be hope on the horizon.

[stevenjm]

If you were living and sleeping with somebody who had active tb and breathing their coughs etc and were still ok 3 months later would that mean you don't have it? Or can it take a while? How long is it usually between initial infection and noticable symptoms?

Edited November 18, 2007 by stevenjm

[FBN]

Good comments Moss,

Don't know where FBN is getting his info and I'm not going to jump as it's probably not his fault ... Grrrrrrr ... but this is typical of the world's perception - having the maid checked - TB can and does affect every type of human it has nothing to do with class/culture/race/economic background. I fact, in the past in Britain it was very common amongst the literary upper classes

Totally agree it is not a class based disease but maid or nanny screening is not a bad idea if you are employing someone from a TB endemic area - in fact it is a requirement in many countries as a condition of maid employment.

There are a few companies working on new vaccines for the new strains so there may be hope on the horizon.

The key word in my post was "endemic" as is kindly pointed out above as well as "nanny" ie a person employed to work closely with infants who are much more susceptable to this disease and prevention at this level is really an employer/parent responsibility.

The same goes for health screening of any worker living and working in closed environments such as oil rigs etc. In Thailand, several cases have occurred over the past few years on local oil rigs. Fortunately, no transmission of the disease occurred in any of these cases to fellow workers that shared accommodation etc.

Statistics published by the Pakistan central statistics department show that TB is the main cause of death for males in the 45 to 49 year age group. It would be irresponsible not to advise screening for TB in this population. This is a scientific and epidemiological fact and should be recognised if we aim to control the spread of this disease.

The aim of health screening is to detect and treat and protect, not to exclude, discriminate or imply lower social status or stigma in any way.

[luumak]

I think likemany diseases it depends on the carrier and your immunity. Despite the realities I do not want to downplay, I have lived a total of four years in really dicey parts of India, Indonesia and Cambodia. No TB.

I do think some sort of situation is brewing thgough with this drug resistant TB. There are places I wont go out of many fears in 5 years.

[Mossfinn]

as "nanny" ie a person employed to work closely with infants who are much more susceptable to this disease and prevention at this level is really an employer/parent responsibility.

Spot on FBN, it is good practice and it will put your mind at rest, I think the point being made was, it should not be a social stigma, your little ones can be just as at risk from so-called other levels of society, but if your maid/nanny is going to have close contact, I think you are being wise.

I also think education is important, when you see someone/anyone sneeze or cough, ask them to cover their mouths or even better into a tissue and then dispose of it sensibly, this is not a nanny state, just wise precautions, I get a lot of black looks when I do it.

This is a scientific and epidemiological fact and should be recognised if we aim to control the spread of this disease.

I did not know this FBN, it is a good tactic to identify certain at risk groups and then educate and inform.

The aim of health screening is to detect and treat and protect,

Again, I agree, however it is difficult to protect when certain Gov'ts take a conscience decision to save money by, 'treating infection', instead of eliminating at source. I believe the U.K stopped the BCG jab circa date of birth 1969 in schools, because they thought it more cost effective to treat the infection rather than inoculate, these people should be put in court for Human Rights abuses.

not to exclude, discriminate or imply lower social status or stigma in any way.

Good Luck

Moss

[seonai]

Point taken FBN Simple misunderstanding

[jukapot]

seonai

I have recently been diagnosed with MAC disease which is related to the TB germ but is not contagious. My frequently out of breath and suffer from terrible fatigue. I don't think I have other symptoms at this time. I have no unusual cough and my liver is OK, Thank God.

What symptoms are you experiencing with Tb ??

I will be taking medication soon and am not anxious to start because of the cost and I am told the the treatment is worse than the disease, Basically its three pills a day for 18 months under the supervision of a doctor. I am curious if the medication is the same as what you are taking, I understand that you are having a hard time and are often sick.

the meds I will be taking are

The current treatment of choice for new patients with either of the two types of lung disease due to MAC is a three-drug regimen of pills. The medications are clarithromycin (Biaxin, made by Abbott Pharmaceuticals) or azithromax (Zithromax, made by Pfizer), (both belong to a chemical class of drugs called macrolides); ethambutol (Myambutol, Barr Pharmaceuticals); and rifabutin (Mycobutin, Pfizer); or rifampin (Rifadin, produced by Aventis Pharmaceuticals). For patients with advanced or severe disease a fourth drug is given as an intramuscular shot or intravenous infusion. This drug is either amikacin (Amikin, by Sicor Pharmaceuticals) or Streptomycin (X-Gen Pharmaceuticals). Other drug companies sometimes produce the generic forms of the medicines.

Good luck with your battle

Tom (aka Jukapot}

[seonai]

Hi Tom,

Well my TB went undiagnosed for a year or so and I am also on the meds for 18 months - 2 years. I have had various combos but right now it's Ethambutol, Rifanah, Izoniazid, Ciprofloxacin and Azithromycin. I don't want to put you off as evryone has different experiences with these drugs but they do have side effects. The most pronounced are - sickness/nausea/stiff knees and joints/appetite probs.

TB symptoms I had (again different for everyone but mine were classic) - bad cough/night sweats/tiredness/weakness and no appetite. It wears you down until it consumes you and kills you if you don't have the treatment.

Please keep discussing here as it's important that people read about this awful disease.

Click on my profile and click view my website and then Seonai's World and you can read my experiences.

Best of luck Tom

[bina]

I believe the U.K stopped the BCG jab circa date of birth 1969 in schools, because they thought it more cost effective to treat the infection rather than inoculate, these people should be put in court for Human Rights abuses.

as far as i know, according to my mom (an ex respiratory therapist so worked with lots of tb) the vaccines were not considered effective and gave a false sense of security and a false positive in tb checks.... the annual tb checks done in schools was considered more effective. this was in the states.

my mom dealt with mostly an ageing population of lots of alcoholics, and gypsies (in maryland!), and HIV positive with tb... she also tested positive once, was treated promptly and that was that....

now is israel tb has made a huge comeback from the immigrants from russia and ethiopia; lots of scandals about segregation, stereotyping etc.. but unfortunately, these groups are the ones that fall between the cracks due to not following thru with medical treatments (we have socialized medicine here but language and culture cause problems as well as finances as socialist medicine doesnt mean free)...

my son's asthma clinic is also one of the main treatment clinics for tb in the jerusalem area (tied in to hudassah tb clinic i think )and apparently they are very good; we also had one nurse here with tb in her internal organs, treated for two years, recuperated, she continues to be a nurse and is as healthy as a horse (its her farmer swiss genes i guess). not sure how she got it as she is our local kibbutz family nurse and doesnt handle large and varied populations so perhaps someone else here had it also w/o our public knowlege. no one treated her any differently because of the tb, either.

while most immigrant workers were supposedly tested before coming over to work, i've always wondered how 'real' those tests were; for all the thai workers, chinese workers, romanians, etc....

we do do screening here in the schools, yearly...

[seonai]

Like I said, everyone'sexperience of TB is different.It is not possible for me to generalise on this. Some people are lucky and just take the drugs for 6-9 months and never have any more probs, others have a lung removed and then run a marathon (true story)others, me, are permanently disabled from it... My advice Jukapot with the drugs isto find a patternfor yourself that suits ie taking them half an hour before food and making sure you eat in 30 minutes. Or seperating them into two piles, one in the morning one at night etc etc. That's if you are not on DOTS

[girlx]

TB can and does affect every type of human it has nothing to do with class/culture/race/economic background. In fact, in the past in Britain it was very common amongst the literary upper classes

isn't TB the same disease they used to call "consumption"? i think it was quite common in all populations at one point.

[seonai]

Absolutely GirlX. It 'consumes' you - hence the reason I only have a tiny part of my lungs left. It is killing 2+ million a year at the moment and is on the rise in the USA and UK. I advise anyone with a cough or feeling of tiredness that won't goaway to have a TB test at the doctor's - it's pain free and easy. Better to catch it early or you'll end up like me

[uhuh]

If you were living and sleeping with somebody who had active tb and breathing their coughs etc and were still ok 3 months later would that mean you don't have it? Or can it take a while? How long is it usually between initial infection and noticable symptoms?

It does not mean u r ok.

You can be infected and not have symptoms for many years - but treatment is recommended.

Or you can develop symptoms very slowly so u dont think of TB for many months.

[TommyGun]

http://www.ghchealth.com/vaccinations-the-...f-the-time.html

some info on vaccinations

[geriatrickid]

TB is now the number one priority for the WHO in asia. Aside from medical impact, the economic devastation predicted is horrific. Countries like India and Thailand cannot afford the costs to prevent the spread, nor can they afford the resultant economic impact. Therefore, the onus is on us to take the necessary precautions and to include screening as part of the regular physical. I get pricked every 18-24 months. The peace of mind alone is worth it for me. Aside from that, we can't do much else except help those that are infected. If a staff member becomes infected, the approach should be one of helping out since a hostile approach will send that person off to work elsewhere to support him or herself and thus spread the illness to those that are unaware of the person's condition.

[Ijustwannateach]

When you say you have a cough with TB, is it different from the cough of the common cold or post-nasal drip? Do you cough up sputum, and is it clear or infectious-looking (yellow-green)? I've had colleagues before with some kind of chronic dry cough- should I worry about them?

"S"

[Sheryl]

If you were living and sleeping with somebody who had active tb and breathing their coughs etc and were still ok 3 months later would that mean you don't have it? Or can it take a while? How long is it usually between initial infection and noticable symptoms?

It does not mean u r ok.

You can be infected and not have symptoms for many years - but treatment is recommended.

Or you can develop symptoms very slowly so u dont think of TB for many months.

Most people when infected with the TB bacilli will mount a successful defense and keep it walled off, nopt develooping the dsiease but having antibodies to it(which will cause a reaction to the TB skin test). In fact a evry hgih percentage opf the piopulation of SE Asia are in this category, infecetd tihe the bacillus but not ill with TB. However such people may develop TB at any time in the future that their immune systems are stressed or weakerned.

Steve, best advise is to have a check-up that includes a TB skin test and X-ray and tell them you had TB exposure. The combination of the chest film and skin test will idetify if you have been infected by the bug but are not yet sick, have started to develop TB, or are luckily neither.

As to how it happens...conventional medical thought is that it requires prolonged contact with an active carrier OR a very weakened immune system. But in recent years people who as far as is known don't fall into either group have been getting it and the simple truth is we don't yet know why. It may be that ehy at some point were in contact with an unusually infective person ("super spreader") and didn't know it, and this could have been at almost any tiem since as mentioned the body when in good condition can often keep the bug walled off and prevent disease.

Hopfeully more will be known soon but for now, the best preventive advice for people who have no known contact with an infected person is just good nutrition, enough sleep, avoid or constructively manage stress...in other words basic good health. If in contact with an infected person or person you suspect might be infected (someone with a productive cough that oersists fior 2 weeks or more is suspect, but of course in a public place like on an airplane you don't know how long a person has been coughing so in that situation, anyone with a productive coiugh) the precautions are very frerquent hand-washing and thei nfected person should wear a mask or you could..but be sure to change it frequently. The hand-washing part is what many people don't realize about repsiratory infections of all sorts...the biggest risk is not breathing in the germs but touching them without knowing it (breathing in can happen, but unless you are very closeby it is morel ikely that you'll put your hand on something that has been aerosolized with bugs from the other person's cough or sneeze).

[seonai]

Sheryl, do you think it is possible that my TB bugs are living in the cavity I have in my right lung? Because the medication didn't work last time - as in I was told to stop in January this year and then became highly infectious again in March. My current consultant is seeking advice froma leading specialist on my case as it is quite unusual.

For IJWT and the others - be aware that the 'classic' symptoms of TB infection don't always appear in every case so it is wise to be checked as Geriatrickid said. I know of two close friends - one being Mossfin on this forum - who had/have TB and neither of the three of us had anything like the same symptoms. My frind Ann had no cough at all, nothing to spit up, only tiredness and a feeling that 'something was wrong'. They had to do a broncoscopy to get a sample to test whether or not she was positive

[Mike45]

Hi

Sheryl, I have read about adverse reactions to the medications for TB. I also realize that many medications are sometimes required for treatment.

I want like to know if patients can expect to have the same kind of problems with the "one Isoniazid a day for 9 months" regiment which is frequently prescribed for latent TB and a clear X-Ray.

Thanks

[Sheryl]

Seonai, there are undoubtedly TB bacilli in that cavity and more to the point, it sounds like they may be drug resistant.

Sometimes in that situation it becomes necessary to surgically remove the affected part of the lung, altho they will try every possible drug treatment first.

Mike, while taking only INH is of course easier to handle than the whole cocktail, INH does have a number of potentially serious side effects. The most commom serious problem is liver toxicityy depression of the bone marrow can also occur. And a few people are allergic to it, as is true of any drug.

It is essential to have periodic blood tests (complete blood count and liver function) before and during INH treatment.

It is also essential to go back to the doctor at once if you start to feel ill, even such seemingly unrelated problems as feeling unusually tired or nausea may be early signs of toxicity.

INH can also cause neuropathy (nerve damage), to prevent this [pyridoxine (Vitamin B6) is always prescribed along with it. But again, any strange symptoms like tingling, numbness should be imemdiately reported whiel taking this.

Don't mean to scare you..to give you a sense of proportion, the incidence of liver toxicity in people under 65 on INH is about 1-2% if they are healthy with no history of drug abuse or alchoholism, higher if they do. So most people do just fine, but it is important to take the drug and its adverse effects seriously and comply fully with the recommended follow up checks.

[luumak]

i dont think its so easy and believe it takes fairly direct contact. ive been all sorts of crazy places and take public transport and no tb. having said that it only takes one (like hiv eh?)

but it is on the rise and on my mind more than ever also fact tb drug resistance is a big problem now.

[Mossfinn]

I believe the U.K stopped the BCG jab circa date of birth 1969 in schools, because they thought it more cost effective to treat the infection rather than inoculate, these people should be put in court for Human Rights abuses.

as far as i know, according to my mom (an ex respiratory therapist so worked with lots of tb) the vaccines were not considered effective and gave a false sense of security and a false positive in tb checks.... the annual tb checks done in schools was considered more effective. this was in the states.

Hi bina, I guess we will just have to disagree, my info came straight from a, 'tropical and infectious diseases', specialist, apart from the Human Rights Issue, that my own rather over the top reaction.

Moss

Edited December 30, 2007 by Mossfinn

[Mossfinn]

When you say you have a cough with TB, is it different from the cough of the common cold or post-nasal drip? Do you cough up sputum, and is it clear or infectious-looking (yellow-green)? I've had colleagues before with some kind of chronic dry cough- should I worry about them?

"S"

The cough in TB are varied, can look and sound similar to the common cold or flu. It can be a racking cough or just a persistent, small, sometimes imperceptible stutter.

Not every TB case will develop into a sputum inducing cough.

As for your colleague, I would suggest a check up.

Moss

[Mossfinn]

Sheryl, do you think it is possible that my TB bugs are living in the cavity I have in my right lung?

Seonai, there are undoubtedly TB bacilli in that cavity and more to the point, it sounds like they may be drug resistant.

Seonai,

As Sheryl has said, every chance you have the little buggers in the cavities, exactly what they advised me earlier this year, difficult to get to, to treat apparently.

Good Luck

Moss

[bina]

moss,

my mom worked as a respiratory therapist with mostly tb patients (before that it was preemies);

this was in the 1970-80's in a hospital in maryland with a large tb patient population , and that was what she told me as i had asked since in israel all the people i know of my age did get tb shots (tb was and is prevalent here)... but nowadays the kids dont get it as a vaccine any more....

she was tested yearly but not vaccinated either (wonder why actually as that is an occupation hazard) just tested. postitive twice, treated as if she had it and then finished. athough i guess there is such a thing as a false positive if exposed but not infected? or vaccinated?

bina