Tuberculosis and Me, a Dilemma !

[DavoTheGun]

Some background, My wife's son moved in with us a month ago, into our new home. we live in a small village in Issan, about 1000 people, on the outskirts.

He has been living with the family in large home before, when i first met this 19 year old boy about 18 Months ago i said to my wife he looks sick and needs to go to a hospital and get a check up, he is very thin only 42 Kilo, this was totally ignored of course.

Since living with us he has this persistent cough, I insisted he go and get a chest Xray, which he did, which I paid for of course, he has Tuberculosis, Now he is in hospital after much argument with him and my Wife.

He should be kept in for at least a week to establish what form he has, this I know, Type M, Hiv. HIV & M What, I need to know!

My requests for this information are being laughed off! It is not a problem they are saying,,he is also going to a college, told I should keep quite! I teach at the college he goes to.

He is being let out of hospital after only 2 Days, because he is making such a fuss about being there, WHAT!

What to Do, this one has me stumped! Thainess!

I expect the usual crap from TVF, but be some good comments, I hope, .

[GuestHouse]

Go talk to your own doctor, or if you do not have a doctor go to an international hospital and talk to a doctor about your concerns.

He will explain if there are any risks to you, perhaps recommend tests/inoculations AND if you ask, will advise you if the TB Type M (?) is a notifiable disease.

If it is a notifiable disease then ask how to proceed.

If the disease is notifiable and contagious it is very likely the lad should not be in college.

Oh and go alone.

Blood, even infected blood, is thicker than water.

Edited August 31, 2014 by GuestHouse

[3NUMBAS]

people still die of TB in los despite the medication available

a galsfriends sister suddenly died at a young age from TB despite the 30bahts scheme

Edited August 31, 2014 by 3NUMBAS

[MAJIC]

people still die of TB in los despite the medication available

a galsfriends sister suddenly died at a young age from TB despite the 30bahts scheme

What is even worse,is the fact one TB vaccination jab is cover for a lifetime!

Edited August 31, 2014 by MAJIC

[Rooo]

Moved to health.

[submaniac]

I would agree with Guesthouse that you need to find a doctor to talk to at least know what is going on (what type it is). They would know the rules and regulations about all this. When I read the post my first thoughts of the potential legal liability. Tuberculosis is an infectious disease. If he's going to a crowded college campus (especially one where you teach at), there's a likelihood of spreading it. I don't know exactly what Thai law says about it, but I do know that in the United States you can be held criminally liable for not warning/engaging in activity which spreads an infectious disease (for example unprotected sex if you have HIV/AIDS, people can and have been criminally prosecuted for that). The fact that you have a job there, and have something to lose, only means you have to be more vigilant in taking care of the problem. (In other words, CYA)

In regards to the vaccine, there is only one vaccine that is available which is the BCG vaccine. http://en.wikipedia.org/wiki/Tuberculosis_vaccines, http://en.wikipedia.org/wiki/BCG_vaccine ("Today, there is only one tubercuosis vaccine available, bacilli Calmetter-Guérin (BCG) which has been around since 1921.[")

The United States never implemented a wide policy of immunization for tuberculosis.http://en.wikipedia.org/wiki/BCG_vaccine:

"United States: The US has never used mass immunization of BCG, relying instead on the detection and treatment of latent tuberculosis."

Whereas in the UK it was widely given:

"United Kingdom: The UK introduced universal BCG immunization in 1953, and until 2005, the UK policy was to immunize all school children at the age of 13, and all neonates born into high-risk groups. The injection was only given once during an individual's lifetime (as there is no evidence of additional protection from more than one vaccination). BCG was also given to protect people who had been exposed to tuberculosis. The peak of tuberculosis incidence is in adolescence and early adulthood, and the MRC trial showed efficacy lasted only 15 years at most."

I know a little bit about it because I was immunized for it in childhood in Thailand and for the rest of my life on hospital questionaires I have to check the box that I was immunized for it (which was in the USA because, like I said, the vaccine is rarely given in the states, and I guess the fact that you were given the vaccine could effect the results of other tests.) I have been getting my immunizations up to date but the tuberculosis one is a little tricky and hard to get in the United States.

The problem with it is that while it works in children, it's effectiveness varies when given to adults:

"Although BCG immunization provides optimal protection for infants and young children,^[3] (including defence against TB meningitis and miliary TB),^[4][5] it poses unpredictable and inconsistent consequences in adults^[6] with efficacy ranging from 0%-80%"

And how long the protection lasts is questionable:

"The duration of protection of BCG is not clearly known. In those studies showing a protective effect, the data are inconsistent. The MRC study showed protection waned to 59% after 15 years and to zero after 20 years; however, a study looking at native Americans immunized in the 1930s found evidence of protection even 60 years after immunization, with only a slight waning in efficacy.^[23]

BCG seems to have its greatest effect in preventing miliary TB or TB meningitis,^[24] so it is still extensively used even in countries where efficacy against pulmonary tuberculosis is negligible."

So long story short, for those people that were immunized with it in childhood, still use precautions when interacting with tuberculosis infected people because you may or may not be protected.

[ezzra]

Shouldn't that read Tuberculosis and I ?

[jacko45k]

I am perplexed by his and your wife's behaviour.

I am sorry to say I think they are trying to keep something from you

[cardinalblue]

You are at risk in a closed environment with an active TB case...You should take a long trip or move out until source is removed.

Disagree about immunization is the way to go.. No effective evidence for it.

The protocol is/should be isolate and treat active TB cases until evidence is negative.Should also investigate other contagious diseases this young man might have...

Incredibly poor public health treatment is this kid is allowed voluntarily to leave hospital...unacceptable Public Health policy

CB

[DavoTheGun]

You are at risk in a closed environment with an active TB case...You should take a long trip or move out until source is removed.

Disagree about immunization is the way to go.. No effective evidence for it.

The protocol is/should be isolate and treat active TB cases until evidence is negative.Should also investigate other contagious diseases this young man might have...

Incredibly poor public health treatment is this kid is allowed voluntarily to leave hospital...unacceptable Public Health policy

CB

I agree entirely, but no so easy for me to do!

[guavagirl]

TB is extremely contagious if you are living under the same roof. It is also very dangerous. My husband had it and refused to see a doctor (we actually thought it was dengue at first). Eventually it went to his brain and he was in a coma. We are very lucky he pulled through and in 100% better, but the doctor said if/when he woke up he may have brain damage.

IMO he should get proper meds now before it is too late!

BTW he was immunized for it but clearly it did not work. The doctors had to do many tests before they could determine what was wrong and had initially ruled TB out due to his immunization. He nearly died in the process.

[stgrhe]

I would move out if my wife wouldn't listen to common sence about such a serious matter.

[recycler]

You and other family members are at risk at your home and so is the population of the school!

As you mention you don't get a lot of cooperation at home, but maybe the school will be more interested in preventing an outbreak.

You may be able to play this with some colleagues to void your direct involvement.

The background may be that they are well aware of the causes and it may involve HIV or whatever "face loss" issue for the family so that they want to keep this quiet and hope it may blow over...heads in the sand...

This and other stories urged me to take my wife's 2 year old son with us very soon after we met hoping to prevent horror in the future.

All the best for you to solve this problem!

[JenniferSG]

Your doc may prescribe prophylactic meds for everyone in the house to avoid your getting sick. I work in a public facility in the U.S. where people with active TB (and who are mentally ill) come in homeless, off their TB meds, refusing to wear a mask, etc. I used to freak out about TB exposure until I'd been tested 10 times (every 2 years) in 20 years and never had a postive exposure despite working with at least 30 people like this over the years. That said, if you're living/sleeping etc. in close quarters where you can inhale spittle, I'd probably not stay under the same roof until you've talked to your doctor. Also, as an employee at the college are you not duty bound to report this info, so as not to risk the health of other students? Just curious.

[EvilDrSomkid]

This is a very difficult situation to be sure. Recently, one of my wife's uncles was found to have TB as well. After being pestered for days to go to the doctor, he goes. And he drives a delivery truck for Yamazaki. I refuse to go and see him. And my wife supports me in this.

However, OP lives in a small village in Isaan. Did he expect another attitude? Its your wife's son! She will not kick him out, but I am still amazed she does not force him to get better.

OP, you are going to have to make some very difficult decisions. Sit your wife down and explain to her the seriousness of the situation. If she refuses to listen, well, you know where you stand...

[Toscano]

I would not have somebody with active TB live in my , my wife's house !!!

There may be a number of ways this young man has contracted TB . Poor living conditions , catching it from another family member or children at school . I think that one of the principal ways Thais get TB is from eating raw meat from local cows . In Isaan the cows are all very thin and look to me as if they have TB . I will never eat beef from our local markets ; but a party delicacy here is finely chopped raw beef , with chillis , intestines , dung , pa la , fish sauce all mixed up like a pate .

My wife's son 20yrs decided to leave his young wife in Bangkok and move home . I told my wife she was not to have him live in our house , sponging off her . He'd completely take over and eat her out of house and home . In fact he went to live with his grandfather , who came home one day and found him in bed with a girl . After that he went to live with the girl's family .

[khunianb]

Advise your wife that you want to see her son's HIV test results. He needs to take the appropriate medications and have his TB treated with a very strict regimen. Ignoring his health situation is highly dangerous as he can infect others with TB, which is increasingly treatment resistant. TB is increasingly a result of suppressed immune response caused by HIV infection, which has not been appropriately treated.

[Sheryl]

I don't understand "He should be kept in for at least a week to establish what form he has, this I know, Type M, Hiv. HIV & M What, I need to know!"

All TB is caused by Mycobacterium Tuberculosis.

He definitely should, however, be tested by HIV because TB-HIV coinfection commonly occur.

TB is not "highly" inhfective, it is harder to transmit than some posters seem to suggest, but certainly among close contacts it can spread, especially if personal hygiene is poor or living quarters crowded. Assuming he has pulmonary TB, which from your mention of cough he probably does, he has been infectious and will remain so for about 4 weeks after starting treatment (assuming, of course, he complies with the treatment). How much of a risk depends in part on whether he has a productive cough (brings up phlegm).

Everyone in the household should be screened for TB (chest Xray and skin test).

After he comes home, and especially for the first month, care should be taken to avoid any contact with his respiratory secretions and everyone in the household should practice frequent hand-washing especially after touching surfaces he may also have touched, and he should be scrupulous about washing his hands often and especially after coughing. However from the sounds of it, he probably will not be.

Suggest you go to an infectious disease specialist for proper screening and bring your wife with you in possible; hearing from a Thai doctor will have some influence on her. It is probably worth paying out of pocket for this.

[farangforever]

For the benefit of anyone getting a chest x-ray anytime, I was advised some time ago by an Amercian Dr. in Bangkok a Dr. and radiologist need to be asked to specifically screen for TB as they may miss it otherwise, latent TB can be burried deep in the lung tissue and therefore hard to spot.

[Gandtee]

Shouldn't that read Tuberculosis and I ?

Oh. Give over!

[RedQualia]

I tested positive for TB some years ago. The doc showed me the chest x-ray, and said not to worry... That my body had "walled off" the small infection and that all was well. Whatever that means. How was I exposed to TB? I dunno, specifically, but

"When people with active pulmonary TB cough, sneeze, speak, sing, or spit, they expel infectious aerosol droplets 0.5 to 5.0 µm in diameter. A single sneeze can release up to 40,000 droplets. Each one of these droplets may transmit the disease, since the infectious dose of tuberculosis is very small (the inhalation of fewer than 10 bacteria may cause an infection)." -- http://en.wikipedia.org/wiki/Tuberculosis

That said, I kinda think there's a good chance that anyone who rides the skytrain regularly, or rides around in Bangkok taxis, could be exposed to such, and repeatedly. Same for anyone who hangs out or lives with local folk on a regular basis. Which is not to say anything bad about the local folk at all. But seems likely that they could represent a greater path for transmission.

I actually believe that I was infected by a girlfriend's father maybe ten years ago when I visited him at his home. He was being kind, I'm sure, sitting near the fan and making sure that it was generally blowing in my direction. He was hospitalized for TB a month or so later.

This is Thailand. Possible (likely?) exposure to TB comes with the territory. Just the way it is. But prolonged and daily exposure to TB seems not a particularly good idea. Were I in your situation, I think I would clearly explain the health risks, then move out, and take my money with me, until the problem was resolved. I can't be sure, but I suspect that would result in fairly rapid resolution of the problem.

[IAMHERE]

GET YOURSELF CHECKED. There are some incurable strains out there. Hope you have not caught it. If He happens to have it ... JUMP SHIP. No girl or boy is worth taking the risk for, most things you can take a chance with albite with precautions. You don't want to take needless chancess.

[ukguyinthai]

Your family is behaving very stupidly to your and their health. Everyone’s life is at risk at home and a school full, yet they tell you to be quiet. They ignore you.

What to do mate is take charge….give the orders “you already know what needs to be done”. If they ignore you, instantly move out, save your own life. Go find a family with a few more brain cells who care about you. You have let this thing drag on far too long already, get yourself checked.Let them know you are 100% serious and you might save some lives,in the school at the least.

[MrY]

people still die of TB in los despite the medication available

a galsfriends sister suddenly died at a young age from TB despite the 30bahts scheme

What is even worse,is the fact one TB vaccination jab is cover for a lifetime!

Nope. Got it anyway. Not 100% effective...

[AnotherOneAmerican]

You are at risk in a closed environment with an active TB case...You should take a long trip or move out until source is removed.

Disagree about immunization is the way to go.. No effective evidence for it.

The protocol is/should be isolate and treat active TB cases until evidence is negative.Should also investigate other contagious diseases this young man might have...

Incredibly poor public health treatment is this kid is allowed voluntarily to leave hospital...unacceptable Public Health policy

CB

What CB says,

Move out of the house immediately, don't go back until everyone living there is clear.

You really don't want to catch TB.

You should also inform his school in the public interest.

But I can accept, that really isn't your business.

[DiDiChok]

It's a shame and I know how the OP feels. Life is said to be cheap in Thailand but I think it's more the Buddhist "What happens is predestined". I've been there when a rural Thai hospital inappropriately gave a pat on the head and a paracetamol. I've also been there when a Thai Doctor acted brilliantly and discovered something potentially fatal that we didn't know about.

In my case the Doctors wouldn't believe me the boy had TB of the lymph glands until I insisted they do a test. I knew because of the pattern his temperature took over a 24 hour period, and it was something I had seen before. The boy hadn't told the Doctor that because of 'Greng Jai' towards the Doctor! The course of tablets to cure that was ฿15,000 and six months treatment.

Then they denied to my face what was also obvious to me, which was that this was caused by the tertiary phase of HIV when multiple opportunistic infections attack. I was so incensed that in the end I had to get him signed up at a proper HIV clinic to get the HAART treatment he needed. Since then he's put on 20 Kg, looks well, no longer coughs and has got himself a job and at least a future life.

I have to say that the OP has got his work cut out if he wants to save the boy. The question for him to ask himself is this: "Do I want to see this through to the end and have I got enough money to do it, or should I leave it to pre-destiny?".

[MAJIC]

people still die of TB in los despite the medication available

a galsfriends sister suddenly died at a young age from TB despite the 30bahts scheme

What is even worse,is the fact one TB vaccination jab is cover for a lifetime!

Nope. Got it anyway. Not 100% effective...

Maybe not everone is covered?,but in the UK everyone is vaccination,and I don't recall any reports of those that contracted TB after vaccination..

[AnotherOneAmerican]

Here we go, vaccine protects 50% of recipients.

So fairly useless.

http://www.immunizationinfo.org/vaccines/tuberculosis

Edited September 1, 2014 by AnotherOneAmerican

[partington]

Here we go, vaccine protects 50% of recipients.

So fairly useless.

http://www.immunizationinfo.org/vaccines/tuberculosis

You are stating a foolish opinion. The exact link you gave says this:

"Those who receive the vaccine may still develop TB, but approximately 80% of recipients are protected from developing life-threatening forms of the disease, such as miliary disease and meningitis (inflammation of the brain)."

If you regard this as "useless" you are a very strange person.

[Sheryl]

The vaccination is recommended only for children as it primarily protects against forms of TB that primarily occur in children,. it is not recommended for adults. (And most Thais will already have had it as children).

So not really pertinent to the OP's situation.Let's stay on topic.