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Respiratory System and Health

Tuberculosis, immune system

The Boston Red Sox and Tuberculosis

By Dr. W. Gifford Jones

April 18, 1993

How close you can be and yet still so far away. A few years ago all the Boston Red Sox team needed was one more strikeout and they would win the World Series. But it didn't happen. In the 1980's it appeared that tuberculosis, the leading cause of death in North America at the turn of the century, was about to receive the final strikeout. But again it didn't happen. What went wrong? And why may it be necessary to help doctors make the TB diagnosis.

Á Dr. Don Kopanoff, a TB specialist at the Centers for Disease Control in Bethesda, Maryland, claims we declared an armistice against TB too soon. Now we have a potential worldwide disaster on our hands.

Á Currently it's estimated that between 10 to 15 million Americans carry the TB germ in its dormant state. In Harlem, New York City, the rate of TB is the same as in sub©Saharan Africa! Rates are escalating in Miami, Oakland and Los Angeles. And in Canada's aboriginal people and urban areas TB is similarly increasing.

Á Dr. Anne Fanning of the Alberta Tuberculosis Service says everyone became mesmerized and believed the antibiotic streptomycin had put an end to TB. So sanatoriums were closed and the whole structure for TB control dismantled. Doctors also forgot that the last cases of TB are the hardest to eradicate. And they made the tragic mistake of failing to think about tuberculosis when the diagnosis should have been obvious.

Á Recently a four month old girl in Alberta had been coughing for four months and had lost weight. The family doctor diagnosed whooping cough. Later a public health nurse suggested a tuberculin skin test which was positive. An X©ray then revealed extensive tuberculosis.

Á Another young child suffering from wheezing and a low grade fever was admitted to hospital. The diagnosis bronchial asthma. He was treated with asthmatic medication and discharged in a few days. A few weeks later due to severe coughing he was again admitted to hospital. X©rays showed tuberculous infiltration of the lungs.

Today everyone in North America has a greater chance of exposure to TB. Immigration has brought many people from Europe and Asia where tuberculosis is on the increase. The World Health Organization reports that in Europe and other industrialized countries there are over 400,000 new cases and 40,000 deaths from TB every year. Even Switzerland has experienced a 33 per cent increase in TB between 1986 and 1990. The situation is worse in underdeveloped nations.

Á Some of the resurgence of TB is tied to the worldwide increase in AIDS. Patients with this disease have a compromised immune system making them easier prey for the TB germ.

Á Doctors are encountering another obstacle. The TB bacillus has become resistant to treatment in about 7 to 10 per cent of cases. In some parts of South East Asia and Latin America it's as high as 30 per cent. Immigrants who come to North America help to reactivate TB in susceptible people such as the elderly, residents of chronic care facilities, alcoholics, drug abusers and those living in slum areas.

Á How infectious is TB? Experts claim you have to be exposed repeatedly in a closed space for long intervals. But if you have a weakened immune system you are more vulnerable to tuberculosis.

Á But there are exceptions to every rule. For instance, one patient 12 months of age developed tuberculosis but no member of the family had this disease. Public Health officials finally identified a person with a large tuberculous lesion who lived in the same apartment building. The families had never met. The only contact could have been in the hallway or laundry room.

Á Tuberculosis infection usually doesn't strike like a 10 ton truck. Investigators believe that 90 per cent of those who develop active disease have harboured the infection for periods longer than one year. The remaining 10 per cent experience a more rapid onset.

Á Can we all help to combat this ancient scourge? First of all doctors must once again add TB to their list of diagnostic possibilities. And until this happens medical consumers may have to nudge them a bit.

Á This doesn't mean we should all become paranoid about anyone who wheezes or coughs. But if a new immigrant from South America or South East Asia has a chronic cough, recommend he or she sees a doctor and suggest the possibility of TB.

Á Can TB be wiped out? The good news is that tuberculosis is 90 per cent preventable and 99 per cent curable. So it can be done. But it will take a mammoth educational effort and a final strikeout to eliminate this ancient killer. First we must all start thinking "TB" again. If we don't it will be easier for the Boston Red Sox to win the World Series. ŒÁ


W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com

My book, �90 + How I Got There� can be obtained by sending $19.95 to:

Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1

Pre-2008 articles by Gifford Jones
Canada Free Press, CFP Editor Judi McLeod