What is tuberculosis: 10 facts to Know

Published on 4 October 2021

We may think of tuberculosis (TB) as a disease of the past, but it is still a current and persistent disease. In fact, TB is one of the leading causes of death from an infectious agent and one of the most burdensome diseases in the world.

Globally, about 2 billion people are infected; about 10 million people suffer from TB disease and 1.5 million of them die from the disease.

According to Dr See Kay Choong, Head & Senior Consultant, Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, there were 1,370 new cases of active TB among Singapore residents in 2020. “The incidence rate was 33.9 cases per 100,000 population in 2020, compared to 34.7 cases per 100,000 in 2019,” said Dr See. 

TB is of particular concern because of several factors:

• Active TB is highly contagious

• It can cause severe illness and can be fatal if untreated

• Latent TB can progress to active TB in those who have poor immunity

• Apart from the lungs, TB can cause serious damage to the brain, heart, kidneys, bones and joints

• Strains of drug-resistant TB are increasing, making the disease harder to treat

Dr See pointed out that TB is particularly dangerous and can cause serious multi-organ damage in people with poorer immune systems, such as young children, older adults, those with poorly managed chronic disease and people on immune-suppressant medications. He added that most patients who get a severe form of the disease require intensive care and treatment, otherwise, the disease can be fatal. Dr See said, “Stopping its spread and treating disease early will reduce the burden of TB.”

This means prompt identification of TB is key to treatment. These days, the disease is quickly and accurately diagnosed with x-rays and molecular tests.

Once TB is confirmed, Dr See highlighted the importance of timely treatment. This usually takes the form of four kinds of oral pills for two months, followed by two kinds of oral pills for another four to seven months.

“Strict compliance is critical,” he said, “If oral pills are taken regularly, cure rates are very high and can be over 90%.” On the contrary, lapses in medication can lead to more problems, such as drug resistance. 

He explained, “This means that patients need to switch to stronger medications and take more of them, including injections. Treatment will also take longer, for as long as one to two years.

In Singapore, TB is treated under MOH’s Directly Observed Therapy (DOT) programme. DOT ensures that TB patients take each dose of medication under the direct observation of a healthcare worker to ensure that the correct dose and combination of medications are taken for the entire course of the treatment. This prevents treatment failure, emergence of drug resistance and further spread of the disease.

Written in consultation with Dr See Kay Choong, Head & Senior Consultant, Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital.

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