UK’s TB battle sends lessons to high-burden Bangladesh

Many may think that tuberculosis, known as the poor people’s disease, may not be there in the UK. But it never went away, with experts saying that low prevalence has given rise to a new problem which can serve as a lesson for high-burden countries like Bangladesh.

Born in the UK, 76-year old Cedri Moizer was diagnosed with tuberculosis in January this year. He is a COPD, a lung condition in which a patient finds it hard to climb even stairs due to shortness of breath. He was also coughing.

But his recent increasingly higher spasms of coughing failed to draw doctors’ attention to the fact that he might have developed tuberculosis.

Moizer told bdnews24.com at Liverpool University hospital, where he had come to share his case with international journalists ahead of the 47th Union World Conference on Lung Health from Oct 26 to Oct 29, that his cough had not gone away with the medicine the first doctor had prescribed.

“I started to lose weight, could not eat, feeling very tired and cold,” he recalled. “Then again went to the doctor with my wife. This time I had a chest X-ray. A few hours later I got a call which told me it looked like a deep-rooted case of TB.”

Then he was further tested to confirm the presence of TB in his body. He said he had completed his six-month medicine after starting in January. “Now I am okay”.

Professor of Clinical Tropical Medicine S Bertel Squire, who is the director of the Centre for Applied Health Research and Delivery of the Liverpool School of Tropical Medicine, said the doctor who missed the diagnosis initially might have not seen any such cases in his career.

“But TB is very much there in the UK,” he said. “With the numbers going down, awareness has gone away.”

Photo : Reuters

“I’ll predict 2O years from now, Bangladesh will have this same kind of numbers as we have today. You will face the problem we are discussing unless you start to think ahead. We have to think how to deal with small numbers,” he told bdnews24.com.

“Many doctors will not be familiar with TB. So they would not recognise the cases. And they may not see (symptoms) until very late. So the transmission potentials go up”.

In fact, he said, TB was not only about numbers. “When you are in any country TB numbers go down; the TB cases that you are left with will be more complex.

Last year, England and Wales together identified 6,24O cases. Of them 2,42O were in London, 57O in the north-west region, which includes Liverpool and Manchester.

Bangladesh is one of the top six TB burden countries in the world, with poor socio-economic conditions.

“In Bangladesh you are now treating patients who have the disease. When you get the numbers down, you will have cases like Cedric, who had the infections in childhood when TB was prevalent in the UK.

“You will still have older patients who will develop reactivation diseases,” he said, adding that treatment of some other diseases can make adults immune system suppressed, giving rise to TB.

“So it ends when you also treat the infected latent cases,” the professor said, adding that the UK was finding latent patients by contact-tracing of family members of an infected person.

“TB is a never ending battle unless we work together,” he said, as he noted that most TB cases in the UK came from people who had emigrated from high-burden South Asian countries.

“We have to tackle this in solidarity…countries like the UK need to share their experiences….we also need to know your experiences,” he said.