Thursday, April 1, 2010

Stop TB Campaign Saudi Arabia


Tuberculosis is a multi-faceted disease caused by a mycobacterium, and which has been a part of human illness and medicine since Ancient times, as evidenced by its presence in Egyptian mummies, and in Egyptian medical treatises from 1500 BC. The Indian Vedas of the same era and the Chinese medical texts as ancient, testify to its universality in time and space. While infection of the lungs, and of the skin are the forms that are most common,  any organ system can be affected. The site of the primary infection determines some of the symptoms but others are systemic, eg fever, night sweats, fatigue, pallor, and weight loss.

La miseria (1886) by Cristóbal Rojas (1857–1890) portraying the 19th century conditions leading to the spread of tuberculosis, particularly among poor artists.

Other names for tuberculosis, usually based on symptoms and signs, as well as historical period, are consumption, phthisis, scrofula, Pott’s Disease, and the White Plague. As a key feature, especially in later stages, is weight loss to the point of cachexia (extreme emaciation), many of the names in various languages including the Latinate consumption, and the Greek phthisis, but also the Indian yaksma and the Incan chaky oncay refer to this sign of illness.

"O soave fanciulla", the aria from Puccini's La Bohème, celebrating the love of the poet Rodolfo and the seamstress Mimi, who will later die of consumption

The writings of Hippocrates, Aristotle, and Galen among the Classic physician-writers, and those in the Old Testament as an illness affecting the Jews while in Egypt, give an indication of the duration and range of the disease as an illness phenomenon. The Great White Plague refers to a 200 year period in Europe from the mid-17th to the mid-19th century when tuberculosis was a major scourge. From the mid-19th to the mid-20th century advances in both public health and infectious diseases--which the effort to control and treat tuberculosis helped to advance--resulted in a dramatic decrease in tuberculosis prevalence, morbidity, and mortality in Europe and North America. The discovery of the antibiotic streptomycin in 1944 was a major turning point.

Ward in a Sanatorium for Tuberculosis

Since then tuberculosis, while remaining a problem in underdeveloped nations throughout, has become a new focus of medical attention due to its associations with poverty and AIDS. Tuberculosis is quintessentially a disease of poverty with its combination of malnutrition, overcrowding, and poor sanitation, and of a weakened immune system. As such, it is now again drawing major research efforts through The Global Fund to Fight AIDS, Tuberculosis and Malaria, and through the American Center for Disease Control, specifically the National Center for HIV, STD, and TB Prevention. In particular, drug resistant strains, now a major problem since the 1980’s, are a prime focus.

The novel, and the film based on it,  focus on testing of TB drugs on Africans, and the threat of a pandemic of drug-resistant TB

As a disease which profoundly affected individuals (death rate of 50%, and high morbidity), families, and societies, tuberculosis also became a cultural phenomenon, much as AIDS did in the latter part of the 20th century--featured as a motif in literary, dramatic, operatic, dance, and art works. This was especially true during the Romantic Period (early 19th century) when the consumptive, and death by consumption, were a particularly “romanticized” character and theme, respectively. Some of them serve as illustrations here.

La dame aux camélias/The Lady of the Camellias--ballet to Chopin's Piano Concerto no.1

Stop TB Campaign--A Personal Learning Curve

I first became aware of the Stop TB Campaign to eradicate tuberculosis around the globe when it appeared on the CV’s of two extremely bright MENA physicians on government scholarship to Canada. I was helping them to prepare their applications to residency programs, and so we discussed their participation in a way similar to what might happen in an interview for a position.

It was a reminder that although we think tuberculosis has been eliminated in the West, in fact it remains a problem throughout the world, and particularly where poverty and overcrowding combine with climate to create perfect conditions for it being endemic. In medical school I was taught that tuberculosis is a disease of poverty, one where poor nutrition makes people susceptible to illness, inadequate public services aren’t able to meet needs for prevention and treatment, its highly contagious nature makes tuberculosis easy to contract, and poor hygiene due to inadequate facilities along with overcrowding makes spread rampant. Though medication is now available for successful outpatient treatment, it is a long course of treatment (up to 1 year depending on the protocol), and compliance is poor.

René-Théophile-Hyacinthe Laennec (February 17, 1781 – August 13, 1826) inventor of the stethoscope, and major figure in the history of medicine, himself died of tuberculosis aged 45, seen here in a painting, auscultating a patient

However, this learning was mainly a hypothetical. Although tuberculosis had been a problem in Canada through the 1st half of the 20th century, it was considered eradicated. The sanatoriums, the great hospital complexes that served as the treatment centres where children and adults would spend years resting, taking in the fresh air wrapped in blankets and seated in wheelchairs parked on verandas, and being fortified with good nutrition, were long gone, and had been transformed into medical, and often major psychiatric hospitals (I trained in 2 different ones, interviewed in a 3rd and attended a talk in a 4th). Our greatest concern was to be aware of those Canadians who had been vaccinated by BCG (Bacillus Calmette-Guérin) inoculation with attenuated live vaccine, usually as children in Britain, and thus would have a positive result to the standard and mandatory Mantoux skin test. Canadians normally test negative to this, showing no previous contact with the tubercle bacillus; and, if they do test positive, it usually means that they had had contact with the illness, but successfully fought it off without ever becoming ill. Their chest x-ray as a follow-up to a positive skin test would be normal.

Kiefer Sutherland's screen debut as Donald in The Bay Boy (1984), a semi-autobiographical film of the director's, Daniel Petrie's, coming of age in Glace Bay, Cape Breton Island, Nova Scotia, during the Great Depression. This clip shows the ravages of tuberculosis (in the brain and spine) on the once brilliant, athletic Joe, and his family. Later, Joe (19) will commit suicide.

It was during that time that I had a discussion with a former professor, now friend, whose older sister died about 1955 after being ill for some years with tuberculosis. My first reaction, after offering condolences, was to ask whether she had drunk unpasteurized milk, and contracted the disease that way. My friend said no, they lived near a dairy farm in rural England, and she caught it from the tubercle particles released into the air by infected cows. Being both a musician and a literary scholar she described beautifully the sound one would hear in the evening of the cows breathing, and blowing heavily. Sadly, their exhalations carried bovine tuberculosis through the air to nearby humans, including her sister. Due to her sister's illness, she spent a number of years living with her maternal aunt's family in France, so that she would be protected and that her parents could cope with the care-giving necessary. This marked her profoundly, in mostly positive, but some negative ways, as did her sister's death--not only for her own loss, but for her mother's failure to ever fully recover from the death of her firstborn.

Fantine's death from tuberculosis, in Les Misérables, the musical based on Victor Hugo's 19th century French novel of the same name

As a clinical clerk (final year of medical school spent on hospital wards, also called an externship), tuberculosis would be a rare discussion point--most memorably of a patient confined to isolation in a hospital room because he had been non-compliant with the year long medical protocol for outpatient treatment. He looked forlorn, lonely, and bored, and hovered in the doorway of his room, as if craving normal company, and wishing to escape. Tuberculosis is so contagious and such a public health hazard in any community that it is one of the few conditions where the government has the power to confine, to quarantine, and to treat a mentally competent patient against their will.

Oil poster, by Mucha Alphonse, Sarah Bernhardt in Alexandre Dumas' La dame aux camélias

When I was an intern, tuberculosis became a more pressing topic, because recent immigrants were arriving in greater numbers from places where tuberculosis was endemic, and so it had to be considered part of a differential diagnosis. This was accompanied by a certain “THEY are messing up our tuberculosis eradication” on the part of some staff. Since many immigrants were also from former British colonies where the live attenuated BCG vaccine was still administered, the diagnosis of tuberculosis was more challenging than a simple scratch test to start.

One particular case stays in mind because the patient, a recent immigrant from an area where TB is endemic, had the classic night sweats, fatigue, and weight loss of tuberculosis, but no respiratory symptoms nor skin lesions, which are the most common forms and the ones with which most are familiar. Ah, but TB is a multi-organ disease and he had TB of the abdomen. Only the infectious disease specialist was delighted with this finding--as a matter of professional interest, while being professionally compassionate and caring of the patient himself.

John Keats (31 October 1795 – 23 February 1821), the youngest of the great English Romantic Poets, died young of tuberculosis, as did his brother

During my residency, TB was making a comeback. There were 3 hypotheses as to why: brought in by recent immigrants who were infected but didn’t show symptoms and had a clear x-ray during their medical approval for a visa; reactivation of strains dormant in old sanatoriums which were now bustling hives of medical and psychiatric care, usually affiliated with teaching hospitals; relaxed public health measures, made compliance by a false belief of immunity. Alas, one needs to add to these the HIV/AIDS epidemic which caused sharp increases in the incidence and prevalence of a number of infectious diseases and cancers due to the increased susceptibility of these immuno-compromised patients.

Susan Sontag's Illness as Metaphor, a philosophical essay on cancer as the paradigmatic 20th century illness, comparing it to tuberculosis as that of the 19th century was followed by AIDS and Its Metaphors, a reflection on the AIDS epidemic of  the later fifth of the 20th century

While doing an elective in Morocco, I spoke with a respirologist who described tuberculosis as still a very active problem in the country. She also talked about seeing forms of tuberculosis and degrees of severity that were “only in text books in France, whereas here they are a regular clinical occurrence”. Later, when I was at a conference in Iran, the opening key note address emphasized that in Iran there were major health problems which required a broad approach to medical ethics, including attention to public health measures but also proper water and sewage systems even in remote areas. I was surprised to learn that tuberculosis was an important problem, in a country which also had the latest in reproductive technologies. However, it made sense that, given that a couple’s (often construed as a woman’s) infertility was a main cause of divorce, reproductive technology would be a main focus of medical interest and effort.

Davos, location of the Sanatorium setting of Thomas Mann's novel The Magic Mountain (1924)

So, back to the students with the Stop TB Campaign as an activity on their CV. In their part of the world tuberculosis is a more active concern for all rather than being a problem in Canada for AIDS patients, immigrants, and native peoples. It was a practical part of their GP training, and of  their GP practice in rural villages. It is a national shame that while rates of tuberculosis are low among non-Aboriginal Canadians, they remain high among Aboriginal Canadians, because of living conditions and insufficient public health care. Most cases are new cases, and most occur in young children, which is unusual compared to the non-Aboriginal population.

Figure 2
Age-standardized rate of TB incidence in Canada by origin, 1991-1999

Although the total percentage of Canadian cases is highest among the foreign born, and higher among non-Aboriginals, as a percentage of the population, it is markedly higher among Aboriginals, who are 30 times more likely to suffer from tuberculosis than is a non-Aboriginal Canadian. These statistics are much closer to those in the 3rd rather than the 1st world. In other words these students will be better prepared to deal with TB when they see it among the immuno-compromised and the foreign born who are most likely to come to their medical attention, but are unlikely, in the same way as most physicians are, to see its impact among Aboriginals particularly in the far north.

Figure 3
Proportion of reported TB cases in Aboriginal peoples in each province/territory, 1999

Stop TB Campaign--Globally

The Stop TB Campaign has as its long term goal the use of public health measures, and antibiotic treatment to eradicate tuberculosis. Its excellent website connects with information and resources from the World Health Organization, among others. Fact sheets on TB in English, Arabic, French, and Spanish are a good starting point for information as is the slideshow 10 fast facts on TB.

Official Stop TB photo of new Goodwill Ambassador Craig David

As for the 2010 campaign, which started mid-March and is now just ending, the same main site has statements from UN President Ban Ki-Moon, and Medical Chair of the campaign, Dr Espinal. Among other areas of interest is one showing the main research priorities and endeavours in prevention, treatment, and eradication. Among the Goodwill Ambassadors for the campaign is the newest, British R& B singer-songwriter, and actor, Craig David.

One of  Craig David's most highly considered song videos

Craig David's brief but informative message about tuberculosis, including his personal connection to tuberculosis in Africa and in Britain, as well as his philosophy of  prevention, treatment, and eradication

The campaign sponsors an annual photography contest which was won this year by David Rochkind for his photojournalism essay on Tuberculosis in Mumbai. An excellent video explains well and esthetically the myths and realities of tuberculosis prevalence, communicability, and treatment, showing misconceptions worldwide. Indeed tuberculosis affects most, if not all countries, such that the Stop TB campaign has 1331 partners worldwide, but the burden of illness is different nationally as the map below shows. These 22 countries alone account for 80% of the tuberculosis cases in the world:

The 22 countries with the greatest TB burden

Of these, those posing the greatest burden are India, China, Indonesia, Nigeria, and South Africa. On the other hand the countries with the highest numbers of cases per 100,000 are Djibouti (813), Somalia (249), Sudan (243), Pakistan (181), and Afghanistan (168).

MENA countries are not high burden countries which are mainly in S-E Asia, and a corridor of sub-Saharan countries running down the east side of the continent (not the Horn of Africa, except Ethiopia but still need to fight to lower tuberculosis prevalence. Of the MENA countries, Morocco (92), Yemen (76), and Qatar (70) have the highest number of cases per 100,000, while Saudi Arabia (46) occupies a middle ground with Iraq (56), and Bahrain (40). Interestingly the West Bank and Gaza Strip are lower (20) but more than double that of Israel (8, classified with European countries due to population composition).

Stop TB Saudi Arabia

Saudi Arabia is among the countries which partners with the Stop TB Campaign, and has 2 partnerships listed, King AbdulAziz University (KAU), and Serafi Mega Mall.  Stop TB Saudi Arabia also has a Facebook Group with 180 photos of the activities of this year's campaigns in Jeddah and Riyadh (some pictured below), including slides of all English and Arabic press items including these 2:

By Fouzia Khan March 16, 2010

JEDDAH – A group of 40 professional scuba divers took part in the Stop TB campaign here on Friday performing an action of gathering at 60 feet under water in the Red Sea. They unfolded a banner which read “Keep our environment clean and Stop TB.”
The 11-day Stop TB campaign was launched in the city on March 15.
The Stop TB Group of Jeddah has sent a strong message to the world to “keep the environment clean and stop spreading the diseases,” said Mohammed Bakhriba, the founder of the Stop TB Group Jeddah.
Dr. Nasha’at Nfouri, environmental specialist said that “our attitude would help or stop spreading of infectious diseases including TB, as we should avoid spitting on the ground, coughing on others’ face and make sure that sunlight enters our houses”. – SG

Saudi Gazette interview on the campaign and its objectives (8th Feb, 09), published on Feb 15th, 09.
(L-R) Dr. Nabeel Noura, Dr. Khalid Radwan and Eng. Mohammad Bakhrieba--quoted this year

By Fouzia Khan March 17, 2010
JEDDAH – The Stop TB (Tuberculosis) campaign was launched here Monday evening by a group of young Saudis with the partnership of the World Health Organization (WHO) and the cooperation of the Ministry of Health.
“We are pleased and proud of the work that has been done by Saudi youth and of their involvement in last year’s Stop TB campaign. Mohammed Bakhrieba, the founder of the Stop TB Group of Jeddah, and his team did an excellent job in creating awareness and promoting the campaign,” said Dr. Sami Badawood, Director General of Health Affairs in Jeddah.
Prof. Awad Abuzaid of the WHO projects in Saudi Arabia explained that the partnership of the community and different sectors of society with WHO and government organizations is very important to tackle both chronic and non-chronic diseases.
“We are very pleased that we joined the Stop TB campaign not only for Jeddah but for the whole Kingdom,” he said.
“This year’s campaign,” he said, “is aimed at containing the use of tobacco in the region. Saudi Arabia is really a tobacco consumption country and it is a grave problem. At the moment, we have two cities, Makkah and Madina, which are tobacco-free, and I hope that in Jeddah the remarkable work being done will bear fruit so that we can get rid of this big problem.”
Dr. Naela Al-Judayel, director general and incharge of the national TB program in the Ministry of Health, said the national TB program has been working since 1970 and is progressing effectively.
Mohammed Bakhrieba quoted WHO statistics showing that one-third of the world’s population is, one way or the other, exposed to TB bacteria. – SG

Among the activities were information booths in a number of main malls including games for children and pamphlets for adults, conferences, an art exhibit, with prizes for the winners of competitions, and certificates for volunteers. The Jeddah group included an underwater demonstration to draw attention to the campaign, as outlined in the article above, and in the pictures below.

Before the dive

Jeddah Divers for Stop TB

 Underwater in Jeddah

More pictures from the Facebook Group's Photos, showing the other activities in Jeddah and Riyadh:

 Opening of the Art and Photography Exhibit

 Paintings on exhibit

Research Poster exhibit

A beautiful welcome

Sharing information and fun with all age groups, Jeddah

 Looking for sweets


Display, Aziz Mall, Jeddah

Display South Mall

Closeup of information pamphlet

Close up of the rest of the pamphlet

Volunteer doctors, at the ready

Volunteers with certificates

Certificates close up

Academic conference

KSU representative

WHO Regional Director, Dr Jazayry

Media interviews

Interns looking at X-rays of chest TB

Lecture break!

And to conclude...

One more Craig David video, many chances does one get to hear an African-Briton R&B singer do a duet with an Italian contestant on an Italian version of American Idol? Not as good as Otis' recording of "Sitting on the Dock of the Bay" but interesting, especially for the remarks and the judges' comments after the song ended...oh and performed on March 22, 2010, just 2 days before International Stop TB Day, March 24, 2010!

Had you heard of this campaign before?
Has TB touched your life in any way?
Is it a major problem in your country? for whom?
Do you know of any former sanatoriums? What are their current uses?
How much awareness do you think we have of the less media magnetic public health problems in the world?
Have you been involved as a volunteer in analogous awareness campaigns?
Which of the cultural representations of TB are you familiar with?
Which do you enjoy esthetically?
Any other thoughts, comments, experiences?


Susanne said...

Thanks for the great information. I recall many years ago when one of my dad's aunts - maybe in her 50s at the time - had TB. I thought she was a goner for sure! I'd just never heard of anyone surviving it, but thankfully she did.

My brother in law - the one from Venezuela - tested positive for TB when he had the skin test. I can't recall if they did any further tests on him though I do believe they offered him medicines free at the local health department. Maybe it's some dormant strain...not sure, but it can be a bit worrisome to imagine he is carrying that around.

Other than that I can't think of how TB has affected my life. I enjoyed the pictures and watched the final video. The R&B singer has a lovely voice. The wild-haired judge (?) was interesting. :) Also the part about the cows somehow affecting the one sister - wow! Thanks for sharing!

Wendy said...

I have twice been checked for TB. Once because my brother was working in the NWT and became a carrier via exposure. The second was about 20 years ago when a co-worker who had just immigrated from Hong Kong was diagnosed with it. Fortunately both times I was given a clean bill of health. Interestingly when I got a job at The Bay in 1972 I was required to have a chest X-ray before being given permanent status to check for TB. Of course that no longer happens.

Chiara, off topic but ... there needs to be a campaign "say NO to Diabetes and sugar" in Saudi and Africa!!

Chiara said...

Susanne--Thank you, and you are welcome! Thanks too for sharing how TB has affected you personally. I guess we forget both that it occurs, and that it is usually highly treatable. The case in the American news of Andrew Speaker who defied US flying laws and had a rare resistant strain put it in the news again in 2007.

Yes, Craig David definitely has a new fan in me! But the white haired judge was a bit of a shock...and, dare I say, a gender-bender.

Now admit you only watched it for the white shoes both were wearing! LOL:)

Chiara said...

Wendy--Thanks for your comment and for sharing about your own experiences with TB. It seems that living in the far north involves increased risk of exposure for everyone, given the rates among the majority population. Hong Kong and China generally remain areas of high concern. I think I was checked at one point for hospital duty but now there is greater concern about Hepatitis vaccination.

There needs to be a "Say NO to sugar and diabetes" around the world, including especially among Canadian natives, but also so many others. Hmmmm... LOL:)

Susanne said...

"Now admit you only watched it for the white shoes both were wearing! LOL:)"

Ha, ha! I DID notice Craig's white shoes since they contrast well with his dark clothes. I also laughed at that, but didn't say anything. But since you did...I laughed at your comment!! :-D

Chiara said...

Susanne--LOL:) Yes I have to say I liked Craig's white shoes better than Emma's but...really WHITE! :)

Sandy said...

Hi Chiara, a bit of an old post -but it popped up today while I was researching TB in Saudi, as I just tested positive myself. So I thought I might ask you some questions. First being why is the standard different based on location? I had a 13mm reaction. In the US that would be considered negative. Here the conclusion is at minimum I have latent TB (assuming the x ray shows nothing active).

I also have a question about what the xray shows. Does it only show active TB? If my TB is latent, is it possible it was ever active and then went dormant? Or was I never contagious to anyone? Final question. I had the screen done at the pediatrician- I was having my son tested (negative). If I move on to treatment what type of Dr. is best? Infectious disease? Anyone who is good?

I guess that's it for now. I was pretty shocked at the Dr. office, it all seemed too Charles Dickens for me-thankfully I've calmed down now.

Chiara said...

Sandy--Hi! That is a bit of a shocker! I assume you mean a Mantoux Test, but even if it is a Heaf Test, a result of 13mm is considered positive internationally.

A positive test means only that at some point you were exposed to the Tubercle Bacillus and successfully fought off the infection, building enough antibodies in the process to make your skin react to the test. It often happens that the person had no symptoms, and was not contagious to others.

That is assuming that the test is a true positive, and not a false positive, meaning that it reflects the true situation in your body and wasn't just a fluke. You could have the test repeated to see if you get another positive result, which would mean a true positive. False positives are fairly common with the Mantoux test because it has a low specificity.

A false positive test could happen if you had been infected with a similar mycobacterium, but not the tuberculin one; if you had a previous BCG vaccination (very common among Brits) against tuberculosis, or if your skin reacted to some other irritant after the test was administered.

The most common reason for a false positive is the BCG vaccine which can give false positives for years. At least in Canada we have that one drilled into us, because of a high number of British immigrants.

You may have become positive because of contact through travel to endemic areas, or exposure to confined spaces with a large population where there is a tubercular problem (eg a nursing home). I assume travel is more likely in your case, if you are genuinely positive, unless you have had such an exposure, maybe through a hospitalization where someone did have the disease and was contagious.

If you have a genuine positive reaction, then the chest X-ray is used to look for active tuberculosis disease currently. Most often nothing is found, especially if you are otherwise healthy. Then the latent disease, ie dormant tuberculosis, would be treated with an antibiotic for a number of months, to prevent active disease developing later on.

The chest x-ray could show scarring from past disease but that is unlikely as you have not been aware of having had a tubercular illness in the past.

If active disease is found, an combination of antibiotics would be used. Current medications are highly effective and much easier to take than in the past. No more living in a sanatorium for years!

The best physician to treat tuberculosis would be a Saudi-based specialist in infectious diseases. Saudi-based because each country has its own subtypes of the illness, and effective antibiotic regimen.

If you have any other questions, now or as you get more information, please don't hesitate to contact me. I treat all emails (and email addresses) as private and confidential. Use the blog email chezchiara2 AT yahoo DOT com and I will reply.

All the best!

Sandy said...

Thanks so much for your reply. I am American so I never had the vaccine- I'm not sure which test I had. Based on what I've been reading up on, I think I should get the blood test to confirm the diagnosis, because I really don't want those antibiotics for 6 months. Some of the side effects don't seem pleasant!

I wondered if it was possible to have an active infection that then went dormant because I have been having a lot of bronchial issues the last year or so. It makes me wonder. Of course my youngest has had everything with me and he tested negative- so who knows. But a part of me is wondering if I have/had an active infection.

Anyway, it just so happens due to another family medical situation that we know of a very good infectious disease dr. and so I'll be going to see him. I'll also get the other kids/hubby screened. For the most part they've been exposed to whatever I've been exposed to.

It's up to you Chiara. I can email you or write here. I thought others might benefit from my experience, but if it's too much on the blog, I can write to you.

It's interesting our children were never vaccinated so I've always been in the habit of getting them (and me) screened periodically. I did not realize that the vaccine wears off and that most of the population here is NOT protected and they do NOT get screens. I'm sure there are many people in my situation, who don't even suspect it is possible they may have TB. Also, as far as I know they do not screen workers for TB who come to live here. Dubai does. I think it's a great service for their population and the global population that they do.

Thank you again!

Majed said...

Sandy, I feel very sorry for you, but don't you worry, there is a cure to it,they even have super pills for super strains.

You know labs make mistakes, some times , killing mistakes, when I was comming to Saudi Arabia from indian, the medical test came positive for HIV, I was alone when they told me so, I could not stand up out of shock, and it was not an any lab it was very famous and well-known, and they refused to hand over the report !!! I could not eat,think, I didn't even know what I was doing, the way they delivered the information almost killed me in a worst way than the disease itself would have, due to panic I had developed ulcer and lever problems, few days later, after I had pulled my scattered peaces together, I went back to the same lab to test again, yet again HIV positive and yet again refused to give me my report.

I returned home to grandmama (may Allah bless her soul) she told me to test again there, Alhamdulliah the test was negative, to tell the truth, I was shocked because I have never had a blood transfusion in my life and I married at 30 without having touched a girl other than my wife , of course not counting the girls I touched before I was ten years old and I am straight.

I was lucky that you have come to comment on this post, as I felt ashamed to ask Chiara about information on this disease (TB) becuase it would be like a free counseling and I hate taking things for free. I am an expatriat I go home to my wife and children once a year for two month after converting working on holidays and weekends into days added to my 30 days annual vacation, on my last vacation my I saw that my wife had lost 10kg of her weight I was afraid and asked about the problem, she told me she dieting to fit in her old jeanses, I told her that is stupid, and to stop it, I also notice that she was warmer than she supposed to be, there was some swelling in lower throat that felt like a swollen gland, I took her to doctors they said it could be a thyroid disease or throat infection, I kept telling them the they should consider HIV or TB as a reason for the swollen gland, they just thought I was being a wise guy but kept making endoscopies and X rays.
at last we knew she has TB she is much better now, but now i am worried about myself i had my children tested, they are all TB negative,and they are all vaccinated in very early age , but I have not yet tested myself for frear of expulsion.
I feel healthy and ok, but after reading your comment and Chiara `s comment on it, i do not know what to do, my purpose in life is the well being of my family nothing else.

Chiara said...

Sandy and Majed--thank you for your comments, and I am happy to reply here so that all may benefit. I have to run, but I will be back to reply more fully. Thanks again, I am sure others reading are glad you both have shared here. That was part of the reason for the post! :D

Sandy said...

Majed, that is really awful that you got such inaccurate and frightening news from what is supposed to be a reputable lab. I learned long ago, that if a lab result seems unlikely get another opinion from another lab. Though no one ever scared me with such awful news as that.

Well Chiara my update is my chest x-ray was clear, which is pretty much what I expected, though I'm glad to have it confirmed. My next step will to be to try to get the blood test- which is more accurate than the skin test. I hope it's available here. But since I'm not in imminent danger from anything, nor contagious, if it isn't available here I'll wait till I'm somewhere it is before I actually consider treatment. TB is so prevelant here, I have no desire to go through treatment, and then a couple years later have to go through it again, because I've again been exposed again.

But if you have any suggestions etc. I'd love to hear it. I plan on having hubby and remaining children take the blood test once we locate it. Might as well be as accurate as possible.

Chiara said...

Sandy and Majed-thank you both again for your comments. I have had some minor medical issues delaying my response.

For now, Sandy, congratulations on your clear chest xray. As I understand the blood test is no more accurate or preferable to the skin test, except that where it is done results are available much faster, within 24hrs. I will take a closer look for availability though, and specificity, and we can share information about it here.

Majed, that is a particularly dreadful way to learn about any HIV result, and it is good you
had a more accurate test. I am glad your wife is recovering well from TB. As far as your own TB testing, it is worth doing, the question is where and when. Perhaps others will also offer some ideas as I search for more information. Perhaps being tested while you are on leave in India is best, unless you are currently symptomatic.

Back with more information as I can get to it! My apologies for the delays again!


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