Tuberculosis: Save One, Save All

by Adepoju Paul Olusegun

It started with a cough, an autumn hack that refused to go away, then came the fevers. They bathed and chilled him, his lungs clattered, his chest tightened and he ached with every gasp. During a wheezing fit at 4 a.m., he felt a warm knot rise from his throat. He ran to the bathroom sink and spewed a mouthful of blood.

I’m dying, he told himself, “because when you cough blood, it’s something really bad.”

It was really bad, and not just for him.

His father was in his office in the choice city of Peru as he tried to go about his daily chores in his dimly lit office. Suddenly, his phone buzzed with a call from a man who introduced himself as Ashkin from A.G. Holley, America’s only functioning sanitarium. The doctor called with a clear message about his son’s illness.

It’s a rare disease, said Ashkin, hard to define. Your son is one of two people in the world known to have had this strain, he said.

“What happened to the other person?” his father asked.

“He died.”

The controversial history of tuberculosis could be traced to homo erectus migration from Africa about 500,000 years ago to Europe. In a recent study that was published in December 7, 2009 issue of American Journal of Anthropology, this young man whose body was recently exhumed in Turkey, in the course of his sojourn (probably in pursuit of greener pastures) had a lowered immune system function arising as a result of interference in form of prevention of vitamin D synthesis by the action of melanin.

Melanin is the color pigment that make blacks black, and whites white. It is found to confer protection from the dangerous UV rays emitted from the sun while as well predisposes individuals to certain medical conditions like hypertension, cancer, multiple sclerosis, cardiovascular diseases, and infections like tuberculosis.

The role of melanin in predisposing an individual to tuberculosis arises when there is interference with the geographic biotic balance where like organisms, individuals are situated in locations that best suit they make up. Like homo erectus, Africans (except albinos) are heavily pigmented hence they could fair well in hot tropical countries while the Europeans who are majorly poorly pigmented can favorably survive in the cold low latitude countries of Europe. Due to migration and incessant search for the golden fleece, the world has found itself still under the heavy influence of tuberculosis as a result of the body trying to adjust to the fewer sunshine nature of lower altitudes.

Before the Alexander Flemming’s (1881 – 1955) 1928 crude penicillin discovery and purification of antibiotic manufacture in 1945 by the British scientists- Howard Florey (1898 – 1968) and Ernst Boris Chain (1906 – 1955), exposure to abundant sunlight in sanitarium was the preferred 100% effective treatment for tuberculosis infections as sunlight stimulates the synthesis of cholecalciferol (vitamin D3) via the conversion of 7-Dehydrocholesterol (vitamin D precursor) to the active form only after exposure to sunlight. These complex steps subsequently lead to the reversal of signs, symptoms and aberrations brought about by tuberculosis and other associated infection. This innate immunity was potent enough.

However, in 1944 a critically ill TB patient was given a new miracle antibiotic and immediately recovered. New drugs quickly followed. They worked so well that by the 1970s in the U.S., it was assumed the disease was a problem of the past. But less than 25 years later, the world is worse than it once was. The major reasons for the comeback were immigration and travel. These two broke down invisible walls that had contained TB.

According to Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention, who was himself infected with tuberculosis while caring for drug-resistant patients at a New York clinic in the early ’90s, “drug resistance is starting to be a very big problem. In the past, people stopped worrying about TB and it came roaring back. We need to make sure that doesn’t happen again. We are all connected by the air we breathe, and that is why this must be everyone’s problem.”

In April 2009, the WHO sounded a global alarm on multi drug resistance when it conveyed the Beijing drug- resistant TB summit. At the gathering, the message was clear- the disease has already spread to all continents and is increasing rapidly. Even worse, WHO estimates only 1 percent of resistant patients received appropriate treatment last year, and there is a huge upburst in resistance.

Apart from inconsistent use of anti TB drugs, individuals are at risk of acquiring the drug resistant strains via another means.

TB germs can float in the air for hours, especially in tight places with little sunlight or fresh air. So every time someone with the deadly coughed, sneezed, laughed or talked, he or she could spread the deadly germs to others. According to the young man who had the first reported case in America, “You feel like you’re killing somebody, like you could kill a lot of people. That is the worst part.”

WHO’s latest data placed tuberculosis as the top single infectious killer of adults worldwide, and it lies dormant in one in three people, 10 percent of which develop active TB, and about 2 million people a year will die from it. The fascinating conundrum about tuberculosis is its treatment.

According to Associated Press, simple TB is simple to treat — as cheap as a $10 course of medication for six to nine months. But if treatment is stopped short, the bacteria fight back and mutate into a tougher strain. It can cost $100,000 a year or more to cure drug-resistant TB, which is described as multi-drug-resistant (MDR), extensively drug-resistant (XDR) and XXDR.

There are more than 500,000 cases of MDR tuberculosis a year worldwide and XDR tuberculosis killed 52 of the first 53 people diagnosed with it in South Africa three years ago. Multi drug resistant tuberculosis has been said to be a time bomb. It has become a man made problem that is costly, deadly, debilitating, and the biggest threat to all current TB control strategies.

Unlike America and other developed countries of the world, Nigeria has no fully operational sanitarium that could be saddled with managing new and virulent forms of the disease. Our current TB centers could be likened to the incidence of 1850 when about 25% of Americans and Europeans who were isolated in sanatoriums died in isolation. Nigeria’s poor medical recording system is another setback to most STOP TB programmes since most drug sales are done over the counter. No one knows who is latently infected and how safe the next breath is, every inhalation is a risk for everyone since MDR TB does not have a distinct aroma. We all breath in fear, and are perfect ingredients for an epidemic disaster.

So the question is: Is this a strain that’s evolving? That’s mutating? That’s becoming more and more resistant?”. I think the answer is yes. Nigerian doctors grappling with these new strains inadvertently give the wrong medicines, and so the TB mutates to become more aggressive and resistant.

Although they are well trained, Nigerian medical laboratory scientists do not have the resources to determine whether a patient’s TB is drug-resistant. Their practice is resource- restricted to sputum culturing and timely drug-susceptibility testing, while expensive processes are performed only in reference laboratories. However, all hope is not lost as WHO is working to make these methods more available in high-risk countries like ours as well as negotiating cheaper prices for second-line drugs.

“There’s a lot of MDR and XDR-TB that hasn’t been diagnosed in Nigeria and this poses a big public health threat, one that is stronger than the Libyan leader’s division option.

It cost the state of Florida $500,000 to treat a Peru national with the first case of TB. They did it not because they love Peru, but for the fact that an untreated MDR TB is

a disaster waiting to happen. As a country, we should borrow a leaf from Florida. We should not wait until disasters happen before we act.

The international community is also not left out. This year’s celebrations mark the halfway point for the Global Plan to Stop Tuberculosis (2006 – 2015). With much at stake, a lot still needs to be done. TB is a highly mutant contagious infection that could be difficult to treat, and a potential tool for biowarfare.

As it stands, weaponizing XXDR TB is a simple task in the hands of a learned medical microbiologist (I can do it) and the cost of treatment ($500,000 per patient) could leave all countries of the world including America grounded like Nigerian Airways, therefore it’s a viable option for terrorists. It therefore becomes imperative for all agencies, governments, bodies, relevant organizations and researchers to speed up the process of combating MDR TB to avert a global Armageddon.

How I wish we could reverse time and go 500,000 years back when sunshine, like the blood of Jesus, can wash us clean of every infirmity like tuberculosis.

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