UNS — Since the World Health Organization (WHO) ranked Indonesia third as the country with the highest Tuberculosis (TBC) cases worldwide in October 2021, the Pulmonologist of Universitas Sebelas Maret (UNS) Surakarta Hospital Consultant, Prof. Dr. Reviono, dr., Sp.P(K), invited all community members to reduce the risk factors that lead to failed TBC treatment.

This invitation was delivered in the Talkshow held by RS UNS to commemorate the world TBC Day under the topic of ‘Investment to Eliminate TBC, Save the Nation,’ on Tuesday (22/3/2022) through UNS Hospital’s official Instagram @rumahsakituns and YouTube live streaming.

Prof. Reviono stated that the world target in 2030 is to reduce the TBC cases by 80% to 20% of the current cases and to reduce 90% of the mortality rate to 10%. “To achieve this elimination target is not an easy task because many problems still require support from all community members. Such as reducing the risk factors that cause failure in TBC treatment. Because it needs funding, energy, and efforts, therefore, the investment is to strengthen the factors that could prevent the failure of TBC treatment,” he stated.

TBC is an illness caused by mycobacterium tuberculosis that often affects lung tissue, although it is not limited to the lung tissues. The illness could affect the brain membrane or brain itself, and even the intestines. TBC infection remains dangerous no matter what organ it affects, and it is one of the old illnesses that is hard to eliminate. Many patients often received late diagnoses and had infected others because of it. “Chronic illness has slow symptoms; thus, people infected with TBC often adapt to their symptoms,” Prof. Reviono stated.

TBC is an endemic illness and is widespread evenly in all provinces in Indonesia. The risk factors that affect one’s immunity to this illness are diabetes, renal failure, malnutrition, and densely populated area with a lack of ventilation and sunlight. During the Covid-19 pandemic, TBC cases tended to decrease worldwide, and Indonesia contributed to the significant decline in this number. The stay-at-home policy is suspected to be the cause of this decrease. However, Prof. Reviono stated that the cases do not decline per se, but instead, the infection is not detected until later on.

The Difference between TBC and Other Lung Infections

TBC was considered suspect, with two weeks (minimum) as its special symptom. Chronic TBC is marked with systemic symptoms such as fever, low appetite, and declined weight. TBC is different from other lung illnesses such as asthma and pneumonia in terms of its causes, time, and onset, with pneumonia tends to be rapid and acute. TBC is treated using TBC medicines, while pneumonia is treated according to its cause. TBC treatment is also harder because of its rapid multiplication and thick cell membrane.

TBC Prevention and Treatment

The existing research showed that six months of treatment is the standard for TBC. After such treatment, the level of bacteria usually decreases and does not affect one’s health. However, lung tissues damages could vary from mild, medium, and severe. “So, if the damage was mild, usually the recovery or lung tissue revolution could return to its initial state. But if (the damage) was medium or severe, there is a cavity (hole in the lung) that could cause residual symptoms, such as coughs. If it is (residual symptom) only cough without other systemic symptoms, without fever, or decreased appetite, I think it could be treated using common cough medicine; it is just symptomatic. But if there is a continuation of these symptoms, you have to be careful. Doctors will investigate if there is recurrence or there may be comorbid or accompanying disease, then that will be considered,” Prof. Reviono stated.

Commemorating World TBC Day, UNS Hospital Physician Invited the Community to Prevent TBC Cases in Indonesia

TBC has four populations, extra-cellular, which could be eliminated easily using antibiotic drugs; intracellular, acidic condition, and dormant, which is impossible to eliminate but manageable so that the bacteria do not cause clinical symptoms. Therefore, people with a good immune system do not need treatment unless they start to show symptoms. “This could lead to latent TB. Once they show immune responses, we usually took two methods, Mantoux and interferon-gamma tests. Treatment is provided once the immune responses are higher than the normal score. But it is preventive in the form of TB preventive therapy,” Prof. Reviono stated.

People recovering from TB could get reinfected if they have close contact with infected people. The current TBC diagnostic is conducted using Molecular Rapid Test (TCM) as the most sensitive test. Although this test is not available in community health centers, samples could be sent to health facilities that run such tests. As a preventive measure, there is also the Bacillus Calmette–Guérin (BCG) vaccine for TBC that, even though it is not yet effective, could prevent severe TBC infection.

TBC in Children

Children generally show different conditions from adults infected with TBC. TBC infection in children is primarily complex or closed TB without the involvement of the respiratory tract. Children also can’t infect others with their symptoms, and the main concern once a child is infected is to find out where the infection came from. “In children, the first infection could not infect other children. In conclusion, children can be infected but cannot infect others,” Prof. Reviono concluded.

TBC symptoms in children are different from adults. In adults, the symptoms are dominated by a cough with phlegm that is not found in children, who usually have a cough with a chronic fever that occurs each day, although it is not high. Children also show decreased appetite or low weights compared to their fellows (below normal) and usually are not diagnosed using TCM. Humas UNS

Reporter: Erliska Yuniar Purbayani
Editor: Dwi Hastuti

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