Tubercle bacillus lurks in broad daylight for unsuspecting victims

KLAIPEDA - For one 26-year-old woman from southern Lithuania, the straw of life cannot be thinner. Brought to the hospital, weak and on the brink of consciousness, she whispers to attending obstetricians that she’s got AIDS. And more. The diagnosis by Kaunas Clinics’ doctors shows she has tuberculosis, an advanced and severe form of it. Having hurriedly performed a Caesarian section, the doctors delivered the baby, but the mother, having only glanced at the fragile 30-week premature new-born, sank into coma. She has been in it for over one week now.

“In her case, this was one of the very worst combinations, AIDS and tuberculosis. Both her illnesses are very advanced. There is an adage: tuberculosis and AIDS kisses death as inseparable partners. When either of them is in progress, it is very hard to treat the patient. In the woman’s case, pregnancy was a complicating factor,” Ruta Nadisauskiene, head of the Obstetrician and Gynecology Department at Kaunas Clinics, said to lrytas.lt
The initial lab tests have shown that the infant is not a carrier of any of the lethal diseases, but the situation may soon change, the doctor says.

In terms of public health, the mother triggered a big public health emergency in the hospital. Not as much for the AIDS as much as for the TB, tubercle bacillus, otherwise known as tuberculosis.
Doctors always employ precautionary measures in anticipation of a contagious disease: the use of disposable syringes, they sterilize their equipment, wear respirators, disposable gloves and garments. This, however, may be not enough to kill the sneaky bacteria tubercle bacillus, carried by this seemingly doomed woman.
The World Health Organization says that tuberculosis is the most widely-spread infectious disease on earth, with over 2 billion people harboring it in their lungs. The data says approximately 2 million people succumb to the infection every year.

“That is only the tip of the iceberg. Most pulmonologists reckon the numbers are much higher than these for one reason – in many lethal cases, especially those registered in the underdeveloped world, the actual reason for death usually never becomes clear,” Joana Mikolaitiene, a pulmonologist, said to The Baltic Times.
She says 90 percent of all TB infection carriers have the so-called asymptomatic form of illness. In other words, the only expression of the illness may be sporadic coughing, weakness and perspiration – the typical indicators of a respiratory infection. “Therefore, many TB infected people never hurry to see a doctor, thinking they are having an ordinary cold which, in fact, turns out to be tuberculosis, a real bomb of infection for people nearby,” the doctor says.

Although the illness is still thought to be a direct outcome of poverty and malnutrition, the truth is different. “Poverty-stricken and homeless persons, sure, risk contracting the infection most often. The trouble is these kinds of persons do not seek medical assistance, thus becoming walking infection bombs. Therefore, the people in their close environment, be it family members, charity workers they deal with, are in the increased zone of TB danger,” says the pulmonologist.
Because of the trickiness of the disease, it has not been curbed anywhere in the world yet. That includes Lithuania. To the contrary, Lithuania had been notorious until recently for one of the highest tuberculosis rates in the entire European Union. “I saw the WHO statistics of 2009, and our country was the second to the top of the list, right after Romania,” Inga Bulotiene, head of the public organization Stop TB, said to The Baltic Times.

She asserts that the number has gone down in recent years, though Lithuania is still among the most tuberculosis-affected European countries. A medical report reveals that there were 2,330 cases reported in 2000, and 1,573 cases in 2010. Out of 968 new TB cases in 2010, the infection was diagnosed in 698 men and 270 women. In terms of localities, the division is nearly equal - 439 TB cases were registered in rural areas and 529 cases in urban areas.
Among children, 11 cases were reported in 2010 and 15 in the previous year, with most of the cases in the age group of 15-17-year-olds.

Edvardas Danila, a pulmonology professor and director of Pulmonology and Allergology at Vilnius Sanatariskes Clinic, says that because of lengthy and complicated treatment, many socially insecure patients cease treatment, endangering others. “It is thought that one TB patient, if uncaring about others, can infect roughly 30-35 other people,” says the professor.

The Stop TB chief Bulotiene, on the topic of peculiaritites, says that “First, unlike in other countries, the tuberculosis rate among Lithuanian children is very high.” She adds that she is puzzled by the statistics. “Generally speaking, there aren’t many differences in child care in neighboring countries but, for some reason, the rate is high only in Lithuania. I believe it is so due to the largest number in the Baltics of child foster homes in Lithuania,” she says. Also, “Partly due to the high illness rate, the entire social care in all foster homes is being overhauled.”

Secondly, the Stop TB head says the high percentage of drug-resistant TB varieties is attributive to the country.
Danila explains this partially by a lack of education. “When tuberculosis is diagnosed, the patient is isolated and must regularly use antibiotics, even when he or she feels better. However, after a temporary improvement, many patients, particularly the socially vulnerable, cease the medication, thus developing drug-resistant forms of the illness later. It is sad that the state cannot enforce a mandatory treatment for its TB patients,” says Danila.

He says that in case of a delayed illness treatment, the tubercle bacillus carriers pose a big danger to people nearby. “Doctors do not always have possibilities to explore the bacteria’s sensitivity to the applied drugs. In the cases of drug-resistant forms of tuberculosis, it is not rare that the first-line medicines do not produce the desired effect, and then the so-called second-generation drugs are prescribed. Upon their application, treatment can last as long as several years. Every year we see more cases of drug-resistant forms of the infection,” says the professor.

Bulotiene stresses a lack of education and prophylactics in battling the sometimes lethal bacteria.
“Most people tend to think that TB is an illness of the past and poverty. On the other hand, tuberculosis patients see the disease as a stigma and they tend to hide it from everyone, even family members. It is like a closed circle,” says Bulotiene.
Thirty-one-year-old archeologist Ramune Butrimaite, a tuberculosis patient, acknowledges the stigma is perhaps the hardest thing to deal with in the lengthy treatment. She has been under it for nearly one year now. Her daily regime is very similar: a handful of drugs in the morning, injections administered every second day and a large portion of TB medicines and stomach and liver-supporting remedies every evening. “Tuberculosis has struck me out of the blue. Frankly, I had not heard much about it before being diagnosed with it,” Butrimaite said to The Baltic Times.

She says the first symptoms were common to a regular cold – a coarse voice and itchy throat.
“I thought I caught a cold after having a bath, or was chilled by my car’s air conditioner,” Ramune recalls.
She admits that she did not rush to see a doctor and let the symptoms drag on until late fall. “Disappointingly, the doctors I went to see were not able to detect the illness right away. First, I was told I had a respiratory infection. Then an otolaryngologist said I have laryngitis, and he prescribed antibiotics. My voice, however, got coarser until I could not sing lullabies to my daughter,” the TB patient remembered.

Ultimately, Vilnius University Hospital’s Santariskes Clinic doctors, suspicious of the unsubdued illness, sent the young woman for an x-ray. It revealed tuberculosis.
“I have always been very active and enjoyed travelling. Now I have to restrict myself, and I have to rest a lot under heavy medication,” Butrimaite confesses.

Several tests determined that the patient is resistant only to two medicines out of a dozen. “One of them was not registered in Lithuania,” the young woman remembers. She jokes she has at least 20 different kinds of pills for breakfast. She does not know how she got infected. The recent tests show she is improving and they, along with a supportive family, encourage her. “Sometimes the whole thing looks pretty weird. After I was diagnosed with the disease, I delved into available information on it. The more I read, the more anxious I got. Such devastating side effects! Thanks to god, I accepted the prescribed medicine, and no remission has been seen,” the patient says.

She learned on the Internet that very close contact is necessary to catch the bacteria. “I have no idea who the precarious contact was in my case. Interestingly, approximately 80 percent of all people carry the tuberculosis bacteria, but only a very few become sick,” says Butrimaite.
She is happy she has not transmitted the infection to her husband and her two-and-a-half year-old daughter. The woman emphasizes that the caring support of her family has been crucial in her treatment. “One with tuberculosis has to be ready for long treatment and tons of drugs. Fortunately, the Patient Fund compensates for the medicine,” says Butrimaite.

She enrolled in Stop TB after the diagnosis, and has become an advocat of TB patients and a lobbyist for some tuberculosis-related policy changes.
With the vastness of the Internet, she says she was surprised to find only a few reports on the genesis of tuberculosis, recommendations, possible side effects and effectiveness of TB medicines. ”That is why I became a member of [Stop TB],” explains Ramune.

The only organization uniting TB patients in the country endeavors to educate the public about tuberculosis prevention and treatment, tools and programs to prevent its spread, cooperating with Lithuanian and global public and non-governmental organizations.

“My main goal is to raise awareness of TB and to make the public understand that even people leading an orderly lifestyle, as well as intelligent people, can be prone to the tuberculosis bacteria,” Butrimaite says.
She pays attention to what she says is the biggest problem besides the public stigma on TB patients – the occasional lack of drugs. “My form of tuberculosis is considered by doctors to be very severe. Therefore, I was prescribed capreomicine, a powerful drug that is usually used when patients have resistance to other TB drugs. My treatment got interrupted because of a lack of the medicine at the hospital I was in. It took four days to send it over from another hospital. This should never happen! Even given a short break, the illness can return, and the backlash is devastating,” warns the Stop TB member.

She lobbies that TB-related medicine be provided to Lithuanian tuberculosis hospitals in a centralized way. If this happens, it may result in a big change at the end of the day for the dozens of tuberculosis patients.