Tuberculosis: A killer of the poor !

The human race is indebted to Dr. Robert Koch of Germany for his landmark discovery of causative bacillus of tuberculosis in 1882. This discovery later won him (Dr. Robert Koch) the Nobel Prize. Dr. Koch worked on many other diseases also. He discovered the causative agent of Cholera in 1883 in Egypt. Both the discoveries of this renowned microbiologist are remarkable and revolutionary in the field of medical science. Dr. Robert Koch’s fundamental discovery of causative agent of tuberculosis set the pace of efforts worldwide to eradicate tuberculosis on the pattern of smallpox. Many nations in the world have already done so. Developing countries are still putting in efforts to eradicate the killer disease of the poor who cannot afford timely diagnosis and treatment in-spite of the free supply of anti-tuberculosis drugs.

Tuberculosis is still on the top of communicable diseases in many countries. Lack of awareness, poverty and associated malnutrition are the invitation for this communicable disease. BCG is the vaccination used to generate immunity against tubercle bacilli, but unfortunately the same has been failed to provide effective immunity in some geographical areas. The laboratory diagnosis of tuberculosis is largely based on x-ray study of the chest and examination of sputum for tubercle bacilli. Once diagnosed, the disease is curable.  Home-based treatment of tuberculosis is as effective and safe as the isolation ward of a hospital. At present the standard-regimen for treatment of tuberculosis is for six-months. However, a re-investigation and follow-up is must.  Extra-pulmonary tuberculosis can be diagnosed by cytological evaluation of 'fine needle aspirate' for tubercle bacilli. Polymerase chain reaction (PCR) is newer diagnostic method for Extra-pulmonary tuberculosis.

Participation of community is must for successful eradication of tuberculosis. If somebody is under treatment at a home, he/she should be confined to a room for at least two months of treatment, and all members of the family should bear mask in case of pulmonary tuberculosis. The preventive and curative efforts should move 'hand-in-hand' for successful eradication of tuberculosis.

Amoebiasis: Bowel amoebiasis and spread of infection to liver and lungs

The organism that causes amoebiasis is a unicellular parasite called Entamoeba histolytica. A variety of clinical presentations are seen. Though the disease is not a major health problem but in serious forms of amoebiasis, significant morbidity and mortality is unavoidable. We may have asymptomatic carriers of amoebic infection. On the other hand Entamoeba histolytica infection may result in fulminant dysentery with fever, diarrhoea, bleeding and even perforation of intestine. The organism can be identified in wet slide preparation of stool specimen obtained from infected patient.

The infection is transmitted by the faeco-oral route. The infection can be an asymptomatic one, that is, the victim could be in good health in-spite of harboring the Entamoeba histolytica infection. In severe cases of infection, Entamoeba histolytica can result in full-fledged frank dysentery along with colonic ulceration. Uncommonly, Entamoeba histolytica can invade organs other than large intestine. Liver is the second common site followed by lungs. The brain, genitals and the skin are other possible sites if infection by the amoeba. The majority of patients do not develop frank-dysentery, i.e. they do not develop diarrhoea with blood or mucus. Vague symptoms, such as discomfort in the tummy, irregularity of bowels, constipation, diarrhoea, griping and tenesmus occur in various combinations. In some cases, low grade fever, loss of weight, pallor, generalized non-specific aches and pains are common. The patient usually carries on his day-to day duties with sub-optimum health and efficiency.

The diagnosis of asymptomatic bowel amoebic infection can be established through repeated fresh stool microscopic examination. The sigmoidoscopic examination of ulcerative lesions of colon and microscopic examination of direct smears obtained from the ulcers would further confirm the diagnosis of amoebic ulcers. Invasion of liver by Entamoeba histolytica is the second commonest form of amoebiasis. The onset is usually insidious but an exceptionally rapid course can be seen during endemics of bowel amoebiasis. The presenting symptoms of liver amoebiasis are pain in the upper right quadrant of tummy, or fever or both. The presence of jaundice is very rare in patients with liver amoebiasis. Fever of uncertain origin is a common problem in many developing countries. One of the causes of the fever of uncertain origin could be amoebic infection of the liver.

The diagnosis of amoebic infection of the lungs and brain requires a high degree of expertise on the part of physician/clinician. The amoebic infection of brain is usually diagnosed at the operation table. Amoebic ulceration of skin is not very rare. Sophisticated techniques like serology and radio-isotopic scan can be of great help in establishing the diagnosis of amoebic abscess of liver, lung or brain. The treatment of amoebiasis is highly effective once a correct diagnosis has been made. Eradication or prevention of amoebiasis in any locality can be achieved only if there are optimum ways of sewage disposal and personal hygiene.

Children’s health, growth and immunization: Our role in preventing preventable diseases

Unless we look after our women and children in a programmed manner in the field of health, we cannot have a happy world around us. Children are still killed or disabled each year by diseases that could have been prevented by immunization. The World Health Organization (WHO) is doing its best to eradicate/eliminate a variety of infectious diseases, but involvement of every citizen of the world is must for compliance of various programs of the WHO. The measles, mumps and rubella triple vaccine (MMR) should be included in the EPI (Expanded Preventable Immunization) program of every country. We should not ignore the facts that measles and mumps can cause considerable morbidity and mortality which could be prevented with optimum immunization. Optimum immunization means full course of vaccination schedule without missing any booster dose.

Apart from vaccination child nutrition and general health must be taken care of. The child health reminds me the efforts of Mr. James P Grant, the Director of United Nations' Children's Fund (UNICEF, 1984), who in 1984 brought out a Report on the State of World's Children, and forwarded a mnemonic GOBI-FFF to remember the techniques which could reduce sadness of the world. In GOBI-FFF, "G" stands for growth monitoring, "O" stands for oral rehydration therapy, "B" stands for breastfeeding, and "I" stands for immunization. The three Fs (FFF) stand for 'family spacing', food supplements and female education. The methods represented by GOBI-FFF are the simplest methods which could help us in tiding over the state of health of children and preventing diseases and saving lives. Consequent upon the compliance of GOBI-FFF, lives of millions of children are saved every year and the health and growth of millions more is protected. Still there is need to protect the children from episodes of common childhood diseases like measles, respiratory infections and diarrhoeal infections.

Various infections also interfere with physiological and psychological development of children. The malnutrition and infections perpetuate each other and may lead to suboptimum brain development. The GOBI methods are not so expensive. Community health workers can be assigned the responsibility of growth monitoring through periodic recording of weight and height of a child. The oral rehydration salts (ORS) should be supplied at cost price to prevent the dehydration caused by diarrhoea. The breastfeeding should be encouraged since it provides ideal nourishment to the child and saves from the infectious hazards of bottle feeding. Immunization against tuberculosis, diphtheria, pertusis (whooping cough) tetanus, polio, measles, mums and rubella protects the child against these serious as well as disabling diseases. Attention should also be given to the health education of mothers. Awareness about the child's health in mothers would definitely make all the healthcare and immunization programs successful. It is well established fact that proper spacing between child births decreases the risks to the heath of the mother and the infant. Food supplements should regularly be supplied to the mothers during pregnancy and vaccination against tetanus should be done. We must put in our best efforts to prevent the preventable diseases since prevention is better than cure.