Irish tuberculosis expert warns against complacency to global epidemic
Posted on: 08 December 2016
An Irish TB expert has warned that we are seeing an increasing number of multidrug resistant tuberculosis (MDR-TB) cases in Ireland, which reflects the pattern seen in Europe, primarily because of the movement of people from countries of high tuberculosis (TB) prevalence. His warning comes as the Centre for Disease Control has today come out with new updated international guidelines on TB diagnosis after 17 years.
The best practice global guidelines were co-authored by Professor Joseph Keane of St. James’s and Trinity College Dublin who is the only Irish author. He has warned against the dangers of complacency about this worldwide disease which infects one third of the global population and kills 1.5 million people every year, more than malaria and HIV.
Professor Keane said: “It is crucial that we do not become complacent about the spread of TB both globally and here at home in Ireland. These new guidelines, which took 8 years to produce, will help in detecting TB, MDR-TB and latent TB infection – which will support disease elimination.”
Dr Anne Marie McLaughlin, Consultant Respiratory Physician at St James’s Hospital, Dublin said: “In Ireland, we have 329 cases of TB per year. The complexity of these cases and the increase in the number of multi-drug resistant cases is pushing the limits of our services. TB patients often are marginalised members of society, with addiction issues. It’s a big challenge to get these persons to take the antibiotics they need, because they need to be on TB medication for 6-48 months.”
Dr Finbarr O’Connell, also a Consultant Respiratory Physician at St James’s Hospital Dublin said: “In 2004, funding for a national TB unit was promised, to be located at St. James’s Hospital. Our public health efforts to fight TB would be helped if this facility was delivered now. The appointment of a national TB controller has been sought by the Irish Thoracic Society, which would advance our care of this epidemic that has not gone away.”
The guidelines were published today by American Thoracic Society (ATS), Infectious Diseases Society of America (IDSA) and Centers for Disease Control and Prevention (CDC) in the journal Clinical Infectious Diseases. They recommend that doctors should employ newer tests in patients at risk for latent or active tuberculosis (TB) infection. They also recommend that doctors shouldn’t overlook active TB disease as a diagnosis, even though it is less of a problem in certain countries, such as Ireland, than in the developing world.
The guidelines recommend healthcare providers consider testing for latent TB in patients who:
- Live with a person who has TB disease
- Immigrated from a country where TB disease is common
- Are in high-risk settings, such as prisons, hostels and homeless shelters
The guidelines are available here: https://cid.oxfordjournals.org/content/early/2016/12/08/cid.ciw694.full
TB spreads through the air and can be a challenging disease to diagnose and treat. Many people can have latent TB, meaning they are infected with the bacteria Mycobacterium tuberculosis, but are asymptomatic and can’t spread the infection to others. Only 5 to 10 percent of people with latent infection ultimately go on to develop the disease itself, about half of those within two years of being infected. Treatment varies depending on whether the TB is latent or becomes active, and directly observed therapy (DOTS) is recommended for patients with this disease.
TB most often affects the lungs, but can affect other parts of the body such as the kidney, spine and brain. Those at higher risk of developing the disease include people with HIV and others with weakened immune systems, those with diabetes, smokers and others who are taking immune-suppressing medications called TNF blockers.