The white plague take two

Few American docs have seen TB...but it is making a comeback due to HIV and homelessness.

However, in rural areas, we don't see a lot. Some of the IHS (Indian Health Service) docs see it, as do those working with Mexican and Asian immigrants.

My husband's father died of TB during the depression. My husband had tb as a lowgrade chronic infection while in medical school, so he treated himself with black market Streptomycin shots...and was "cured" , i.e. went into an inactive state.

The bad news is that Streptomycin affected his hearing, and so he can barely hear without a strong hearing aid.

The TB germ is a slow infection. When you first get it, it takes a couple weeks to build up your immune system. The body activates WBC to wall it off and destroy it. Until those cells get "sensitized", the infection is easy to overlook--a typical "primary" TB is pneumonia with effusion. And primary TB may spread to other organs-- one terrible form is tb meningitis, or tb of the bones, a slow painful killer.

In poor countries, they "vaccinate" for TB with BCG vaccine, that makes the sensitive wbc 's...such a person still may get "secondary" type tb, but it saves hundreds of children from meningitis etc.

Typical tb is a slow chest infection. You get a chronic cough, low fever, fatigue, and can last for years. It is quite infectious to those in the same home or room---which is why a foodhandler with tb might infect hundreds ( about 20 years ago, this occured in the US Congress cafeteria).

On X ray, you see cavities in the upper lung field, where the wbc's walled off the infection unsuccessfully, and you get "tubercles"-- think of them as pus pockets full of cheesy foul pus. If one breaks open, you can get pneumonia in the lower lungs where the pus spread. And, of course, coughing hard can break the fragile blood vessles in the walls of the tubercle, killing by hemoptysis.

One terrible story was at an Indian clinic where I worked 30 years ago...the tribe was demonstrating in front of a hospital against the doctor in charge. It seems that one of the elders was hospitalized and they missed it was TB...instead of tranferring to a larger center for bronchosopy to discover if cancer or tb was causing his pneumonia, they just treated him routinely...(the head doctor was under pressure not to transfer because of lack of funding). As a result, he started spitting up massive blood (hemoptysis)...and they flew him out...in the local air ambulance, which at the time was the Cessna owned by the local funeral director...the unpressurized airplane flight made things worse, and he essentially exanguinated and died in the plane...

Thank God we don't see such things any more...and the IHS, despite chronic underfunding, now has much more local input (and even tribal adminstration) running their hospitals...which now have to meet national standards. They still serve a need-- you still need docs specialized in TB, Diabetes, and cross cultural sensitivity---but their standards are no longer second class...

Ben Nighthorse Campbell, call your office....