By Dr. John Bishop
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Have you ever been asked to do a TB test because you were travelling to another country? Let’s talk about this topic that’s as old as humanity itself—Tuberculosis (TB).
It’s one of those diseases that you’ve probably heard about, maybe even studied in school, but it often feels like it’s lurking in the background of our collective consciousness. But don’t be fooled; TB is very much an active threat, especially in certain parts of the world, and understanding it is crucial.
When moving from countries like Nigeria, India, or Pakistan to Western countries such as the United States, the United Kingdom, or Canada, one of the mandatory steps you’ll likely encounter is a tuberculosis (TB) test. This is if you will spend longer than 6 months in those countries.
This requirement stems from the fact that TB remains more prevalent in these regions compared to many Western countries, where the incidence of TB is generally low. The test ensures that those moving into these countries do not carry latent or active TB, which could pose a public health risk.
TB is like that shadow you don’t notice until it’s too late. It’s caused by Mycobacterium tuberculosis, a bacterium that primarily targets the lungs, though it can spread to other parts of the body like the kidneys, spine, and brain.
The thing about TB is that it’s incredibly sneaky—most people infected with the bacteria don’t actually get sick. This is what we call “latent TB infection” (LTBI). You’re carrying the bacteria, but you’re not showing symptoms and can’t spread it.
However, without treatment, there’s a 5-10% chance that latent TB will become active TB at some point in your life. Western nations are particularly vigilant about TB because of this.
This is the reason there is an established protocol requiring TB screening for individuals arriving from countries with a high incidence of TB who plan to stay for more than six months.
This measure is not just a formality; it’s a critical component of public health strategy to prevent the reintroduction and spread of TB in these low-incidence areas.
When TB becomes active, that’s when the problems start. Think of the worst cough you’ve ever had—now imagine it lasting for three weeks or more, often with blood in the sputum, fever, night sweats, and weight loss.
That’s TB in action. The disease spreads through the air when someone with active TB in their lungs coughs, sneezes, or even talks. It’s as easy as inhaling a few droplets carrying the bacteria, which is why TB can spread rapidly in crowded places.
Who’s at Risk?
Here’s where it gets concerning: TB doesn’t discriminate, but it does favour certain conditions.
People with weakened immune systems—like those with HIV/AIDS, diabetes, or malnutrition—are at a higher risk.
Poverty, overcrowded living conditions, and lack of access to healthcare also increase the likelihood of TB spreading. This is why TB is still rampant in many developing countries, even though it’s less common in places with better healthcare systems.
The diagnosis of TB requires a high index of suspicion if it is not prevalent in that community. You may think it’s just a cough or Pneumonia and be taking other treatments that simply will not work.
A detailed history from your doctor including travel history is important. General physical examination follows especially a chest examination.
The testing typically involves a chest X-ray and, if needed, further tests like the Mantoux tuberculin skin test or an IGRA blood test. In some cases CT scan may be needed to establish a diagnosis.
The good news? TB is curable.
Treatment involves a course of specific antibiotics that must be taken for 6-9 months. One of these medications will notoriously turn your urine red during the period it is being taken. It is perfectly normal.
However, here’s the catch—if the treatment is not completed properly, it can lead to drug-resistant TB, a much more dangerous and difficult form to treat.
This is why there was the Directly Observed Therapy (DOT) initiative where people with TB go to a clinic every day to collect their medicine and swallow it in front of healthcare workers 😂. I doubt if this practice is still being done but the idea was to make sure people took their medicines.
If you decide to be a wise guy and not show up. There were Community Health Extension Workers (CHEW) who would come to your house and make sure you received treatment. Like I said, I’m not sure if this practice still happens in rural areas.
Preventing TB involves a mix of public health strategies: improving living conditions, providing vaccinations (BCG vaccine), and ensuring that those with latent TB get the proper treatment to prevent it from becoming active.
TB may not be as dramatic as some other diseases, but it’s a persistent and deadly threat, especially in vulnerable populations.
So, the next time you hear about TB, don’t just think of it as an old-timers illness that’s been relegated to the history books.
It’s still out there, and the fight against it is far from over. Staying informed and supporting global health initiatives are key in keeping this ancient foe at bay.
If you’re in a healthcare field or have the means to support global health initiatives, consider getting involved in TB awareness and prevention programs. Every bit helps in the fight against this relentless disease.
Follow me @DrJohnBishop for regular health awareness on topics affecting daily living.