GERARD W. FRANK, M.D., UCLA MEDICAL GROUP
Tuberculosis has been one of mankind’s scourges for thousands of years. Before modern-day medicine, it was known as “consumption” because it seemed to eat up the body. Literature and opera are replete with victims of the disease. It was not until the late 19th century that Robert Koch identified the “tubercle bacillus” that gave the disease its name. In doing so, he founded the modern science of microbiology.
Tuberculosis in Europe and America reached epidemic proportions in the 19th century, probably due to urban crowding brought on by the Industrial Revolution. Then in the early 20th century, it declined, due to improved social conditions but long before effective antibiotics were discovered. That occurred prior to World War II but the drugs did not become readily available until the late 1940s.
Today, in the industrialized world, we think of tuberculosis as rare, although it saw a resurgence in the U.S. with the AIDS epidemic and waves of immigration from the Far East. It remains a major health problem in third-world countries, with hundreds of millions exposed and tens of millions of deaths each year. In many countries, the cost of treatment is a huge financial burden.
But what about Los Angeles? Are we at risk? The answer, unfortunately, is “yes.” The case rate in Los Angeles is one of the highest in our nation. Fortunately, there is a simple test to detect the disease and provide appropriate treatment. Ironically, of all the people exposed to the germ, only up to 10 percent will ever become sick. The primary medical goal is to identify exposed people and treat them to prevent the spread of significant disease. This is called “prophylaxis.”
Tuberculosis spreads when an infected person coughs tiny droplets into the air and someone else is close enough to breathe in those droplets. Once exposed, the immune system reacts and leaves a clue to the presence of germs. This is the skin test for TB, the so-called “PPD.” Ideally, as a public health measure, the test should be administered to all high-risk groups, including recent immigrants, homeless, prisoners, patients in nursing facilities, those with impaired immune systems and healthcare workers. A positive skin test will lead to other tests – x-rays and cultures– to identify active disease. Those who live or work with someone who has been diagnosed with active TB should always be tested.
The medical communities in Los Angeles and other urban centers need to have a raised awareness of TB. It should be suspected in any person with persistent cough, especially if coughing blood, recurrent fevers, night sweats or weight loss. Prophylaxis for those who have been exposed but do not have active disease requires only one antibiotic.
By contrast, active disease must be treated with at least four antibiotics for a prolonged period. Older folks may remember when lung associations had “breathmobiles” equipped with x-ray machines to find TB cases in the community. While such measures are no longer considered effective or necessary, we must all be aware of the risk and report any unusual respiratory symptoms to our doctors.
Dr. Gerard Frank is a board-certified internal medicine specialist and pulmonologist with the UCLA Medical Group in Santa Monica and an associate clinical professor at the David Geffen School of Medicine at UCLA.