White Plagua

Tuberculosis is described as white plague and kills more people in the world than any other infectious disease. Mycobacterium tuberculosis has been present in the human population since antiquity - fragments of the spinal column from Egyptian mummies dated 2400 B.C. show definite pathological signs of tubercular decay.

The registered number of new cases of TB worldwide roughly correlates with economic conditions: the highest incidences are seen in the countries of Africa, Asia, and Latin America with the lowest gross national products. WHO estimates that eight million people get TB every year, of whom 95% lives in developing countries. An estimated 3 million people die from TB every year.

In 1998 the World Health Organization* compiled a list of fifteen countries heavily exposed to tuberculosis. Moldova was among them.

*The World Health Organization (WHO) is a specialized agency of the United Nations that directs and coordinates international health work. WHO currently has 191 member states.
WHO's main functions are:

• to give worldwide guidance in the field of health,
• to set global standards for health,
• to cooperate with governments in strengthening national health programs,
• to develop and transfer appropriate health technology, information, and standards.

The number of reported tuberculosis patients in Europe rose from 280 000 in 1995 to almost 370 000 in 2000. In 2000, almost 70% of all reported cases occurred in the NIS, mainly affecting young men, current and former prison inmates, people with alcohol problems and other socially disadvantaged people. The breakdown in the health care infrastructure and the deterioration of living conditions in these countries are to blame. In western European countries, tuberculosis strikes hardest at drug users, elderly people and migrants. Throughout the Region, HIV-infected people are at special risk of the disease.
(Press release EURO/11/02 Copenhagen and The Hague, 6 June 2002)

In January 2002 official data shows over 12 thousand registered cases of the disease. These are typically people from 20 to 50 years of age. Men are at greater risk. TB is a contagious disease. Like common cold, it spreads through the air. Only people who are sick with pulmonary TB (TB of the lungs) are infectious. When infectious people cough, sneeze, talk or spit, they propel TB germs known as bacilli into the air. A person needs only to inhale one bacilli to become infected. >/p>

Left untreated, each person with active TB will infect between 10 and 15 people on average each year. However, people infected with TB will not necessarily get sick with the disease. The immune system "walls off" the TB bacilli which are protected by a thick waxy coat, and can lie dormant for years. When a person's immune system is weakened, (especially if the person has HIV) the chances of getting sick are greater.

In 1882, Robert Koch discovered a staining technique that enabled him to see Mycobacterium tuberculosis. Over 90% of people are predisposed to getting the disease and sometimes it only takes to breathe in. Primary symptoms are: loss of weight, loss of energy, poor appetite, fever and wet cough.

Last year over a thousand people died from TB in Moldova and 20% of these were children. Statistics does not decline with time and the question arising form this is why does it happen?
From the beginning of economic reform in Moldova the well-operated tuberculosis prevention medical system fell apart. In the former times TB centers were established in every region and town of the country. In Vorniceni, for example, there was a free hospital for secondary tuberculosis patients. Today Tirnovo, Cornesti, and Ciadir-Lunga children’s sanatoria have no financial resources. Unlike other countries Moldova has still not developed a national tuberculosis prevention program. We basically ended up face to face with the problem but with no effective means to fight it.

The free medical assistance includes tuberculin skin tests*, chest X-rays, polymerase chain reaction tests and bronchoscopy to reveal the disease.

*The TB skin test is based upon the type 4 hypersensitivity reaction. If a previous TB infection has occurred, there are sensitized lymphocytes that can react to another encounter with antigens from TB organisms. For the TB skin test, a measured amount of tuberculin purified protein derivative (PPD) is injected intracutaneously to form a small wheal, typically measured on the forearm. In 48 to 72 hours, a positive reaction is marked by an area of red induration that can be measured by gentle palpation (redness from itching and scratching doesn't count). Reactions over 10 mm in size are considered positive in non-immunocompromised persons. A positive skin test indicates the need for yearly chest X-rays to detect active disease. Polymerase chain reaction, allows detection of M. tuberculosis DNA, this is generally performed on sputum samples. Results can be available within 6 hours.

Rural population still applies traditional treatment methods, which have been practiced of old. Necessary drugs are not procured and their combinations vital to the health of the patients are not available. Vitamins carried in fruit and vegetables decrease the risk of tuberculosis. The TB situation is considered stable and under control when there is one infected person per one million people. The 2001 statistics for Moldova shows a ratio of 1:1468, which fluctuates depending on the region. In Ciorescu with its penitentiary the ratio is a shocking 1:384. In small prison cells in bad living conditions TB spreads exceedingly fast.

Doctors have been bringing up the problem of the tuberculosis epidemic since 1991. Since then the situation has grown even worse. The municipal treatment center located in the outskirts of Chisinau was closed down due to complete absence of necessary funding. According to former managing director Natalia Stegarescu the center used to extend free medical help to patients sent there by personal doctors. Many needy patients with secondary tuberculosis and decayed lung tissue were brought to the center. Statistics shows that approximately 32% of all patients are normal working people with relatively stable and healthy lifestyles. 68% are market vendors and tradespeople traveling to make a living.

Doctor Margarita Ivanova said that TB bacilli are very resistant and can live in the earth up to twelve months. Formerly all patients were obliged to carry around a special bottle for sputum. Nobody wants to do that today and Chisinau is basically covered in spit. Patients are growing increasingly aggressive with tendencies to infect others. The situation becomes seriously complex during the summer months, when bacilli reproduce faster. Children are primary victims of the disease so it is important to establish a high sense of personal hygiene from a young age. There are no schools for infected children and they are not accepted to regular ones.

The healthier the body and the stronger our immune system, the less chances there are of catching this air transmitted sickness. TB bacilli survive in temperatures as high as 50 degrees C. Take care when drinking in public places and eating off food stands. Personal hygiene is a good habit even without considering it a means of evading an infection. And let us hope that some day our government will adopt some sort of a TB prevention program.

• Someone in the world is newly infected with TB every second.
• Nearly one percent of the world's population is infected with TB each year.
• Overall, one-third of the world's population is infected with the TB bacillus.
• 5 - 10 percent of people who are infected with TB become sick or infectious at some time during their life.

By Liudmila Mamaliga
and Natalia Corobco