March 24, 2021

Tuberculosis: not just a disease of the past

24 March marks World TB day, an annual event to commemorate the date in 1882 when Robert Koch announced his discovery of Myobacterium tuberculosis, the bacterium that causes tuberculosis (TB). Koch’s discovery opened the way toward diagnosing and curing this disease. The event is designed to raise public awareness that tuberculosis, despite being curable, remains the world’s deadliest infectious disease.

TB is often thought of as a disease of a bygone era. Koch’s discovery and then the development in the 1940s and 1950s of the antibiotics streptomycin and isoniazid, led many people to assume that TB had virtually been eradicated. In reality, that couldn’t be further from the truth.

The World Health Organisation (WHO) estimates that, globally, over 4,000 people die of TB each day and nearly 30,000 fall ill with this preventable and curable disease. England has one of the highest rates of TB in Western Europe, with 4,725 cases reported in 2019. Of those patients, nearly 40% were from London, which has become known as the TB capital of Europe.

The lasting and long-term effects of TB

TB usually affects the lungs, but can also affect other areas of the body, such as the brain, spinal cord, liver, heart and spine. If treated early, TB can usually be cured with antibiotics. However, if left untreated, TB can cause permanent and severe organ damage and ultimately, death. It is therefore important that TB infections are picked up early and treatment given promptly, before any permanent damage occurs.

In some people, the body builds a defensive barrier around the infection and the bacteria can lie dormant, suppressed by the immune system. This is known as latent TB. Someone has latent TB if they are infected with the bacteria but do not have signs of active TB and do not feel ill.

People with latent TB are not infectious and cannot spread TB infection to others. However, approximately 5-10 % of people with TB will go on to develop active TB. There is an added risk in those who take medication to suppress the immune system, including some medications to treat conditions such as: rheumatoid arthritis; psoriatic arthritis; Crohn’s disease; ulcerative colitis and psoriasis to name a few. Effective drugs are available for the treatment of latent TB and taking a complete course of treatment can prevent the infection from becoming active disease.

Our perspective

In our experience as a clinical negligence solicitors, there is currently a lack of awareness of TB and its devastating effects.

Despite the fact that the signs and symptoms are relatively easy to identify and testing is widely available, it is clear that cases of TB are being missed and are not being picked up until permanent damage has been done.

Whilst treatment for latent TB is usually straightforward, with minimal long-term side effects, we have seen several cases where there has been a failure to diagnose and treat latent TB before staring a patient on immune-suppressant drugs. Those patients have then gone on to develop active TB, requiring extensive treatment, prolonged hospital stays and a delay in treating their underlying condition.

Lucy Crawford recently represented a patient who developed active TB following treatment with Infliximab, an immunosuppressant, for colitis and proctitis. No screening for latent TB had been carried out before treatment.

The patient suffered from weight loss, fever and flu like symptoms before he was eventually diagnosed with TB, several months after starting treatment. In 2020, our client accepted an out of court settlement of £30,000 on the basis of pain, suffering and loss of amenity he endured as a result in the delay of diagnosis and the commencement of medication without prior testing.

TB is not a disease of the past and World TB day reminds us that it remains the world’s deadliest infectious disease. Anything that can raise awareness of the challenges faced in treating and eliminating this deadly disease can only be a good thing.

If you are concerned about TB, here are the key signs to look out for and raise with a medical professional:

  • a persistent cough that lasts more than three weeks and usually brings up phlegm
  • weight loss
  • night sweats
  • high temperature
  • tiredness and fatigue
  • loss of appetite
  • swellings in the neck.
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