Last week a 37-year old woman came all the way from a district to the city in search of a "cure" for her malady. The night before she saw me, she had gone to one of Klinik 1 Malaysia nearby for breathlessness and she was nebulised ( given a bronchodilator through a spray pump). Normally patients are given this treatment to alleviate their asthmatic attacks.
This poor woman gave a long history of coughs (more than five months). She had gone to the district hospital a couple of times and getting no relief, she started to medicate herself, buying over the counter (OTC) medicine apart from seeking traditional treatment.
Her relatives brought her to the city when her condition deteriorated with severe breathlessness. Upon questioning, it was revealed that she coughed badly and occasionally her sputum was blood-streaked. She has evening fever and excessive sweating and her weight has drastically declined. Physical examination revealed reduced air entry on her left lung with fine crackles on auscultation but no wheezing was heard. And there are enlarged lymph nodes (lymphadenopathy) on the left neck area ( posterior triangle). All classic signs and symptoms of tuberculosis.
The next thing to do was a chest X-ray and sputum test for acid fast bacilli ( Mycobacterium tuberculosis- the germs causing this preventable disease). Her chest xray shows widespread consolidation of the left lung with a tiny area of respirable lung tissues. The sputum was positive for the bacteria.
The question is how many persons has this lady infected over all those months that she was not detected? She had had contact with a health facility last February 2014 on two occasions and yet was not diagnosed.
A colleague opined that the case was due to a low index of suspicion but for me it was more likely due to poor history taking and worst still if it was a case of pure laziness on the case of the health worker to take the history. It could be a case of " What is your complaint?" and the timid patient would have replied "coughs" and the doctor proceeded to prescribe a cough medicine and dismissed the woman without going into the nature,character and duration of the symptom.
The woman is put on an anti-TB treatment but the extensiveness of the infection on her right lung would affect the prognosis and as a result, her morbidity and impact on her family and economic contribution.
As TB is a notifiable communicable disease, Public Health service would have to trace all her contacts and test them and given treatment should any found to be positive.
TB is still a public health problem in Malaysia particularly in areas where there are many immigrants, legal and illegal.
This poor woman gave a long history of coughs (more than five months). She had gone to the district hospital a couple of times and getting no relief, she started to medicate herself, buying over the counter (OTC) medicine apart from seeking traditional treatment.
Her relatives brought her to the city when her condition deteriorated with severe breathlessness. Upon questioning, it was revealed that she coughed badly and occasionally her sputum was blood-streaked. She has evening fever and excessive sweating and her weight has drastically declined. Physical examination revealed reduced air entry on her left lung with fine crackles on auscultation but no wheezing was heard. And there are enlarged lymph nodes (lymphadenopathy) on the left neck area ( posterior triangle). All classic signs and symptoms of tuberculosis.
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| This is the patient's Chest XRay- her left lung is virtually consolidated with a very small unaffected apical area. The right lung is over expanded to compensate for affected breathing function of the left lung. |
The next thing to do was a chest X-ray and sputum test for acid fast bacilli ( Mycobacterium tuberculosis- the germs causing this preventable disease). Her chest xray shows widespread consolidation of the left lung with a tiny area of respirable lung tissues. The sputum was positive for the bacteria.
The question is how many persons has this lady infected over all those months that she was not detected? She had had contact with a health facility last February 2014 on two occasions and yet was not diagnosed.
A colleague opined that the case was due to a low index of suspicion but for me it was more likely due to poor history taking and worst still if it was a case of pure laziness on the case of the health worker to take the history. It could be a case of " What is your complaint?" and the timid patient would have replied "coughs" and the doctor proceeded to prescribe a cough medicine and dismissed the woman without going into the nature,character and duration of the symptom.
The woman is put on an anti-TB treatment but the extensiveness of the infection on her right lung would affect the prognosis and as a result, her morbidity and impact on her family and economic contribution.
As TB is a notifiable communicable disease, Public Health service would have to trace all her contacts and test them and given treatment should any found to be positive.
TB is still a public health problem in Malaysia particularly in areas where there are many immigrants, legal and illegal.
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