TB Spreads at Japanese School

[Taro Toporific]

Tuberculosis Spreads at Japanese School
ABC 7 News / 13 Apr
Two students at a school near Tokyo have contracted tuberculosis and 16 others were suspected of being infected, after a teacher there was hospitalized with the disease in February, an official said Monday.... ... The number of tuberculosis patients in Japan is the highest among rich, industrialized countries, with 32,828 people contracting the disease in 2002, according ...

Q: How the hell does this happen when it's a REQUIREMENT to have the TB/Diph/Tet shot before enrolling in a Japanese school and Japan has universal socialized medicine?

[Big Booger]

It is treatable and preventable.

How?


ANd what are the symptoms? I mean I teach, and don't want some pisswad teacher giving me a disease like TB.. or a student for that matter.

[Taro Toporific]

It is treatable and preventable.

How?

Check the FAQ at the CDC, Center for Disease Control

http://www.cdc.gov/travel/diseases.htm#TB

[Taro Toporific]

ANd what are the symptoms? I mean I teach, and don't want some pisswad teacher giving me a disease like TB.. or a student for that matter.

If you're in the danger zone (Osaka to Kyushu) and schools are reporting TB, start getting the TB skin test yearly. If your school district has active TB (butter up local govn't health nurse to find out the truth) get the BCG vaccine for TB (named after the French scientists Calmette and Gu&#233]http://images.google.com/images?q=tbn:eVQoJ4rjbh4J:www.lung.ca/tb/images/full_archive/094_tb_from_milk.jpg[/img]

[Big Booger]

Yeah I went and did a little indepth research:

Patients may present without symptoms or in an extremely debilitated state. Symptom-free disease may be detected during routine screening. Symptoms may include malaise, weight loss, and night sweats. Most patients with TB have pulmonary disease; extrapulmonary disease usually is seen in immunocompromised patients. TB in an HIV patient may present atypically. These patients have a higher risk for developing multidrug-resistant TB (MDR-TB) and miliary TB. Usually, a longer course of therapy is needed and, because of interactions with other medications, the regimen may require adjustment.

Symptoms include: cough that is worse in the morning (sometimes with hemoptysis, blood in the sputum), chest pain, breathlessness, night sweats, and signs of pneumonia. In advanced disease, there may be extreme weight loss. Examination with a stethoscope may reveal diminished breath sounds, bronchial breathing, tracheal deviation, and coarse crackles. Tuberculosis is difficult to diagnose because the signs and symptoms are seen in other diseases, such as the following:

* Carcinoma of the lung (frequently creates cavities in lung tissue)
* Pneumonia (can proceed to cavitation and resemble TB on chest x-ray)
* Allergic bronchopulmonary asperigollosis (marked by inflammatory granulomatous lesions in bronchi)
* Sarcoidosis, allergic alveolitis, pneumoconiosis, silicosis (biopsy and allergy screening eliminate these from diagnosis; silicosis predisposes to tuberculosis)
* Anorexia nervosa, diabetes mellitus, hyperthyroidism (chronic malaise, fatigue and cachexia [wasting])
* Mediastinial lymphadenopathy (may also be lymphoma)

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Diagnosis

Diagnosis essentially depends on isolating the bacteria from tissue. Chest x-ray reveals cavitation, calcification (healed disease), and nodes in the upper lobes, but cannot confirm the diagnosis. Granulomas with caseation obtained in biopsy indicate the diagnosis, but if caseation is not present, other possible diagnoses include sarcoidosis and lymphoma. Sputum smears and cultures are useful in diagnosing pulmonary tuberculosis. Usually, three early morning specimens of sputum are obtained on three different days. The specimen is prepared on a slide, stained with an acid-fast dye, and observed under a microscope. The slide may show the characteristic acid-fast bacilli (AFB). Unfortunately, this alone does not confirm the diagnosis, because many mycobacterium species have a similar appearance.

Definitive diagnosis requires growing the bacteria and confirming that the culture is M. tuberculosis with biochemical tests or DNA probes. This can take several weeks. Smears that give a negative result initially can produce a positive result in a culture weeks later.

Urine cultures sometimes provide a diagnosis of Mycobacterium tuberculosis, especially in the case of genitourinary TB.

In a gastric aspirates test, a small nasogastric tube is placed in the stomach early in the morning and gastric contents are suctioned and processed for smears and culture.

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In lymph node biopsy an enlarged lymph node is removed and a portion is cultured. The remaining portion is sent for histology (staining) and examined under a microscope. Frequently, a caseating granuloma and sometimes an AFB are seen. Unfortunately, the presence of caseating granulomas without AFB is nonspecific and can indicate other diseases.

Culture of body fluids
Fluid drained from the pleural space, the pericardial space, or the peritoneal space (see Anatomy of the Respiratory System) may be positive for AFB on smear and positive for TB on culture. If the smears are not positive in the case of TB pleurisy (they are only positive 50% of the time), a biopsy of the pleural membrane may yield a diagnosis. In suspected pericardial TB, pericardial fluid is drained. Biopsies of the pericardial membrane may be taken at the same time.

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Bronchoalveolar lavage is often the next diagnostic test performed in patients with suspected pulmonary TB when sputum smears are negative.

The fiberoptic bronchoscope, a flexible tube about as big around as a pencil, is slid into either the nose or the mouth and passed down the back of the throat, into the trachea, and into each lung. There are no pain fibers in the tracheobronchial tree, so the procedure does not hurt. Topical lidocaine is sprayed into the back of the throat to inhibit the gag reflex and light sedation is given. The patient may cough during the procedure, so small doses of lidocaine are sprayed into the lungs occasionally during the procedure to numb the cough receptors. The procedure can take from 5 minutes to an hour.

To sample material from the alveolar space, the bronchoscope is advanced as far as possible into the lungs. The tube forms a seal with the airway wall, so fluids cannot go behind the bronchoscope tip. Sterile saline is pushed through the bronchoscope to the alveolar space, where it flushes out bacteria and loose cells. The solution is then suctioned out, cultured, and stained. Bronchoscopy for tuberculosis may initially involve bronchoalveolar lavage only.

Biopsy is often performed if an abnormality is seen in the airways during bronchoscopy (uncommon with tuberculosis). A thin wire is threaded through the bronchoscope and small biopsy forceps attached to the end of the wire remove several tissue samples from the bronchi. The samples are then sent to a laboratory for analysis.

BUt what are ways to prevent it? and then to treat it once you get it?

[mnine]

They don't give the vaccine anymore in North America. Once you get the vaccine, you will always test positive on the skin test, but the effects of the vaccine wear off after a few years in a large proportion of people.

If you test positive, they give you antibiotics for a year. Depending on the suspected strain, you will get 1-3 different antibiotics + a vitamin (can't remember which, pyroxin or something, a B vitamin against possible nerve problems). If you got it in Russia or certain innercity populations, with a prevalence of multiple drug resistant (MDR?) TB, you are somewhat SOL.

The pisser is, you have to take it every day. If you forget, you are in some kind of friggin limbo and the doc isn't too happy with you.

[GomiGirl]

But if you have been exposed and not become ill, it is quite likely that you have immunity.

The only way to check this is to have the skin test.. a little stamp like contraption pressed onto your skin.. then in two weeks they check to see if you have a reaction. If no then you are not immume and thus need the full vaccine. This is another stamp like contraption, just larger.

Doesn't really hurt from memory. But then getting shots etc has never worried me.

[mnine]

But if you have been exposed and not become ill, it is quite likely that you have immunity.

that's very untrue. you can be a carrier for years before it becomes active ("latent TB"). the skin test just shows the presense of antibodies.

it's not so easy to catch TB though. a person has to be infectious (active TB, and in the lungs), they have to cough out sputum, and you have to breath enough of the suspension.. (obviously little kids in a school or a cramped prison is a great environment for that).. if TB manifested in the brain, spine, or other organs, its not as easy to transmit casually. i'm pretty sure all major cities still have a TB sanatarium type facility to deal with active infectious cases. (...and distinguished from latent TB cases who are managed by the yearlong course of antibiotics at home).