Tuberculosis is a debilitating disease many might erroneously think has been left in the past. While it’s true that it was discovered in the 1880s, the reality is that it is still very much around today.

In fact, TB is endemic in Malaysia – just like dengue and, now, Covid-19. While Malaysia is not on the World Health Organization’s top-30 high-burden countries for TB, it is still viewed as having a high incidence rate, estimated at 92 per 100,000 population.

Every year, between 20,000 and 25,000 cases of TB are recorded, resulting in an average of 1,500 to 2,000 deaths. In 2018, pre-pandemic, Malaysia recorded 25,837 cases. In 2020 and 2021, this decreased marginally to 23,644 and 21,727 respectively.

Meanwhile, close to 25,400 TB cases were reported last year, with 2,572 deaths.

Malaysians carry the scar of the BCG vaccine given as babies and at primary school. This shot protects us against TB, but its effectiveness wanes over the years and, by the time we are adults, many of us no longer have immunity.

1. What causes it?

TB is caused by the mycobacterium tuberculosis bacterium, which can attack different parts of the body, with the lungs – referred to as pulmonary tuberculosis (PTB) – being the most common.

Otherwise, extrapulmonary tuberculosis (EPTB) is the term used to categorise TB when it manifests in other parts of the body, including the lymph nodes, bones (usually the spine) and, in rare cases, the gut. In patients who are immunosuppressed such as those living with HIV, it can attack the brain.

The most susceptible are the elderly, those with lowered immunity such as diabetics, people who are immunosuppressed such as those on chronic steroid therapy, and people living with HIV. Young children are also more at risk because their immune systems would still be developing, which is why they are given the BCG jab.

Others include those who live in overcrowded living spaces, making it easier for the bacteria to pass on, such as migrant workers and the poor.

2. Signs and symptoms

The four primary symptoms of PTB are a chronic cough, profuse night sweats, weight loss, and a recurrent rise in body temperature in the evenings. In EPTB manifestations, it presents itself as swollen lymph nodes, chronic back pain and fragile bones, a sensitive gut and, if in the brain, seizures, headaches, confusion, and even alterations in personality.

One of the challenges in detecting TB is that it doesn’t present symptoms immediately. “You could have been exposed long ago, and the bacteria will stay latent or dormant in the body and hibernate. Symptoms can come up months or even years later,” says Dr James Koh from a medical university in Kuala Lumpur.

This slow and subtle onset is unlikely to set off alarm bells until the disease has advanced to the point that you cough up blood.

3. How do you test for TB?

For PTB, an X-ray of the lungs will show “cavities”, a telling sign of TB. There is also a saliva test and a skin test. In cases of EPTB, a biopsy of the bone or swelling might need to be done.

Don’t wait to cough up blood – see a doctor if you have had a persistent cough for two weeks. Taking into account your general state of health, the doctor will know whether to test you for TB or not.

Do the same if you have unexplained night sweats and weight loss, together with swollen lymph nodes or chronic back pain.

4. How contagious is it?

Similar to all respiratory diseases, TB spread by water droplets that come from coughing or spitting. However, unlike Covid-19, the bacteria is heavy, so these droplets need to be significant.

“You have to be in quite close contact and in a situation where there’s prolonged exposure; generally, more than eight hours a day,” Koh said. Some examples of close contacts would be immediate carers, office mates, or those living in the same house.

A person with latent or dormant TB is not infectious, and neither are those who have EPTB without the infection in the lungs.

5. Treatment for TB

TB treatment is straightforward but long: a combination of four antibiotics is prescribed for between six months and a year, depending on the part of the body affected.

For PTB, it is generally within six months, while EPTB needs nine to 12 months. Newer medications can potentially treat TB within three months, but Malaysia does not have the facility yet.

It is crucial to take the medication on time and as prescribed, failing which the bacteria could become resistant to the drug.

Once treatment has begun, a person will be non-infective in 10-14 days. In hospitals, he or she will be put in isolation, but there is no prescribed quarantine period. “The most important thing is to wear a mask and wash your hands frequently,” Koh said.

6. What can you do?

As there is no “booster shot” to raise immunity levels against TB, the best way to keep it at bay is to adhere to a healthy lifestyle.

Be aware of symptoms, as early treatment is crucial. If left for too long, even after recovery, TB can leave scarring on the lungs that will forever curb a person’s breathing capacity.

“When a person has recovered, maintain a good diet, exercise, and don’t smoke. You can get reinfected with TB, and that can get quite bad,” Koh said.

Education on the disease is also crucial to avoid stigmatising those with TB. Perhaps not helped by the portrayal of the disease in movies, TB is often seen as a “dirty disease” and a confirmed death note.

In truth, it is far from this, and this perception can lead to delays in seeking treatment arising from a sense of helplessness, fear of isolation, and rejection by society. Remember: the disease is curable and it can happen to anyone.