We are in first place in the EU in terms of the number of TB cases, a contagious disease with a high degree of mortality, draw the attention of doctors from the “Marius Nasta” Institute. Last year alone, 9,572 cases were registered, of which over 400 were among children. And these are the official figures. Unofficially, the number of illnesses could be much higher, but often patients confuse the disease with a long cold.
The infectious disease, mistaken for a cold, is spreading in Romania – Photo Archive
Tuberculosis, often confused with a cold, sickens more and more Romanians from year to year, draw the attention of doctors. The infection rate in 2023 was 48 cases per hundred thousand inhabitants. The number of cases increased by more than 700 compared to 2022 and reached 9,572, according to data published by the “Marius Nasta” Institute. It is the third year in a row that the incidence of tuberculosis is increasing in our country. The most cases were registered in Dolj, Teleorman, Giurgiu, Brăila and Botoşani, where over 75 cases/100,000 inhabitants were registered. The counties of Covasna, Bistriţa-Năsăud, Alba, Braşov and Sălaj are at the opposite pole, with less than 30 cases/100,000 inhabitants. More worryingly, the condition is increasingly present among children.
Tuberculosis among children
The diagnosis is more difficult in the case of small ones, and sometimes it will not be confirmed bacteriologically. Most of the time, in 90% of cases, the infection is asymptomatic among children, but it remains in the body and can be a source of illness over time. Last year, 429 cases of tuberculosis among children were reported. The counties with a high incidence are Teleorman, with almost 80 cases/100,000 inhabitants, Brăila, Giurgiu, Călăraşi and Bihor.
“Tuberculosis is a disease produced by the Koch bacillus, which can infect any person, producing the disease under the conditions of the association of some favorable factors. Contact with a case of tuberculosis is defined as spending more than 4 hours with a person with tuberculosis. Favorable factors can be internal or external, being represented by diseases that lower immunity, alcoholism, HIV infection, stress, air pollution level“, explained Beatrice Mahler.
COVID-19, pollution and decreased immunity
And the number of TB cases could be much higher, given that, in the latent state, most infections are asymptomatic. The WHO estimates that a quarter of the global population has been infected with TB bacteria, but most people will not develop the disease.
Among the factors that contributed to the increase in cases among children are: contact with sick adults; limited access to health systems in certain areas of Romania, which can lead to delays in diagnosis and treatment; weakened immunity or the existence of an immature immune system, which makes them more susceptible to infections, but also stress and poor socio-economic conditions can increase the risk of tuberculosis, by decreasing their resistance to infections and by exposure to risk factors.
Moreover, the latest studies show that there is a link between small particle pollution and tuberculosis.
“Air pollution can influence the health of the lungs in various ways, the study carried out in Romania indicates that there is a link between the level of PM2.5 and tuberculosis, through several mechanisms. Assessing the risk of infection with Koch bacillus from the perspective of air quality and not only the predisposing factors related to socio-economic conditions creates a different perspective on the needs that we must adopt in the fight against tuberculosis“, said Dr. Beatrice Mahler.
In our country, there are two areas with a high risk of infection that overlap with two geographical territories where pollution is high, located in the southern part of Romania and in the eastern part, the doctor also said.
More serious forms of tuberculosis have been reported after the COVID-19 pandemic, Lucica Diţiu, executive director of the United Nations Global Partnership to Stop Tuberculosis, warns.
“After COVID, the forms of tuberculosis that appeared were very complicated, people stayed at home and did not get treated, and when they went to the hospital they came out with some very serious forms of tuberculosis, in most countries. What we are beginning to see now, and this is the most horrifying thing, is a phenomenon related to the treatment of resistant tuberculosis. A new drug, bedaquiline, is used, but when the treatment is done poorly, antibiotic resistance occurs. Any impairment of antibiotic treatment in terms of duration, frequency or quality of the drug can lead to resistance, and what we're seeing after COVID is an increase in resistance to this antibiotic, which is very serious because it's a new drug that we're getting into many hopes. If you resist him, it's serious because you don't have much left to give. We have already seen this in India“, draws the specialist's attention.
More and more difficult to deal with
Tuberculosis is treated with 4 antibiotics: zoniazid, rifampicin, pyrazinamide, ethambutol, which are administered in doses corresponding to body weight, for two months. Then, for the next 4 months, only isoniazid and rifampicin will be given in higher doses only 3 days a week.
“A few years ago, simple tuberculosis was treated for a period of 6 months and up to two years – resistant tuberculosis. There are new drugs that make the treatment of resistant tuberculosis reduced from two years to 6 months, non-injectable, and for the common one reduced from 6 to 4 months. We offer funds to researchers to reduce them to two and one month, respectively. Romania has medicines, people can treat themselves normally, and if not, then there is a problem“, explained the doctor specializing in pulmonary diseases Lucica Dițiu.
There are also cases where the microbe becomes resistant to antituberculosis drugs. This happens when the treatment is not administered correctly: omission of one or more drugs, unjustified discontinuation of medication, incorrect doses or regimens. The duration of treatment increases in these cases from half a year to a year and a half.
“Tuberculosis remains a public health topic on the agenda in Romania and, even though after a period of constant decrease since 2004 in the incidence of tuberculosis, when it was around 140, if I'm not mistaken, and we reached somewhere around 50 in recent years, apparently the number of cases is increasing. Of course these are the values, growth is slow. I am convinced that this is also a result of the pandemic that led to a reduction in the activities related to the diagnosis of tuberculosis and it is a rebound, which is not unusual, especially since it is not a dramatic increase. (…) The problem of multidrug-resistant tuberculosis, which concerns the authorities in Romania, the WHO, the European Commission, remains a sensitive issue and we do everything we can to ensure medication and treatment compliance of patients“, said Alexandru Rafila, the Minister of Health.
How tuberculosis is transmitted
The condition is almost exclusively respiratory, “through the small drops of saliva eliminated by the patient with pulmonary tuberculosis by coughing, sneezing or even speaking”, say the doctors from the “Marius Nasta” Institute. Objects or clothes worn by tuberculosis patients cannot transmit the disease. Patients quickly become non-contagious after a few days of starting treatment.
Immunocompromised people, who suffer from cancer, autoimmune diseases, diabetes, HIV and others, are at a higher risk of getting sick. Moreover, approximately 40% of people infected with HIV die from tuberculosis.
symptom
It is most often located in the lung, and the symptoms of the disease include: cough that lasts more than 3 weeks and does not respond to treatment, sometimes hemoptysis, i.e. expectoration of blood, fatigue, weakness, night sweats, decreased appetite associated with decreased in weight, according to the “Marius Nasta” Institute. Chest pain or pain when coughing or breathing is another sign, as is a low-grade fever. Doctors make this diagnosis following a lung x-ray and sputum analysis, which includes microscopic examination.
