Tuberculosis has once again become the leading cause of death from infectious diseases in the world, dethroning COVID-19, according to a WHO report. However, the figures should be seen in correlation with what happened during the pandemic, says pulmonologist Beatrice Mahler, explaining why.
The incidence of tuberculosis is increasing, the figures show. PHOTO: Adevărul archive
According to a recently released World Health Organization report, tuberculosis has replaced COVID-19 as the leading cause of death from infectious diseases in 2023, Reuters writes. In 2023, 8.2 million people will be diagnosed with tuberculosis for the first time, the highest number since 1995, since WHO has been monitoring tuberculosis globally. For 2022, WHO reports 7.5 million illnesses. The good news is that deaths associated with the disease fell to 1.25 million in 2023, down from 1.32 million in 2022, but the figure was still high enough to dethrone COVID-19, the infectious disease that caused the previous year’s more deaths.
“We have to start from the fact that during the pandemic the diagnosis rate dropped a lot”
In Romania, according to data published this spring, more than 9,500 cases of illness were registered in 2023, the numbers being on the rise compared to previous years. The tuberculosis incidence rate among the population reached 48 cases/100,000 inhabitants, compared to 46.3 in 2022 and 39.7 in 2021.
The numbers may not be as worrying as they seem, however. Specialists have in mind the threshold of 2020, when a sudden decrease was recorded, explains pulmonologist Beatrice Mahler, manager of the “Marius Nasta” Institute of Pneumophthisiology.
“It’s an upward trend, but we have to start from the fact that during the pandemic the diagnosis rate dropped a lot, all over the world. On the statistical data that we have, and what we observed in the Romanian program data, there is indeed an increase starting from 2021, 2022, 2023, but starting from the point of 2020, when the decrease was brutal and false. It was a false drop in the number of cases and now we have an increase. However, this growth, at least in Romania, according to the data of 2023 had not yet reached the level of 2019. So I would not necessarily panic. It’s good that we diagnose”said Dr. Mahler, for “Adevărul”.
New treatment regimens for multidrug-resistant tuberculosis
There is treatment and there are also modern methods of diagnosis, and for the treatment of multidrug-resistant tuberculosis (MDR), Romania has, from this year, access to short treatment schemes, which shorten the healing period from approximately two years to periods of less than a year , added Mahler.
“It’s a great thing for patients, especially since this new generation treatment not only cures tuberculosis faster, but lowers mortality a lot. However, there are also in this period, or we still have, quite a few cases of people who have tuberculosis which is in an extensive form. People who present themselves very late, who have multiple locations of tuberculosis and who, by presenting late to the doctor, bring their families and children with them. They don’t always get sick, but they do get infected and have to get treatment,” doctor Beatrice Mahler explained the situation facing specialized hospitals.
The increase in the number of illnesses was expected, the doctor also said, explaining that it will take some time until a decrease is recorded again, most likely in 2024 as the numbers continue to rise.
“It is expected that we will have an increase in the number. From the moment we saw that brutal drop, we expected an increase to follow and we will be on the increase for a while, after which we will start to move the incidence curve in the other direction. I don’t think it will happen, however, even on the dates of 2024. For several years, we expected to have an increase in the number of tuberculosis cases, because there were people left in the population who remained a focus for a long time and who got sick . And the bad thing about this disease is that it doesn’t always make you sick right away. You can pick up Koch’s bacillus, become infected with it, and get sick at a time when the body’s immunity goes down, whether you get an autoimmune disease, or, for example, you develop diabetes that goes out of balance, or you develop a cancer, and then you develop the disease at the time when you are with weak immunity”, explained Dr. Mahler.
Drug dependent patients, problematic category
The figures for multidrug-resistant tuberculosis are also increasing, “but we are at an extremely low level compared to the incidence of MDR cases that Romania had and far below the level of multidrug-resistant tuberculosis that our neighbors in Moldova havethey have Ukraine”, says the doctor. What patients need to understand is the need to complete the full course of treatment for susceptible TB.
“If susceptible tuberculosis is treated, and patients understand the need for treatment until the end, the chance of a person developing resistance to reinfection is much lower.” explains the pulmonologist.
Multidrug-resistant tuberculosis can be acquired in two ways: through contact with a person who has tuberculosis with a microbe resistant to treatment; through a treatment that is incomplete, appearing as a rule in people who have abandoned, that is “they start treatment for sensitive tuberculosis, take the treatment as they want, after which the germs create weapons so that they can resist the drugs that treat sensitive tuberculosis. This is how resistance occurs. With one drug, with two, resistance to almost all tuberculostatic drugs can be established”, explained the doctor.
Susceptible TB has a six-month treatment regimen, and in case of relapse, the patient will receive treatment for eight months. And for susceptible tuberculosis, there are hopes that new treatments, given for shorter durations, will be available in the future, with trials currently underway.
Regarding patient compliance, doctor Beatrice Mahler emphasizes that there are two problematic categories: the person who requires special social support, who does not always have sufficient conditions to follow the therapeutic regimen, and the drug user patient who has tuberculosis. Patients in the last category need an adapted, multidisciplinary therapy.
“As a rule, these people also have the pathology that a drug user has. Not to mention the withdrawal, the tendency to continue using drugs. They are a little more fragile from many points of view, and then for them I hope that solutions will be found to help them in a real way, on various levels. We have now hired a psychiatrist in the “Marius Nasta” Institute, but we managed to do that in Bucharest, in the “Marius Nasta” Institute. Things must be taken a little further, centers must be created where they can benefit not only from tuberculostatic treatment, but also from treatment and support to give up drugs, from other specialties that help these people who are unfortunately sick not only tuberculosis”, doctor Beatrice Mahler drew attention.
