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Ewa did not feel sick, she did not cough up blood, and she never thought that she might have tuberculosis. The disease, although known for a long time, is still not easy to diagnose.
– Tuberculosis was previously associated with the disease of artists from the Romantic period. Probably not only artists were sick, but in high school we got to know their biographies, which showed that many suffered from consumption, says 28-year-old Ewa, who has just finished treating this somewhat forgotten disease. We know her from the life stories of many Poles, because in our country the incidence was very high. – After World War II, Poland was one of the countries with the highest incidence of this disease. And that is why today – despite the decline in the number of cases – it is still higher than in the countries of the old European Union – says prof. Kazimierz Roszkowski-Śliż, director of the Institute of Tuberculosis and Lung Diseases in Warsaw.
Incidence of tuberculosis in Poland
– Since the 50s, the incidence of tuberculosis in Poland has decreased tenfold. For example, in 1957 there were over 82. cases, while in 2009 – 8236 – reassured Dr. Maria Korzeniewska-Koseła from the Department of Epidemiology and Organization for Fighting Tuberculosis in Warsaw. As specialists assure, the epidemiological situation regarding tuberculosis in Poland is good. – Tuberculosis is not coming back. It was and is present, but its incidence is systematically decreasing. However, when it comes to the number of recorded cases, the differences between individual voivodships are huge, e.g. in the Lubelskie Voivodeship it is three times greater than in the Lubuskie Voivodeship – informs prof. Roszkowski-Śliż.
X-ray of the lungs in the diagnosis of tuberculosis
Ewa had a bad cold, but since her business trip to Tel Aviv had been carefully planned in advance, she decided to go. On the plane, she was sitting next to a foreigner who was coughing terribly. They were quite a duo. He was coughing into a handkerchief and she was snot. After returning to Poland, she managed to heal her cold. But she was still suffering from the cough. A month and a half later, she decided to see her GP. The doctor listened carefully and said that the lungs were clean. So she prescribed cough syrup. Did not help. After a week, Ewa went to another doctor. She ordered an x-ray of the lungs. – I was wondering whether to do them because I stopped coughing. But I thought to myself that everyone should X-ray their lungs from time to time – says Ewa. When she showed the doctor the photos, she said she had pneumonia, but sent her to a pulmonologist to be sure of the diagnosis.
Infection with mycobacteria tuberculosis
The most common source of infection is a person suffering from tuberculosis, who excretes mycobacteria along with the secretions from the respiratory tract. The patient expels them when coughing, exposing, sneezing or even talking. One patient with active mycobacteria can infect about 15 people a year. Mycobacteria, along with the air current, enter the body through the respiratory tract during inhalation. Infection with mycobacterium tuberculosis is not synonymous with the development of the disease. This happens only in 3-8 percent. Most often in a situation of weakened immunity. In most people, mycobacteria are eliminated by the immune system or remain dormant without causing disease symptoms. Unfortunately, an infected person is at risk of developing tuberculosis throughout their lives.
Bronchoskopia
– I went to the clinic at the Institute of Tuberculosis and Lung Diseases. There, additional photos were taken and a bronchoscopy was taken. While I was waiting in the waiting room, one of the patients sitting next to me asked if I was spitting blood too. I thought to myself: I don’t even have a cough anymore. So what am I doing here? – recalls Ewa. After bronchoscopy, she was told that when the test results were ready, the clinic would contact her. – I was sitting in a cafe with a friend who was six months pregnant. She wanted to try my hot chocolate and drank from my glass. Then a lady from the clinic called and invited me for a visit the next day – she says. Ewa was surprised when she heard the diagnosis – tuberculosis.
Misdiagnosis
Although tuberculosis can be cured in almost all patients, it must be diagnosed first. In Poland, however, tuberculosis is often detected too late. – The blame for this is borne by both patients who ignore symptoms and primary care physicians who prescribe another antibiotic for patients with persistent respiratory symptoms, cough, expectoration of sputum, or shortness of breath, instead of sending them for a chest X-ray examination, she emphasizes prof. Roszkowski-Śliż. In his opinion, the problem is also that patients do not follow medical recommendations and often stop therapy. It is dangerous not only for them, because the disease can recur, but also for society, because they infect others and increase the risk of emergence of strains resistant to the available drugs.
Actively mycobacterial
Ewa’s entire family took a lung X-ray picture. Fortunately, no one got infected. – I don’t think I was actively tuberculosis – says Ewa. She was given a 6-month sick leave. During this time, she had to take medication. Due to the burden on the liver with such a number of tablets, she was completely forbidden to drink alcohol. Doctors emphasized that she should not overstrain. Today she is healthy, but needs to check her lungs more often. The trace of the disease is visible on X-rays. According to Dr. Korzeniewska-Koseła, drug resistance is rare in Poland. Tuberculosis caused by the most dangerous mycobacteria from the so-called Extended multi-drug resistance (XDR) was detected in the years 2000-2009 in 19 patients. For comparison, in Romania, in 2009 alone, there were as many as 22 such patients.
Tuberculosis incidence among children
Contrary to the post-war years, a small percentage of children and adolescents now suffer from tuberculosis. In 2009, cases in the age group under 14 accounted for 1,2 percent. all new cases of tuberculosis. The disease is most often diagnosed in the elderly, especially after the age of 60. Epidemiological studies conducted in the Mazowieckie Voivodeship show that less than one-fifth of adult Poles are currently infected with this bacterium and may develop tuberculosis in the future. As much as 43 percent. of them are people over 60 years of age.
Text: Halina Pilonis
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