Hello and welcome to HealthFocus, a production of the Ministry of Health and Wellness. I am Fenelle Neptune. Today we have with us the Senior Medical Officer for Infectious Diseases Unit in the Ministry of Health, Dr. Gil Kejada, who will speak with us on tuberculosis, which is TB. Welcome to the program. Thank you, Ms. Neptune. Wonderful. Okay, so for some persons, they've heard the word tuberculosis or TB. Can you tell us what exactly is this? Okay, so tuberculosis is an infection that has actually been around for more than a century, many centuries actually. And it was first discovered by a scientist by the name of Robert Koch and that was back in 1882. He actually put a name to it and the funny thing is he named this bacteria, mycobacterium tuberculosis, on the 24th of March. So from about 1982, World Tuberculosis Day has been commemorated on this day. Tuberculosis is an infection that can infect the chest. Before it used to be known as something called consumption and it was called consumption because of some of the things you would get, some of the signs of it. So we're talking about things like weight loss. Persons would get that look, sort of like a cancer patient when they have what we call a catechic look, they kind of become skeletal after a while. But tuberculosis in St. Lucia used to be common but it has gone down quite a bit. We are what the WHO defines as a low burden incidence country. So we have annually less than 10 cases per 100,000 persons. But it is still in St. Lucia and I think a lot of persons are not aware of this. It can present as a chest infection. It can present as infection of other parts of the body. So where you get things like swollen lymph nodes. It can affect the bladder. It can affect the bones. But the most common cases that we know of are cases affecting the lungs, what we call pulmonary TB.  So they have to protect other persons by taking certain measures. So it can be spread by cough, droplet infection. And a lot of times when we diagnose persons with pulmonary TB, initially, we advise a period of hospitalization to initiate what we call the intensive phase of treatment, which is at least two months of treatment. And then we have four months of treatment. But a lot of things are dependent. So what I would say is that the minimum time for treatment, pulmonary TB is not an uncomplicated chest infection. It is curable, but it's not uncomplicated. So you find that you're going to have to be taking medication for at least six months. And depending on some of your test results, you may find that the six months may actually be nine months. What we call extra pulmonary TB, which is TB which affects places that are not the lungs, like the bladder, like the bones, like the lymph nodes. It can take at least 12 months to treat. So I think sometimes when persons come in, we had a person who was diagnosed with pulmonary TB, who had changes on their chest x-ray, who had actual biopsy of the tissue and was found to have pulmonary TB, but said I have no symptoms. But the fact of the matter is they have pulmonary TB, which means they would be infectious to other persons in terms of those droplets. So they would require the period of isolation and treatment. OK. So actually, so there's two types of TB? Three, when you think about it. So you have pulmonary TB in the lungs, extra pulmonary TB affecting other areas. Pulmonary TB, you can infect other persons when you have pulmonary TB that has not been cured. But then we also have latent TB. So latent TB is a phase, latent means it's sleeping, OK? So, or dormant, right? And you cannot infect other persons if you have latent TB. But the risk with latent TB is that it can develop into active TB. So when it develops into active TB, then it can be spread to other persons. But TB is curable. So if you catch it in the latent phase, then there's a very low risk of it converting to active pulmonary TB. OK. And how do you go about diagnosing someone with TB? OK, so first of all, you have to have it on your list of person came into a chest infection, is this TB? So we usually look for things like symptoms together. So we're looking at fever, cough, weight loss, loss of appetite, night sweats, OK? We usually look for persons who have that persistent cough, those night sweats, that weight loss, for at least two weeks or more. So imagine you went to see the doctor with what you thought was an uncomplicated infection, doctor diagnosed a chest infection, treated it, it hasn't gone away. It's still there, it's persisting. At that point, you do some sputum samples, OK? So you would probably want to take a sample to test for forms of bacteria. I would like you to hold on to that thought we are due for a break. Not a problem. We'll be back in a moment. It's hair, the biointellicence biobutton, an innovation to the Ministry of Health's approach in battling COVID-19. The biobutton is a state-of-the-art device. It supports people keeping regular checks of signs of possible COVID-19 infection while placed in home quarantine. It monitors temperature, heart rate and respiratory rate. It is very simple. Just link it to your smartphone and place the button on your chest. It's that easy. The biobutton costs only 100 US for the 14-day period. For further information, please contact the Epidemiology Unit at 468-5325 or 468-5324. Welcome back. We will continue our discussion with Dr Gilcajado on tuberculosis. Before we took the break, we're discussing diagnosis of tuberculosis and you spoke about sputum sample being taken. You were going a little more in depth if you can explain this, please. Before 2018, how we would diagnose would be to take sputum samples and look under a microscope for what we call acid phosphacilli, just signs of the bacteria to put it simplistically. Because of a global fund grant that we were under, the donor is the global fund, in 2018, we actually got GeneXpert technology, which allows us to utilize that sputum to diagnose TB.  Just because you have the acid phosphacilli, the AFBs in your sputum, doesn't necessarily mean it's being caused by the mycobacterium tuberculosis. Because I think people need to understand there are other mycobacteria out there that cause similar symptoms, but they cause what we call non-tubular chest infections. Okay, so back to your question. Sorry, because I went off, of course, a little bit. So the GeneXpert would use the sputum to diagnose the presence of TB. And once it's diagnosed as positive for TB, the GeneXpert then goes on to do a further test for one of the drugs that are used to treat TB. It's called rifampicin, and what it does is rifampicin resistance testing. Because, unfortunately, TB requires at least four drug combinations together, four medications in combination, to manage at least the first two months. And then if you are successful in your treatment in the first two months and you had, say, the AFBs in your sputum, when you were first diagnosed, we hope at the end of the first two months of treatment, those AFBs have disappeared from your sputum, and then you now have to complete what we call the continuous phase of treatment, which is four months of two medications. Okay, and is a blood test used as well to determine? So in terms of testing, so if you suspect the patient has active TB, we don't usually recommend that you test for using things like the man-to-test, or there's something else called an IGRA test, okay? What we have in St. Lucia to test for latent TB is the man-to-test. And what the man-to-test is that there's a reagent called tuberculin. It's injected under the skin, usually around hair or hair, right? Just a little bubble under the skin, and it's read two days later, 24 to 72 hours later. So if there's any reaction there, depending on the amount of reaction that can determine the presence of TB, okay? If it's latent TB, it's the possibility of active TB. When you do that test and it's reactive, we don't just leave it there. You actually send for a chest X-ray to determine if there's evidence of active TB on the chest X-ray, okay? And then if there's no evidence of active TB, and we determine that it's latent TB, that's the sleeping TB, the one that's not, you're not able to infect other persons when you have it, then it can be treated and cured of TB. Active pulmonary TB, you can be treated and cured as well. Okay, and when you mentioned the while ago about the different types of TB just a while ago, you mentioned in terms of spreading it. How does, how can somebody actually spread TB to another person?  So much, we're in the era of COVID-19. So we know all about using masks to prevent the spread of droplets, same concept. And TB is a highly infectious disease as well. Okay, and it can definitely be cured? It can be cured. Unfortunately, persons are still dying from TB. The WHO estimated that in 2019, there were about 10 million cases of TB in the world. In 2019, St. Lucia had six cases of TB. About 1.4 million persons globally died of TB in 2019. Two persons died of TB in St. Lucia. The idea is we need to catch TB early so that we can cure it and prevent any deaths from TB. Okay, so as it relates to the picture for St. Lucia with TB, would you say that we have a lot of persons affected by TB? So when someone is diagnosed with TB, we need to look at who lives with them. We need to look at where they frequent because those would all be contacts, okay? So all those persons would have to be investigated to determine if they have any TB infections themselves. So they would be tested using the man to test. I had mentioned the IGRA test. IGRA is a blood test because you ask me if you can test for it by blood. IGRA is a blood test, but it's not something we process in St. Lucia. It's something that has to be sent out of country to be tested. And it's a little more expensive and it's usually offered through private facilities, right? Mantu testing is available in the public sector. And I think I should say right now, anything associated with TB and TB diagnostics and TB management, because it falls under the Public Health Act, it is free, of course, to the clients, okay? Because we're talking about a communicable disease. So because of this, another Public Health Act, all management testing, et cetera, are free, of course, to the clients. Well, we have come to the end of our discussion for today. I want to thank you so much for being part of this program and educating us on Tuberculosis TB. Thank you, Ms. Neptune. I appreciate the opportunity to do so. Thank you. Well, that's how we come to the end of the program on behalf of the entire production team. I am Funnel Neptune. Thanks for watching. Until next time.