Dr Abdul Razak (left) and nurse Lalitha Gopalan check a patient at the respiratory clinic. — Picture by Azneal Ishak

KUALA LUMPUR, May 29 — Tuberculosis (TB) cases continue to rise over the years as Malaysians do not take it seriously. This was evident following the outbreak of the disease at Maktab Rendah Sains Mara (MRSM) in Taiping, Perak.

While TB has always associated with the influx of migrants into the country, statistics from the Health Ministry show otherwise.

Only 20 per cent of cases are contributed by foreigners.

Malay Mail spoke to Senior Consultant of Respiratory at the Institute of Respiratory Medicine, Prof Datuk Dr Abdul Razak Mutallif, who said Malaysians must rid the myth that foreigners are the culprits.

He also said a new trend is setting in urban areas and crowded places, no thanks to public ignorance.

Malay Mail: TB is rampant among immigrants, but the statistics show Malaysians are contracting it. Why is that?

Dr Abdul Razak: TB has always been an issue among Malaysians. In the last 10 years, only 15 to 20 per cent of cases in Malaysia are contributed by foreigners that come into the country. A total of 80 to 85 per cent are still Malaysians.

MM: What is the main reason for the increase in TB cases?

AR: It is because the cases are tackled at a late stage, when they already start showing severe symptoms. When patients are treated at a late stage, the problem is they have already spread it to many others in contact with them. The best example is the MRSM incident. One person had TB and it was not detected early and within a year and it spread to 11 others.

MM: How fast can someone spread TB?

AR: A person who has contracted TB but has no knowledge about it is likely to pass it on to 10 other people within a year. That is how it spread at MRSM. That is why early detection is crucial, because when it is detected late, the TB germs are already in the air.

MM: How long do TB germs remain in one’s body?

AR: TB can sit in your body for years. For example, a person could have contracted TB 20 years ago, but now as you grow older it can be activated with medical problems. That’s how it emerges. It is infectious but not immediate. No fixed period of time.

MM: Is there a fixed time-frame for symptoms to show?

AR: It varies from a person’s immune system as well as the load of germs. Someone who is working in a hospital and exposed constantly to TB patients ... if the patient is contracted with mild TB, and the germs in the baseline are not so high, the chances of contracting from him are much lower because of the lower load. The baseline load (germ) plays a crucial role.

MM: Symptoms of TB that need treatment immediately?

AR: Cough and fever, loss of appetite and weight loss. Most common is 90 per cent start with cough for a few weeks, with phlegm, and some with severe cases with cough of blood.

MM: What are the steps taken to control the spread of TB?

AR: When a person contracts TB we ensure a contact tracing is done for the whole family. That is how we managed to trace the other cases at MRSM as well. We found a few positive TB carriers through contact tracing even before they showed the symptoms. The three or four of them who were found positive were through contact tracing.

MM: Explain contact tracing?

AR: Anyone staying with the TB patient under one roof for more than eight hours a day. It covers house, school, workplace. In the case of a school, we will screen the whole school. If it is a house, all those living in that house. The procedure is we must screen at least 80 per cent of the people the person had contact with.

MM: Where do TB cases grow?

AR: TB will grow further in poor living conditions, overcrowding, among the malnourished and in places with poor ventilation. This is where the concerns are — prisons, rehabilitation centres, lock-ups, urban poor living in deplorable conditions and those living in camps or in one close, cramped area.

MM: What are the steps to prevent TB?

AR: The only two ways you can play a role to prevent TB are to keep yourself healthy, by having a good immune system, and keep underlining diseases under control.

MM: When you say people are taking it lightly, you mean?

AR: I feel the people’s ignorance where they are not bothered and they come in late ... that is the biggest problem for us to treat. Within the first two weeks of symptoms, people still go for antibiotics and cough mixtures. They will only go for further checks when their cough has gone so bad. People don’t understand that TB is never contracted out of the blue — it is contracted from someone. Two million litres of air goes into our lungs everyday and if we are unlucky to take in few germs , you just had it.

MM: What is the cost in treating TB and is it labour intensive?

AR: TB treatment is about RM300 per patient (for the drugs only), which is free for all in government hospitals. TB patients don’t need to be admitted unless there are complications. It is cost-effective, it is only for six months. TB can be cured 100 per cent.

MM: How about Multidrug-resistant TB (MDR-TB) in Malaysia?

AR: MDRTB is not high in Malaysia. Less than 1 per cent. But it is increasing in the last 10 years. About 10 years ago we had only about 20 cases but now we have about 100 cases a year. This has got to do with poor patience compliance. They don’t take medicines properly and the germs become resistant.