" 'Pesteng' AHEM!"

Two patients from a prominent school came in today because of radiologic findings of : “suspicious apical infiltrates”. One is the school building supervisor who claims to spend a lot of time climbing stairs and running around the campus. The other is a school driver who says he only smokes 1-2 sticks per day. Both have no complaints of cough, fever and night sweats.

When your x-ray comes out with findings of suspicious apical infiltrates, it meant that the radiologist saw some white streaks on the x-ray plate which lies on top of bony structures. These white streaks may be suggestive of pulmonary tuberculosis, that’s why they will suggest a different view: the apicolordotic view.

Pulmonary Tuberculosis (PTB) is endemic in the Philippines. Almost every Filipino is exposed to the disease. No wonder why other countries are strict when it comes to health status of Filipinos who travel abroad. However, the government has implemented a good program for the possible eradication of TB. What used to be a deadly disease of the past is now curable. The Directly Observed Treatment Strategy (DOTS) is an innovative way of following up and managing patients with PTB.

What symptoms should you look for if you’re thinking of PTB? The pathognomonic symptom is a chronic cough of more than 2 weeks in the absence of allergy or other infectious disease. Other symptoms such as, easy fatigability, low grade fever and night sweats are also referable to PTB. People with chronic diseases or are immunocompromised are vulnerable to the disease. Lack of sleep and stress may render the immune system dysfunctional hence, those who don’t rest and get enough sleep may easily get infected.

Exposure to PTB, chronic cough and positive CXR findings are suggestive of PTB. To check for exposure some doctors request for a Mantoux Test or PPD test. A substance is injected subcutaneously on the ventral surface of the arm and observed for reaction or hyperaemia. The result is read after 72 hours, the size of the wheal formed is measured. For those who come in with productive cough, sputum AFB smear is warranted to check if the patient is actively passing out the bacilli.

When a diagnosis is made, immediate chemotherapy with quadruple drugs is started. Two months intensive phase and four months maintenance phase is the recommendation. Usually, patients on treatment will have a feeling of wellness after 2 weeks of treatment, however, the minimum length of time that a patient is not allowed to work is 1 month.
For suspicious infiltrates, when the apicolordotic view shows negative results, treatment is not necessary.

Again and again, I will not get tired of instilling this to my patients: keep your immune system strong; the military force within the body should always be competent to fight all offending factors. The only way to achieve this is proper nutrition and exercise and never, never abuse your body!