Study links spread of pneumonia to tuberculosis

Mary Githu lost her two-year-old daughter, Immaculate Wairimu, last year after a persistent case of pneumonia.

“My daughter was admitted for five days and discharged after showing signs of recovering. After a few days she became sick again. She was coughing and breathing heavily. She died during our second visit to the hospital.”

Baby Immaculate is among the many children who succumb to the disease annually, despite receiving treatment.

Pneumonia is a leading killer disease in Kenya, with the majority of its victims being children below five years. Worldwide, advances in research have enabled scientists to identify causes of the disease in children and thus develop appropriate remedies.

Major causes of the deadly disease are well known and vaccines are also available to protect children from the two types of pneumonia (hib and pnemoccocal).

Despite the progress, researchers are yet to determine all bacterial causes of pneumonia, which compromises the ability of health experts to effectively treat some pneumonia strains as was the case with Immaculate.

“Most children often get well. But the condition of some may not improve even with treatment, making doctors wonder where the problem might be,” said Dr Jacquie Oliwa, a paediatrician and researcher at Kemri Welcome Trust (KWT).

As such, research is ongoing in different parts of the word with the aim of discovering causes of pneumonia.

However, inroads have also been made. A recent study published in the Lancet Respiratory Medicine Journal revealed that the bacteria that causes TB can also lead to the development of pneumonia. The researchers analysed numerous studies conducted across Africa in TB-prevalent countries such as South Africa, Zimbabwe and Malawi.

They found that a significant proportion of children who had suffered from pneumonia or died of it were also infected with TB.

Dr Oliwa, the lead author of the Lancet study, said that even though none of the studies were done in Kenya, local health experts need to be concerned by the findings as Kenya is one of the countries with a high burden of TB.

The study, titled 'Tuberculosis as a Cause or Comorbidity of Childhood Pneumonia in Tuberculosis Endemic Areas: A Systematic Review,' expounds on various linkages between TB and pneumonia.

Researchers note that TB may directly cause pneumonia by inflaming the lungs of those infected, thus blocking their airways with pus and other liquids. This leads to breathing complications.

Dr Oliwa said that TB may also be an indirect cause of pneumonia. Once it strikes, it lowers the immunity of patients thus making them susceptible to other organisms that cause pneumonia.

Sometimes a child suffering from pneumonia may test positive for the TB bacteria as well as other organisms such as streptococcus, which causes pneumonia. This leads to a co-infection of TB and pneumonia.

As a result, doctors who offer medication for pneumonia and ignore TB may compromise their patients’ treatment.

This could lead to patients’ health deteriorating and making them susceptible to life-threatening complications.

Dr Oliwa urged health workers to be vigilant and consider screening children with pneumonia for TB, especially if they take long to recover or have numerous pneumonia attacks.

But this is an uphill task because of the difficulties associated with diagnosing TB in children.

Whereas adults can effectively cough out sputum (a mixture of saliva and mucus) which is used to confirm whether a person is infected with TB or not, young children have a weak cough and tend to swallow the sputum instead of expelling it.

So doctors usually rely on common TB symptoms and background information on children to determine whether they should be treated for TB or not.

For example, if a child has incessant coughs and lives with an adult suffering from TB, then the baby will likely be treated for the disease.

In certain instances, doctors rely on chest X-rays and skin tests. But these do not give clear-cut results for TB infection.

The standard test is the use of sputum, which is tested for TB bacteria thus enabling doctors to make the right diagnosis.

To address this diagnosis hurdles in children, the Ministry of Health is already piloting a technology known as sputum induction.

Through this technique, children suspected of being infected with TB are given a saline solution which acts as an irritant to their respiratory systems.

This causes the secretion of sputum which is collected via a tube inserted through the nose or mouth to the back of the throat. Though uncomfortable, the technique is not harmful to patients and has been safely carried out in children as young as two months. This method enables doctor to determine with certainty the TB status of a child.

This is especially important since TB treatment is usually intensive and takes a long duration of six months or more.

The medication may also predispose patients to unpleasant side effects such as nausea, vomiting, dizziness and lack of appetite.

“So you really need to be sure that a child has TB before beginning the treatment,” said Dr Oliwa.

Widely adopted

Kenya is conducting a nationwide TB survey targeting people above 15 years.

Through the exercise, health officials seek to identify and treat adults suffering from the disease and prevent its spread to children.

This could in turn reduce the risk of the children developing pneumonia that is associated with TB.

Once widely adopted, Dr Oliwa said, the sputum induction technology will enable experts to collect data on the number of children suffering from TB in the country.

“If we don’t know how many children are infected then we can’t effectively reach all of them with treatment,” she said. Untreated children also act as reservoirs of TB bacteria thereby increasing transmission rates. Health experts warn that if children have both pneumonia and TB and get treatment for the former, it can lead to the development of multi-drug resistant TB which is deadly and more difficult and expensive to manage.

Having the correct TB diagnosis technology is not enough. Dr Oliwa said that awareness should be created to break barriers that could prevent mothers from taking their children to hospital for TB tests, such as the false assumption that everyone with the disease is also HIV positive.

Common symptoms of TB include persistent coughing (sometimes with sputum or blood), chest pains, weakness, weight loss, fever and sweating at night.

The disease is treatable with antibiotics which are given free of charge in public, faith-based and some private health facilities.

Infected people expel TB germs into the air when they cough, sneeze, laugh or talk. The disease is then spread from person to person as people inhale the germs.

Thus, staying in open and well ventilated environments is recommended to reduce transmission. People are also advised to cover their mouths while coughing.

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