Due to the pandemic, there are patients with tuberculosis who arrive with advanced diagnosis in Argentina

The coronavirus pandemic had multiple impacts on social and economic life, and on the diagnosis and care of other diseases. Mass lockdowns and other mobility restrictions discouraged people from going to care, and one of the most affected groups is those who had acquired tuberculosis, which is an infection caused by bacteria. As in 2020 there were patients who could not be diagnosed and did not receive treatment, some are now serious.

“As we do not have access to early diagnosis, today we are dealing with very serious cases of people with tuberculosis, both in adults and children. It's a side effect of the coronavirus pandemic. There is a qualitative difference in the state of situation of patients because of diagnostic delay. It is terrible because it is a disease that can be detected early, treated and cured,” Dr. Domingo Palmero, director of the Institute of Tisionopneumonology “Prof. Dr. Raúl Vaccarezza”, which depends on the Faculty of Medicine of the UBA and one of the reference centers for tuberculosis in Argentina, told Infobae.

In 2020, Argentina recorded a tuberculosis notification rate of 24 per 100,000 inhabitants for all cases, 14.8% lower than in 2019 (28.2 per 100,000), according to the Bulletin on Tuberculosis published by the Ministry of Health of the Nation. In the first year of the pandemic, only 10,896 cases were reported, of which 10,268 (94.2%) were new cases or relapses. Sixty percent of patients were between 15 and 39 years old.

56.7% of the cases reported in 2020 were males. 65% of the reported cases were the province of Buenos Aires and the Autonomous City of Buenos Aires (CABA). The highest total reporting rate was recorded in the province of Salta. According to the National Health portfolio, there was a reduction in notifications.

“The impact reached all age groups, sex and most jurisdictions, with reductions greater than 60% between both years. The magnitude and extent of the decline suggest potentially missed or delayed diagnoses of tuberculosis, which would favor continuity in the chain of transmission of tuberculous bacillus in the community,” said the Ministry's experts.

On the other hand, according to provisional information for 2021, the reporting of tuberculosis cases increased by 13.8% in relation to the number of cases (1,422 notifications more than in 2020) and 12.7% in relation to the rate per 100,000 inhabitants, from 22.6 in 2020 to 25.5 in 2021. In other words, the report of tuberculosis cases would have returned in 2021 to the level of 2019, before the pandemic progressed. In 2020, 656 tuberculosis deaths were recorded in Argentina. This figure is similar to that of 2019, with a decrease of only 1.8% (12 cases).

During 2021, the reporting of tuberculosis cases increased again as much of the country's mobility resumed. According to Dr. Palmero, “the situation that occurred in Argentina has also been recorded in other countries as reported by WHO. We now see a qualitative difference because the disease evolved because it was not diagnosed in time and people did not access treatment,” he said.

The treatment lasts 6 months with different oral medications. “There is a minimum treatment regimen and if the patient complies with it, it is completely cured,” Palmero explained. “The diagnosis should be as early as possible so that there is no lung destruction. When you are late for treatment, there may be sequelae in the lung and infections with other pathogens. The patient may develop respiratory failure and die from the aftermath of advanced tuberculosis,” he added.

Nowadays, Dr. Palmero stressed that it is important to search for people who have been close contacts with patients, such as cohabitants or co-workers. In these cases, close contacts are examined to detect the tubercle bacillus if they have been infected.

With regard to prevention, the BCG vaccine is indicated in children, which prevents tuberculous meningitis and other forms. “But it is not useful to revaccinate in adulthood because it does not give more protection. For this reason, it is important to detect cases in time as the respiratory symptomatic person, who has a cough and yellow-green expectoration for more than 15 days. A thorough study of close contacts is also needed to diagnose the infection at a very early stage,” he said.

Tuberculosis is today the second leading cause of death from infectious disease (after COVID-19) according to the World Health Organization. It is caused by bacteria, Mycobacterium tuberculosis, which usually affects the lungs. It can be spread when people with tuberculosis spill bacteria into the air, such as by coughing. These microbes can be suspended in the air in enclosed spaces without ventilation.

Approximately 90% of people who fall ill with tuberculosis each year live in 30 countries. Most people who develop the disease are adults. In 2020, men accounted for 56% of all cases of TB, adult women 33% and children 11%.

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