2023-09-25 05:06:23
Money Today Reporter Park Jeong-ryeol | 2023.09.25 14:06
[박정렬의 신의료인]
Tuberculosis is known as the ‘disease of poverty.’ Even now, deaths are concentrated in low-income and developing countries in Asia and Africa, such as North Korea, Bangladesh, and Congo. In 1952, during the Korean War, tuberculosis was so prevalent in South Korea that the number of patients reached 1.2 million. With economic growth, the number of tuberculosis patients decreased significantly, but following 2000, as the national management system became negligent, the tuberculosis incidence rate soared, and the country still ranked first in incidence and tied for third in mortality among the 38 member countries of the Organization for Economic Co-operation and Development (OECD). It carries a ‘stigma’. Among the legal infectious diseases, tuberculosis has the second largest number of patients following COVID-19 and chickenpox, and the infectious disease with the second highest number of deaths following COVID-19 (as of 2021).
Due to the high incidence of tuberculosis, children’s health cannot be guaranteed. Infant tuberculosis is defined as “a disease with a low incidence but is fatal.” Although the number of patients is small, tuberculosis meningitis, in which tuberculosis bacteria infiltrate the meninges, and migratory tuberculosis, which spreads throughout the body through blood and lymph and forms nodules, occur more frequently in children under the age of five than in adults. It is a dangerous disease that can lead to death. For children and adolescents over the age of 5 with normal immune function, the lifetime risk of developing tuberculosis is only 5-10% even if infected with tuberculosis bacteria. However, younger children, especially those under 2 years of age, have a 40-50% risk of developing tuberculosis. Extrapulmonary tuberculosis, which infiltrates areas other than the lungs, is more than twice as common in children (25-35%) than in adults (10-15%).
Professor Jiyoung Park of the Department of Pediatrics at Chung-Ang University Hospital explains the symptoms and risks of tuberculosis in infants and young children. Professor Park emphasized the importance of treating latent tuberculosis in infants and young children, saying, “We must keep in mind that when tuberculosis progresses, anti-tuberculosis treatment is complex with multiple drugs.”/Photo = Chung-Ang University Hospital Most of the infections in infants and young children are those with tuberculosis. It occurs through close contact with family members, especially caregivers, including parents. Immunity can be achieved through BCG vaccination within 4 weeks of birth, but 100% prevention cannot be guaranteed. Professor Park Ji-young of the Department of Pediatrics and Adolescents at Chung-Ang University Hospital said, “Even adult infectious tuberculosis patients who are expected to be somewhat less infectious due to a negative sputum smear test are reported to have a 30-40% rate of transmission to children,” adding, “The rate of transmission to children is reported to be up to 30-40%.” “The risk of developing the disease is higher the younger you are. It is 5-10% in healthy adults but 50% in infants, and the risk of developing disseminated tuberculosis such as tuberculous meningitis and miliary tuberculosis, which can even lead to death, is also higher in infants.”
Unlike adults, tuberculosis in infants and young children is difficult to detect because it does not show the characteristic symptoms of tuberculosis. Professor Park explained, “Unlike in adults, tuberculosis generally occurs due to re-infection or reactivation of latent tuberculosis, in children, tuberculosis occurs as a first infection, and there is a significant difference in clinical features.” Symptoms are very diverse, including incessant coughing, fever, weight loss, poor growth, and decreased activity, but regarding half of children who develop pulmonary tuberculosis from their first infection do not show ‘classic’ symptoms such as coughing. Professor Park advised, “If abnormal symptoms that may suggest tuberculosis, including fever or cough, persist for more than two weeks despite taking medication, I recommend getting an X-ray test at least once.”
Although an accurate survey has not yet been conducted, it is estimated that a significant number of infants and young children are also suffering from ‘latent tuberculosis’, as the incidence rate in adults is not decreasing at all. Latent tuberculosis is a condition that has not yet developed into diseases such as pulmonary tuberculosis, so it is not contagious and is less difficult to treat than regular tuberculosis. Latent tuberculosis in infants and young children can be treated like in adults by taking one type of medicine for 4 or 9 months, or taking two or more drugs for 3 months. Professor Park emphasized, “To prevent tuberculosis in infants and young children, adults, including parents, need to take the lead in personal hygiene such as tuberculosis treatment and wearing masks, while also actively treating latent tuberculosis in themselves and their children.”
[저작권자 @머니투데이, 무단전재 및 재배포 금지]
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