tuberculosis

by Dan Laxer
The Suburban

In the fall doctors were concerned about the rise in the number of cases of walking pneumonia, particularly among small children. Now, with flu season in full swing, with the usual warnings and vaccine recommendations, doctors are worried about the rise, albeit slight, in tuberculosis.

The incidence of TB in Canada and Quebec is generally low. The average number of cases in Montreal each year is around 120. But in 2024 there were a reported 200 cases of the disease, or 9.4 for every 100,000 people. That’s an increase of 54 percent, prompting the Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l’Île-de-Montréal – the city’s public health authority – to issue an Appel à la vigilance, warning doctors to be on the lookout.

According to Dr. Mitch Shulman, in Montreal if a patient presents with symptoms like a cough, a low-grade fever, a bit of weight loss, tuberculosis would not be the obvious diagnosis. Shulman, a regular contributor to The Suburban, is an Associate Professor in the Department of Emergency Medicine at McGill Medical School as well as an Attending Physician in the Emergency Department of the McGill University Health Centre. For the most part, he explains, TB is brought in by those coming from, or having travelled to, countries with a high incidence of untreated TB, like Southeast Asia or Africa.

In Quebec reporting and treating the disease is mandatory. In fact, it is the only disease in the province that carries that requirement. Shulman says the advisory is to suggest that it might be appropriate, where symptoms warrant, to get a patient’s travel history and to test for TB.

There are fundamentally two forms of the disease. Latent TB, which stays in the lungs, won’t necessarily cause symptoms. The problem is when it becomes active either through travel, stress, or a change in health status. Then it becomes transmissible.

“It really is a function of poor living conditions, unsanitary living conditions, malnutrition,” says Shulman. “And under those circumstances, if you’re living close to someone with TB for prolonged periods of time TB can be spread.”

TB is treatable, though, “with the right antibiotics, in the right sequence, taken for the right amount of time.” What is worrisome, says Shulman, are the cases of treatment-resistant TB which, if they becomes the dominant strain could lead to a health crisis, which is why global health organizations keep a close watch on the bacteria.

For most people living on the island of Montreal TB is not a concern. Where it does become a concern, Shulman says, is in First Nations communities. “Because of living conditions like crowding, poor housing, and in some cases malnutrition and poor access to healthcare, we do know that the rate of tuberculosis in some First Nations communities is much higher. That’s a clear sign of a failure on our part to take care of people properly, to make certain that they receive adequate nutrition, water, and housing.”