(By William Egbuna)
As a physician for 50, years I have recognized the epidemic proportions of Tuberculosis in Nigeria despite the BCG Immunization. From infancy when virtually all Nigerians have tuberculosis, the incidence reduces somewhat at youth, then thins out in middle age to the elderly. More recently in my experience, it became obvious that in the older Nigerian population, tuberculosis was still rampart but latent. Remnants of this chronic infection are found in lymph glands in the neck, in larynx, pericardium, kidneys and the gonads.
This left many questions unanswered: the source of the epidemic; why the BCG given at birth has failed to even reduce the incidence; frequent failure and prolonged nature of curative treatment. The dormant tuberculosis is reactivated by secondary serious infections or diseases such as diabetes and especially HIV. Virtually every HIV patient has associated Tuberculosis.
Inspiration
Through inspiration, answers were provided to the above questions. Further revelations were also made on associated diseases and consequences to Nigerians’ health! The first discovery is that virtually all Nigerians have been born with congenital syphilis. This is transmitted vertically from the infected woman, through the pregnancy to her baby.
The second discovery is that what we doctors have been treating for several decades as tuberculosis is not the naturally occurring disease but BCG infection. The Nigerian with unrecognised Congenital Syphilis is given BCG at birth to stimulate immune antibodies for protection against tuberculosis. But this baby’s immune system is seriously impaired by the syphilis infection. Consequently, the baby cannot contain the attenuated Tuberculosis germ (BCG), which now spreads through the organs and tissues of the developing body along side the Syphilis germs.
Syphilis and BCG infection
It is this combination of congenital syphilis and BCG Immunization that cause most, if not all, the intra uterine deaths, paranatal deaths congenital malformation, the highest childhood deaths, in the world, crippling heart and kidney disease that lead to medical tourism! Others are liver damage, gastric ulcers, brain disease and most of the infertility problems in males and females including uterine fibroids.
Congenital syphilis
This is an old disease and medical diagnosis which is mostly clinical dates back 400 years. The disease is suspected even from early childhood by the stigmata. The VDRL Test used in clinical practice is insensitive in adults and completely non-reactive in children for obvious reasons of the depressed immune status. The clinical pathology and features of Congenital Syphilis are so unique, specific and diagnostic especially in the Syphilitic Heart Disease which I find in over 50% of Nigerians from the age of about 6 years. This is the main cause of sudden deaths in the country. Next to heart disease as cause of sudden deaths in stroke from neurosyphilis.
Tuberculosis
The lymphnodes from the BCG are traced from the Supraclaricular fossa on the side of the BCG Immunisation to the neck, then cross over to the other side of the neck and fossa. The infection ie the germs proceed upwards to the brain and meninges. Then downwards to the pericardium and heart, the liver, kidneys, stomach and intestines, the gonads and uterus.
Lumbar puncture, X-rays, ultrasonography and urine examination are useful clinical tools for confirming tuberculosis or assessing degree of damage to tissue and organs. The various Tuberculin Tests are deceptively negative, by virtue of the afore mentioned depressed immune state.
Errors in diagnosis
The combination of these two infections in sick Nigerian from birth cause all the bizarre symptoms that make him invoke witchcraft, spiritual attack, juju etc as causes. And the patient is treating malaria, typhoid, staphylococcus, E.coli, candida etc throughout his life. Many unwarranted surgeries are also performed such as craniotomies, thoracotomies, appendicectomies and amputations.
Solution
The whole syndrome in preventable, treatable and curable with this foregoing background knowledge. Even many bad heart and kidney cases that take Nigerians abroad, recover on conservative management. While efforts are being made at expanding our tertiary health institutions, we should pay particular attention to our basic health Services.