Coronavirus disease 2019 (COVID-19) and tuberculosis (TB) are two major infectious diseases causing serious public health problems. The main route of transmission of both these diseases are through respiratory droplets and they primarily target the lungs. Their coinfection; COVID-TB, can lead to worse outcomes among the coinfected patients. Both diseases have similar signs and symptoms such as cough, fever and difficulty breathing, however, TB has a longer incubation period with a slower onset of disease.^{1, 2, 3}

According to the World Health Organization (WHO), the COVID-19 pandemic had caused disruption of the tuberculosis control leading to an increase in the TB mortality rate, for the first time in more than a decade.^{4, 5} This means that patients are not receiving timely treatment and the transmission of the infection is continued as they have limited access to essential services due to the current situation.

TB is curable and preventable. About 85% of people who develop TB disease can be successfully treated and treatment has the additional benefit of curbing onward transmission of infection.⁴ Therefore, to reduce the prevalence of both these infectious diseases and the burden of coinfection, essential services should actively engage in ensuring an effective and rapid response to COVID-19 while ensuring that TB testing and care are maintained.¹

Simultaneous and integrated testing for COVID-19 and TB which includes COVID-19 screening for all patients diagnosed with TB and TB screening for all patients with confirmed COVID-19 can be done to improve the detection of both diseases. It is especially important in the care of people who are vulnerable to unfavorable outcomes, including death like the older age group and people with certain comorbidities like diabetes mellitus and chronic obstructive pulmonary disease. This approach can also help to mitigate the gap caused by the pandemic in diagnosing and controlling tuberculosis.^{6, 7}

Together we can defeat COVID-19 and TB.

At Pantai Premier Pathology, we provide Tuberculosis (TB) and Coronavirus disease 2019 (COVID-19) Tests :

1. Mycobacterium TB QuantiFERON test
2. AFB-sputum test
3. COVID-19 RTK antigen testing
4. RT-PCR testing

References:

1.  Song, W. M., Zhao, J. Y., Zhang, Q. Y., Liu, S. Q., Zhu, X. H., An, Q. Q., … & Li, H. C. (2021). COVID-19 and Tuberculosis Coinfection: An Overview of Case Reports/Case Series and Meta-Analysis. Frontiers in medicine, 8.
2. Nikolayevskyy, V., Holicka, Y., van Soolingen, D., van der Werf, M. J., Ködmön, C., Surkova, E., … & Cirillo, D. (2021). Impact of the COVID-19 pandemic on tuberculosis laboratory services in Europe. European Respiratory Journal, 57(1).
3. Global Tuberculosis Programme. (n.d.). World Health Organization (WHO). Retrieved March 22, 2022, from https://www.who.int/teams/global-tuberculosis-programme/covid-19\
4. Global tuberculosis report 2021. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO.
5.  Pai, M., Kasaeva, T., & Swaminathan, S. (2022). Covid-19’s Devastating Effect on Tuberculosis Care—A Path to Recovery. New England Journal of Medicine.
6. Ruhwald, M., Hannay, E., Sarin, S., Kao, K., Sen, R., & Chadha, S. (2022). Considerations for simultaneous testing of COVID-19 and tuberculosis in high-burden countries. The Lancet. Global Health.
7.  World Health Organization (WHO). (2020). Tuberculosis and COVID-19. https://www.who.int/docs/default-source/documents/tuberculosis/infonote-tb-covid-19.pdf

Breast cancer is the most common form of cancer among women in Malaysia. According to the Statistics report made by Global Cancer Observatory in 2020, Breast cancer has been ranked first in the incidence and prevalence rate of cancer among Malaysians.¹ In addition, Chinese women in Malaysia seemed to be at the greatest risk among breast cancer patients, with and incidence rate of 40.7 per 100,000 population; followed by Indian women (38.1 per 100,000) and Malay women (31.5 per 100,000), as reported by Malaysia National Cancer Registry Report 2012-2016.^{2, 3}

Breast cancer is a type of cancer that develops in the breast when the cells in the lobules (milk producing glands) or the ducts becomes abnormal and divide uncontrollably. Breast cancer cells typically would form a tumour that can be seen on an x-ray or felt as a lump. It occurs almost entirely in women, but men can get breast cancer too.^{4, 5}

It is important to understand that most breast lumps are benign and non-cancerous. Non-cancerous breast tumours are abnormal growths which do not spread outside of the breast and are usually non-life-threatening. However, some types of benign breast lumps are able to increase the incidence risk of woman getting breast cancer. Any breast lump or changes needs to be examined by a health care professional to determine if it is benign or malignant (cancerous) and whether it may contribute to the risk of developing cancer in the future.⁴

As with most cancers, the earlier the breast cancer is detected and diagnosed, the better the chances for a successful treatment. The treatment for breast cancer depends on the diagnosis which includes local treatment that comprises of surgery and radiotherapy or an adjuvant therapy (additional to surgery) that comprises of combinations of radiation therapy, hormone therapy, targeted therapy, or biological therapy.

Learn about the different types of treatments available for your cancer by seeking your consultants for a better understanding and to make an informed choice about your treatment options. Most importantly, remember to be positive and to lead a normal life after your breast cancer treatment. Cancer is not the end, but the beginning of a new life with proper treatment!

Treatment recommendations are tailored and personalized and depends on several factors such as stage of the tumour, tumour’s subtype, genomic markers, patient’s age, patient’s menopausal status, the presence of BRCA1 or BRCA2 mutations. Some of the test for breast cancer that can help your specialists to make informed decisions which can be done at PPP are BRCA1&2, HER2 FISH, Homologous Recombinant Repair (HRR), PIK3CA Test and more.

For more information on the tests provided, please contact us at +603-42809115 (Customer Service) or email us at info@premierpathology.com.my

References:

1. International Agency for Research on Cancer. (2020). Malaysia. [Fact Sheet]. World Health Organization (WHO) https://gco.iarc.fr/today/data/factsheets/populations/458-malaysia-fact-sheets.pdf
2. Cancer Cases Rise In Malaysia, Chinese Most Prone. (2020, January 3). Code Blue. https://codeblue.galencentre.org/2020/01/03/cancer-cases-rise-in-malaysia-chinese-most-prone/
3. Ministry of Health Malaysia. (2019, June). Malaysia National Cancer Registry Report 2012–2016 (No. 5). National Cancer Registry, NCI. https://drive.google.com/file/d/1BuPWrb05N2Jez6sEP8VM5r6JtJtlPN5W/view
4. What Is Breast Cancer? (2018, September 18). American Cancer Society. https://www.cancer.org/cancer/breast-cancer/about/what-is-breast-cancer.html

TNF-α inhibitor recipients face an increased risk of developing active TB

Autoimmune disorders such as rheumatoid arthritis, inflammatory bowel disease and Crohn’s disease are commonly treated with biologics to slow progression of the disease. Unfortunately, biologics such as TNF-α inhibitors can also increase the likelihood that patients carrying latent TB infection will progress to active TB ^(1–3). As a result, many biologic treatments carry a warning stating that TB infection should be investigated and treated prior to initiating therapy.

• More than one third of the world’s population is believed to carry latent TB infection ⁽⁴⁾
• Patients receiving TNF-α inhibitor therapy face up to a 9-fold increased relative risk of developing active TB ⁽⁵⁾
• TB reactivation risk should be evaluated in all patients prior to biologic therapy ^{(2, 6)}

Published data indicate that QuantiFERON technology may provide more accurate detection of TB infection prior to start anti-TNF-α treatment

Studies performed among patients with chronic immune diseases have reported improved performance by detecting TB infection with QuantiFERON technology compared to the tuberculin skin test (TST) ^{(1, 2, 7, 8).}

“In a TB-endemic population, the QuantiFeron-TB Gold In-Tube assay seemed to be a more accurate test for detection of LTBI in RA patients compared with the TST, and may potentially improve the targeting of prophylactic therapy before treatment with anti-TNF agents.” – Ponce de Leon (2008)

Before you initiate TNF-α inhibitor therapy, get tested with QuantiFERON-TB Gold Plus for accurate TB detection. For more information on the tests provided, please contact us at +603-42809115 (Customer Service) or email us at info@premierpathology.com.my

References:

1. Matulis, G., Juni, P., Villiger, P.M., and Gadola, S.D. (2008) Detection of latent tuberculosis in immunosuppressed patients with autoimmune diseases: performance of a Mycobacterium tuberculosis antigen-specific interferon gamma assay. Ann. Rheum. Dis. 67, 84–90.
2. Cantini, F., et al. (2017) Risk of tuberculosis reactivation in patients with Rheumatoid Arthritis, Ankylosing Spondylitis, and Psoriatic Arthritis receiving non-anti-TNF-targeted biologics. Mediators Inflamm. 2017:8909834
3. Swaminath,A. Bhadelia, N., and Wang, Y.C. (2013) Cost-effectiveness of QuantiFERON testing before initiation of biological therapy in inflammatory bowel disease. Inflamm. Bowel Dis. 19, 2444–2449.
4. World Health Organization. Tuberculosis Fact Sheet. http://www.who. int/mediacentre/factsheets/fs104/en/. Accessed Sept 18 2017.
5. Lobue, P. and Menzies, D. (2010) Treatment of latent tuberculosis infection: An update. Respirology. 15, 603.
6. World Health Organization. (2015) Guidelines on the management of latent tuberculosis infection. WHO/HTM/TB/2015.01.
7. Ponce de Leon, D., et al. (2008) Comparison of an interferon-gamma assay with tuberculin skin testing for detection of tuberculosis (TB) infection in patients with rheumatoid arthritis in a TB-endemic population. J. Rheumatol. 35, 776–781.
8. Mariette, X., et al. (2012) Influence of replacing tuberculin skin test with ex vivo interferon γ release assays on decision to administer prophylactic antituberculosis antibiotics before anti-TNF therapy. Ann. Rheum. Dis. 71, 1783–1790.