Not TB Sniffed At
It is well past midnight in the Philippine megalopolis, Manila. The skies have opened, battering rooftops with enough intensity to drown out the marauding night-chatter of hidden creatures in the surrounding undergrowth. Admittedly, these rains are nothing on the recent devastating floods of the Southern provinces of Mindanao – with all of those displaced and lost in our deepest and heartfelt thoughts.
As I begin to write, between sips of much-missed Buko juice, a ballooning mosquito is in deep focus, cemented to my right deltoid, doing her level best to suck the life out of me; hopefully conscious there are exams to prepare for and that I could really do without Malaria or Dengue right now. I take the (barely relevant) risk, restless over one of the more light-hearted and quirky medical chats conjured up today, in that favoured place to laugh through innovative ideas – a cosy, familiar, independent Café. With a Filipino Doctor, a Material’s Scientist and a Coffee Venturist for company, our conversation shifts from limestone-producing bacteria to the still expanding problem of HIV/AIDS – or “immunocompromised hosts” as often labelled here in the language of Archipelagan Taboo – to that other pervasive global scourge, Tuberculosis. We know so much about TB already that it risks becoming the number one killer of our conversation too. That is, until, with a casual conviction, the young Doctor reflects – “You know, I swear I can just walk onto a ward and sniff out TB”.
With a pang of anosmic jealousy, I am magically entertained by the idea. Of all the medical superpowers to have, globally speaking, this must rank right at the top. I take a moment to imagine the possibility of training my nose to detect more than a British chip shop or a leaking colostomy bag. It seems a tall order, but I don’t disbelieve him either. I just spent a few months with a clinical partner who has such a powerful sense of smell that she was widely considered to be permanently pregnant. If this were true, by now the baby-bump should be the size of a Bull Elephant; so I feel we can safely rule that diagnosis out. And then again, perhaps human Sniffomics is a touch far-fetched.
Having said this, Giant Rat Sniffomics might have much more clout. Adding to the humour, the African Giant Pouched Rat Cricetomys gambianus can out-perform some lab tests when it comes to diagnosing TB after rigorous coaching. I’m not convinced that letting a Giant Rat loose on wards, with a plethora of patients complaining of ‘Shortness of Breath’, would go down too well by modern healthcare standards. Semmelweis would be turning in his Hungarian grave!
Dogs, however, are much more cuddly and comprehensible. The UK ‘Medical Detection Dogs’ Charity are well versed in training canines for sniffing out various cancers and ailments. If you take the idea to the swamps of Asia and sub-Saharan Africa, you can even trust dogs to source out mosquito larvae. Still though, I am willing to bet that even the pungency of hospital food would transfix any German Shepherd over an oncological emergency, let alone an infectious one.
I have heard first-hand, in my current Hospital base of Leicestershire (England), just how seriously the world of ‘Breathomics’ is being taken in microbial diagnostics. Wired Magazine refers to the technological concept as ‘the Nanonose’, where a smellprint for conditions ranging from TB to colon cancer can be detected at an early stage of the disease process with the essential principle being: early diagnosis > prompt treatment > increased chances of survival. The idea is that chemical traces from a person’s breath, particular to the disease in question, can be picked up by an electronic device to help determine a diagnosis. Research and Development is taking a multi-national effort, as is often the best way to approach any Global Health problem. Some of the work is even being carried out on my own English doorstep – with attention on diagnosing both Pulmonary and Extra-Pulmonary TB.
What researchers rightfully rave on about is that such a diagnostic can save on expensive and invasive routine investigations such as blood tests, sputum sample culture analysis and biopsies. A cheap, reliable breathalyser could find its niche in low resource settings where the other diagnostic tools are cumbersome to source and implement. There is the caveat of putting a few Giant Rats and Cuddly Canines out of employment but, if you really think about it – and I mean beyond the clinic – the potential for a TB Nanonose rings a calm, world-beating sense of understanding and mission. It is easy to comprehend how even here in the Philippines – a secondary home but a country and identity I wish I grasped, knew and felt more of – the impact of a breath TB diagnostic could be immense. The incidence of HIV/AIDS is rising, outstripping its South East Asian counterparts. Tuberculosis likes HIV, and is quite happy to spread its multi-drug resistant forms among rural poorly-sanitised hideaways as much as it is throughout urban dwellers lacking a decent count of white blood cells.
Diagnostics are rarely seen as ‘ground-breaking’ ideas. It lacks the heroism of elimination, the rush of novel discovery, and the urgency of life-threatening surgery. It doesn’t come close to the Wolbachia idea for Dengue Elimination (now that really is cool!). All this really amounts to is a person’s breath and some degree of olfaction (again, damn my anosmia), but this small and smart idea could make giant ripples in the way to curbing a truly global problem which has left a definitive mark on human society since the time of Egyptian Pharaohs and Mummies.
How one laughable coffee-shop remark can spark enough courage to re-visit a once impassioned yet desperately amateur and poorly conceived blog on Tropical Diseases opens a whole different can of introspective worms. I guess, bubbling below the often-vacant surface of a ‘surplus to requirement medical student’, I’ve still got the bug. It’s one of the deepest and most meaningful feelings to take, and own, heading into the New Year.