The news of the passing of Ms. Butrasaran Thongchiew, or Namtan The Star has sparked a significant wave of awareness among Thais about the mysterious disease known as “nasal tuberculosis”, a serious illness that the medical team at Siriraj Hospital has identified as a rare condition occurring in 1 in a million cases. Following the report from the Siriraj medical faculty, it was confirmed that the cause of death was nasal tuberculosis.

         When tuberculosis is mentioned, many people may be familiar with it, but they might not realize it can be a deadly disease. However, statistics show that there are hundreds of thousands of tuberculosis cases in Thailand, making it the 14th highest country in the world for tuberculosis rates.

         Professor Dr. Prakit Watthasathakij, Secretary-General of the Anti-Smoking Foundation and a specialist in pulmonary diseases, explained that typically, about 80% of tuberculosis patients are diagnosed with lung infections, while 20% have it outside the lungs. The most common sites are lymph nodes, followed by bones, intestines, and skin. Nasal tuberculosis is rare, occurring in 1 in a million cases, and is less contagious than other forms of tuberculosis.

         The cause of tuberculosis is the bacterium Mycobacterium tuberculosis, which spreads through inhaling air containing the bacteria. This bacterium has special properties that allow it to survive in dry air, cold, heat, and chemicals, remaining airborne for extended periods, except it does not withstand sunlight. When a patient inhales droplets containing tuberculosis bacteria, larger particles may get trapped in the nose or throat, usually not causing disease, while smaller particles reach the lungs. Some of these bacteria are destroyed by the body's immune system, but those that survive can multiply and cause infection. If the immune system is strong, it can inhibit the multiplication of the tuberculosis bacteria.

         Tuberculosis spreads through droplets that are 1-5 microns in size, which can reach the alveoli in the lungs and cause infection. These droplets can be produced by coughing, sneezing, talking, or singing. If the droplets are larger, they may get trapped in the nasal mucosa, which typically does not lead to disease.

         The frightening aspect of nasal tuberculosis is that patients often show no symptoms. The only signs may be nosebleeds or coughing up blood. Therefore, to avoid negligence, if symptoms suggestive of tuberculosis arise, such as low-grade fever similar to flu, especially in the afternoons or evenings, or at night, along with body aches, fatigue, loss of appetite, weight loss, night sweats, or coughing up blood accompanied by chest pain in advanced tuberculosis patients, one should consult a doctor.

         When asked who is at risk for nasal tuberculosis, the answer is ‘everyone’, especially if they have been in contact with or in places where tuberculosis patients are spreading the disease. Those at higher risk include close contacts of tuberculosis patients, diabetics, the elderly, individuals on immunosuppressive medications or various steroids, recent surgery patients who are in a weakened state, cancer patients undergoing chemotherapy, organ transplant recipients, and HIV patients.

         Currently, tuberculosis can be treated with various medications. In the initial stage of treatment, patients must be hospitalized to control the spread of the bacteria. Once symptoms improve, doctors may allow them to continue treatment at home. However, it is crucial to continue taking medication consistently and not to stop on their own, even if symptoms improve, to prevent drug-resistant tuberculosis, which is harder to treat.

         In cases where patients have dangerous complications, such as severe coughing up blood, air leakage into the pleural cavity, or the spread of tuberculosis into the bloodstream, close medical supervision is necessary.

To prevent tuberculosis, it is recommended to maintain good health, have annual health check-ups, and exercise regularly.