Dear Mr./Ms.,

I have a younger brother aged 38 who has been living in Thailand since about 8 years. There he contracted TBC in his first year being there. He never developed "open" TBC.

The discussion at home (I'm living in Italy and am married to an Italian wife) we are having is a difficult one:
Doctors in Italy in general have the opinion that someone should get treated even if TBC is latent since there is always the risk that at some point someone could develop "open" TBC. Since it is not exactly clear when one does so, they reason: better to cure now than to take any chances.

In Thailand however as well as in Holland (my brother and I are Dutch) they have the opinion that since he is not part of any risk group (doesn't have HIV, nor needs chemo therapy) there is no need whatsoever to treat him.
On top of that, they reason, TBC is endemic in Thailand, so considering the chances that he will get reinfected again, it makes no sense to treat him.

My personal view on the matter is, since they told him that once he starts coughing for about a week he should be checked, and that could mean that he developed "open" TBC... bear with me.... He would be taking the concious risk of developing "open" TBC, maybe being alert to it, but nevertheless would be walking around (potentially) for a week (maybe longer) infecting people around him, and then only after that getting diagnosed and treated.
For this matter, my wife is clear: he does not enter our home unless he gets treated. We have two kids, and she wants no risk that he might accidently infect them.

I tend to agree with her, since I feel that saying: if you cough for a week, have yourself checked, sounds like: if you develop "open" TBC we will treat you and we think it is ok to take our chances that you will have infected others in the mean time. Who in turn will get the same advice and potentially in the future infect others, and so on. That doesn't sound like a good endemic control strategy to me.

Now aside from my concern for his personal health (he seems to be ok with the way he's dealing with it for now), I am greatly concerned with the fact that he got an advice that to me doesn't make a lot of sense, not even from a medical point of view.

I read in several publications online that there are more and more specialists who seem to share my view and try to advocate treatment of all latent cases to keep them from developing "open" TBC in the future, claiming that this is the only way to truly fight TBC in the world.

So, am I paranoid, or do I have a point? Is it reasonable to demand from him to get cured before meeting him, just to avoid the risk of potential infection, in case he just happens to develop "open" TBC?
Or, are his doctors in Thailand right and is there no risk of infection as long as he gets checked when he has been coughing for a week on end? This considering that TBC is endemic in Thailand and he does run a big risk of contracting the infection again, even if he does get treated.

Also, I forget to mention that it seems that there are more ways in which TBC can reveal itself once it develops to a disease (bone, skin, organs, etc.). Am I right that this also means that when someone in general developes TBC it does not have to be the lung disease, but could be one of the other forms just as much, with other ways of transmitting it? Other than just coughing, I mean.

Don't get me wrong though, I am focussing only on the chances of him infecting others and not at all on his own health. This is mostly because he himself choses to deal with it this way. If there would be a way to convince him to get treated also for his own good, I'd love to know about it.

Thanks in advance for your reply.

Best regards,

Marc