Today is World TB Day

Despite the declining number of cases, TB is still a life-threatening disease in the world. World TB Day is observed on March 24 every year. The event commemorates the date in 1882 when Dr Robert Koch announced the discovery of bacillus that causes tuberculosis. This year’s theme is “Find TB. Treat TB. Working together to eliminate TB.”

Accurate and complete diagnosis is the need of the hour

Tuberculosis continues to claim over 1000 lives every single day and is also one of the leading causes of deaths in the country. Adding to the woes is the worrisome trend of extremely drug resistance and total drug resistant strains. TB is a contagious disease and hence complete and accurate diagnosis becomes paramount for infection control, proper disease management and better clinical outcomes.

Types of Tuberculosis:

• Mono-resistant: Resistant to a single drug
• Poly-resistant: Resistance to more than one drug but not to the combination of Isoniazid and Rifampicin
• Multi-resistant (MDR): Resistance to at least Isoniazid and Rifampicin
• Extensively Drug Resistant (XDR) : MDR plus resistance to fluoroquinolones and at least 1 of 3 injectable drugs (Amikacin, Kanamycin, Capreomycin)
• Extremely Drug Resistant (XXDR): TB which is resistant to all first and second line TB drugs

The WHO has set protocols for TB diagnosis and four tests have been approved: LED microscope, liquid culture and two molecular tests viz. Gene Xpert and Line ProbeAassay. Liquid Culture still continues to be the gold standard and takes up to two weeks for a report to be produced. Liquid Culture gives complete diagnosis and indicates resistance to first line and second line of drugs.

Gene Xpert is another test that has been widely used since 2014 owing to a faster turnaround time. Results are available within two hours and it is possible to determine accurately the presence of tuberculosis and if it is Multi-resistant; however the GenExpert test does not give any insights on resistance to drugs other than Rifampicin or second line drugs. If the GenExpert report suggests Multi-drug resistance, the patient needs to undergo Liquid Culture test that will decide the course of treatment.

Commenting on World Tuberculosis Day, Dr Shamma Shetye, Chief of Lab Services, Metropolis Healthcare said “GenXpert is slowly becoming a standard test for tuberculosis. It is important to know if you are suffering from Primary or MDR TB before treatment is started.” We have validated Genexpert for extrapulmonary samples as per WHO guidelines and find it to be very promising.

“Awareness is the first step towards good health. In infections such as Tuberculosis, it is important that patients are fully aware of the burden of the disease, the types of tests needed, the drugs used for treatment, duration of treatment, disease monitoring and treatment progression. It is heartening to note that mortality from Tuberculosis has come down in India in the past decade but the infection spread is yet to be brought under control. Health awareness on a large scale is required to tackle a burden like Tuberculosis. We have seen India take strides in tackling Polio and Leprosy; the nation now needs to take up TB control on priority,” he concluded.

Hear Act Learn Treat Tuberculosis

It can be treated!

TB is a disease that does not know boundaries - in that sense it is a 'democratic ' disease and anyone can get it. In fact there are over 10 lakh patients with TB who are not detected as of now. The problem of drug resistant TB is also becoming widespread. A partnership between the government run programs and private practitioners and hospitals is required to eliminate the disease. Many patients go to private providers for TB care and there is a need to standardize care and follow treatment guidelines.

TB is curable in most patients but this depends on a sincere and directly observed treatment plan which is many months in duration. Close monitoring by the patient for side effects and also by their doctor is important. General physicians or specialists like pulmonologists and infectious disease specialists are involved in managing TB.

As we get better at managing our health and have high technology solutions for many medical problems the hope is that TB is also soon conquered. Fortunately there are newer rapid tests and better medications in the pipeline. There is work on vaccines and also on better systems to prevent the spread. As a member of the public on this important day I think it would be great for people to identify people who may have a cough and suggest an evaluation if it is not improving. TB can be tested and treated in a simple manner if identified early. Let us all join together in eliminating this disease which has affected our society, economy and productivity for decade.

10 things to know about TB

1. Most of us have latent TB foci inside our lungs. We all are exposed to the organism early on in life and would have formed foci of infection in the lungs (primary TB). Our immune system would have contained the infection and prevented us from suffering the disease. It is when our immune system becomes weak for some reason or is overwhelmed by the infection or any other cause, that we suffer the disease (reactivation). The organisms can travel from the foci of infection in the lungs to other sites leading to secondary infection (TB of lymph nodes, spine etc).

2. By maintaining good health and immunity, you can prevent getting infected with tuberculosis. Nutritious food, adequate sleep, exercise and leading a life with minimal stress go a long way in helping our immunity fight any infection well including TB. Work on improving your immunity by including diet rich in antioxidants. Have atleast 4-5 servings of fresh vegetables and fruits everyday. If you cannot have it due to certain practical constraints, make sure you take your daily dose of antioxidants/multivitamins after consulting your doctor. Anti-oxidants help fight free radicals produced in the body due to any kind of disease/stress and help in cell repair.

3. Fresh air and sunlight can help prevent TB. The microbes in TB thrive in cold, damp places. Whether you are at home or office, remember to open all your windows for a major portion of the day to let the sunlight and air in.

4. Tuberculosis primarily affects the lungs but can affect other organs too. Cough that lasts for more than 3 weeks, streaks of blood in the sputum (phlegm), low-grade fever, difficulty in breathing and unexplained weight loss are the commonest symptoms of TB of the lungs. TB of other organ systems present with varied symptoms. For example: TB of the skin could present with a non healing ulcer, TB of the spine could present with backache, stiffness or even swelling in the back/groin, TB of the intestines could present with abdominal distension and absolute constipation. Even a non-healing anal fistula could be due to TB. TB of the lymph nodes can present with swellings at multiple sites of the body. TB of the covering of the brain and spinal cord can cause TB Meningitis, especially in children.

5. With the BCG vaccine, you cannot be resistant to TB throughout your life. It also doesn’t help in secondary forms of TB. That said, one still needs to get the BCG vaccine soon after birth.

6. TB is a fully treatable disease if the full course of medications are taken properly and regular follow-ups are done with the doctor. The main drugs used for TB are Isoniazid, Rifampicin, Pyrazinamide, Ethambutol and Streptomycin. But always take these medicines under the doctor’s supervision because indiscriminate use can lead to jaundice, liver failure and kidney failure. The duration of the treatment varies from case to case and is at least for 6 months. Testing and treatment is available free of cost at all government hospitals, primary and community health centres.

7. Follow full course of TB treatment prescribed. Not doing so can lead to the organisms developing resistance to the first-line drugs used in treatment causing MDR-TB (multi-drug resistant TB).

8. MDR-TB does not respond to standard TB drugs, is difficult and costly to treat. The MDR-TB prevalence is estimated to be 2.3 per cent among new cases and 12-17 per cent among re-treatment cases.

9.One of the major causes of infertility among women from the lower socio-economic conditions is genital TB. When latent bacilli in the lungs get reactivated, they often spread to different parts of the body including the genital tract. It can infect either the uterus and/or the fallopian tubes and usually does not show any symptoms. A very difficult disease to diagnose, only the culture from a tissue sample obtained from a genital tract can help.

10. Children including babies can suffer from TB, but often go undiagnosed. According to the WHO, around half a million babies and children get ill with TB every year and 70000 die due to it. Children under three years of age, especially those who are malnourished and with compromised immune systems are particularly prone to the disease. However, the symptoms often go unnoticed causing higher mortality rates.

To prevent TB in children, get them immunized with the BCG vaccine soon after birth. People in your family, including house-help, who would come in close contact with the children need to be screened. Also, breastfeeding the baby for at least six months increases their immunity against all infections including TB.