Tuberculosis is known to mankind since March 24, 1882 when Sir Robert Koch isolated the Tubercle Bacilli.
Let’s understand that TB spreads through air. A person affected by this disease spreads the infection through coughing. Over crowding is a very important reason for the spread of this disease from person to person. Poor ventilation, small houses, and over crowding are the basic causes for the increasing prevalence of TB in developing countries like India.
Though many of us get infected with the TB bacilli not all of us develop this disease. The reason for this is the body immunity. Poor nutrition, malnutrition, diabetes, and HIV are some of the important causes which are leading to poor immunity.
India is gradually showing an increase in diabetes in urban and rural areas and this is one of the important causes of an increase in TB cases in India.
The problems, which we are facing, are:
1. Delay in the diagnosis;
2. Patients taking irregular treatment;
3. Patients stopping treatment because of financial issues;
4. Lack of awareness amongst patients about steps to be taken to prevent the spread of TB.
Family physicians are doing good work by diagnosing TB early and with the cooperation of the municipal corporation several health education awareness programmes are being undertaken to involve more general physicians and consultants in the DOTS (Directly Observed Treatment Short Course) programme of the BMC (Brihanmumbai Municipal Corporation, also known as the Municipal Corporation of Greater Mumbai).
The step necessary to curb tuberculosis is public-private participation.
The biggest threat today is Drug Resistant TB. Drug resistance means the TB Bacilli are unable to be killed by the primary drugs used for treating TB. The drugs used for drug resistant TB are expensive. Also, there is a delay in diagnosing Drug Resistant TB.
There is a need to sensitise doctors in suspecting drug resistance and advising the necessary tests at the earliest.
Sputum for GeneXpert is a standard test used to diagnose DR TB (Drug Resistant TB). Many private labs are now doing this test. Also, municipal hospitals are now offering this test free of cost.
The challenges in DR TB are:
1. Late diagnosis of drug resistance. By the time the patient is diagnosed he passes on the resistant bacilli to many others.
2. The treatment of Drug Resistance being costly many patients leave it half way.
3. The side effects of the 2nd line Anti-TB drugs make the patient take the medicines irregularly.
4. The treatment duration ranges from 2 to 3 years because of which many patients do not complete the therapy.
For a successful treatment the patient and his family needs to be counselled about the risks of irregular treatment. Also, nutritious food needs to be ensured to give a good immunity to the patient.
A new drug, Bedaquiline, has arrived for tackling Drug Resistant TB. Its usage in India is presently on a trial basis at Sewri TB Hospital, Mumbai. Its use is indicated in MDR TB (Multi-Drug-Resistant Tuberculosis) and XDR TB (Extensively Drug-Resistant TB) patients. A selected number of patients are going to be enrolled in Bedaquiline study in Mumbai. After its results are available it would be convenient for us to ascertain its efficacy/tolerance.
TB in India can be tackled with a joint effort of the private physicians, municipal corporation, and patient counselling. Early diagnosis and treatment along with nutritional supplements are needed. Control of diabetes is an important step towards controlling the spread of TB.
Dr Salil Bendre
Head of Department, Pulmonary Medicine, Nanavati Super Speciality Hospital, Mumbai
Professor and Head of Department, Pulmonary Medicine, K J Somaiya Medical College, Mumbai