— Dr. Richa Sareen- Associate Consultant- Pulmonology at Fortis Hospital Vasant Kunj
Every year 24th March is observed as the “World TB Day”. It was on this day in 1882, that Dr. Robert Koch announced to the medical fraternity that he had found the cause of tuberculosis, the Mycobacterium tuberculosis bacillus. At that time, TB was widely prevalent and was causing huge morbidity and mortality. This discovery paved way for further research in the diagnosis and treatment of tuberculosis. 139 years later, we are still struggling to control this disease.
TB is the highest single most infection-causing mortality worldwide. TB is also the leading cause of infection in HIV-positive people. India is the highest TB burden country in the world having an estimated incidence of 26.9 lakh cases and over 4.45 lakh deaths due to TB in 2019 (as per WHO). These numbers are alarming and need to be addressed as a priority. In India, the age distribution of TB diagnosed incident cases shows a predominance in the adolescent and young adult age groups between 15 to 30 years. This comprises the young population, who are more mobile and active and this contributes to the further spread of infection.
Tuberculosis can involve almost all organs of the body, most commonly the lungs. TB disease is classified into pulmonary TB (involving the lungs) and extrapulmonary TB (involving any other organ, apart from the lungs). Pulmonary TB is one, that can spread from person to person, as when the infected patient coughs, thousands of TB bacilli are released into the environment. When a healthy person inhales these TB bacilli, it goes within the lungs and initiates primary infection.
TB infection is also of two types: latent TB infection and active TB infection. In latent infection, the TB bacilli remain dormant in the body but do not cause disease at present. At times, when the immunity of the body goes down, the dormant TB bacilli becomes active and causes the disease. In India, almost 50% of the population has latent TB infection, and every year 5-10% of these develop active TB disease. So the TB disease burden in India is huge.
The most common symptoms of TB are low-grade fever, night sweats, a decrease in appetite, and loss of weight. Pulmonary TB patients also have coughs (with or without sputum), shortness of breath, and sometimes blood in sputum. Symptoms of extrapulmonary TB vary as per the organs involved. With the advancement in the medical field, there are multiple tests available to diagnose TB early. Some genetic-based tests like gen expert and CBNAAT give results in a few hours. It’s important to recognize the early signs of TB and consult the specialist physician at the earliest so that the disease can be diagnosed early and appropriate treatment can be started.
Another obstacle to the eradication of TB that we face is the emergence of drug resistance. This happens either because of an incorrect treatment regime, or the patient leaves the treatment midway after initial improvement, or sometimes the patient is infected with the TB bacillus which is inherently resistant to the standard TB medicines. This is becoming a huge problem in resource-limited countries like India. Drug-resistant TB requires a prolonged course of medicines (up to 2 years) which includes injectable medicines as well for a long time. Despite that too, drug-resistant TB is difficult to treat and can sometimes cause long-term effects and may even cause death.
So in a nutshell, TB is one disease that has to be taken seriously. It requires early diagnosis, prompt and accurate treatment and regular follow-ups to ensure treatment response.