Tuberculosis has been infecting humans since antiquity.Mycobacterium tuberculosis was first described and identified on 24 th March 1882 by Robert Koch.He received the Nobel prize for this discovery in 1905. World tuberculosis day was established on 24 th March for this reason. Roughly one third of the world’s population has been infected by TB at the rate of 1 percent population per year. This is the commonest cause of death by infection after HIV AIDS.
- What is tuberculosis? Tuberculosis is an infectious disease caused by a mycobacterium and usually affects the lungs. However each and every part of our body can be infected except hair and nails.
- What are different forms of tuberculosis ? A tuberculosis infection need not make you sick all the time. There are two types of tuberculosis. One is the latent one wherein the bacteria remains silent for a long time without causing symptoms. There is about 10 % chance that latent infection would become active disease. In active tuberculosis the immune system does not stop the bacteria from multiplying and these people are sick. If not treated properly TB can be fatal.
- How does tuberculosis spread? Tuberculosis spreads from one person to another through tiny droplets released on coughing and sneezing. Active infection occurs commonly in those who smoke, have diabetes or have HIV/ AIDS.
- What are the symptoms of tuberculosis ? Cough that lasts for more than two to three weeks, blood in spit, low grade evening rise of temperature, loss of appetite and weight, fatigue , alternating constipation and diarrhoea are few common symptoms. As tuberculosis can involve any organ one can have symptoms related to them. Headache, vomiting and fever with neck pain may be due to TB meningitis. Fertility issues can be due to infection in the Fallopian tubes or uterus. Backache or joint pains can be due to TB of vertebrae or joints. Tuberculosis of the skin, eyes, pleural space,lymph nodes are common.
- Who are at risk of getting tuberculosis in India? In India tuberculosis is extremely common. In fact the whole population is at risk. It does not spare even the rich and mighty. Those in contact with infected patients, those with diabetes, HIV, alcoholics, malnourished people, those residing in crowded areas, those on steroids are at particular risk. Medical students , nurses and doctors are also at risk.
- Which investigations are commonly done to diagnose tuberculosis ? A proper clinical examination can raise a high index of suspicion. Xray of the chest, abdominal sonography or CT scan of the abdomen, examination of body fluids are important. Demonstration of tuberculosis bacillus is the gold standard investigation. This however is not possible in all cases. Aspiration cytology, sputum examination for tuberculosis bacteria, lymph node or a tissue biopsy are usually done.Quantiform TB gold test and other immunological tests are useful. Culture of TB bacteria is extremely important in selected cases.
- How is tuberculosis treated ? As against other infections, TB is treated with 4 antibiotics at a time for initial 2 months and reduced number for next 6 to 9 months and even longer in bone or joint TB. There are specific guidelines for usage of these drugs. Improper treatment can lead to serious drug resistance cases which are very difficult to treat and may require treatment for 2 years.
- What is DOTS ? This is a directly observed treatment short course. The WHO announced a new strategy called DOTS for the world wide control of tuberculosis. In this a health worker directly administers the medicine so that the compliance is improved. This prevents antibiotic resistance and also prevents the spread of the disease.
- How is the spread of the disease prevented? After almost 2 months of regular treatment the person becomes non contagious. To prevent others from getting infected stay at home in a well ventilated room for 6 weeks in case the sputum is positive for the bacilli . Cover your mouth any time you cough, laugh or sneeze. Wearing a mask is also suggested.
- How effective is the BCG vaccine ? In children it reduces the risk of getting infected by 20 percent. The risk of infection turning into a disease by 60 percent.
- What is XDR tuberculosis ? Tuberculosis that is resistant to Isoniazid, Rifampicin, and quinolone and one of the injectable anti tuberculosis drug like Amikacin, Kanamycin or Capreomycin is Extended form of tuberculosis resistance.
- What is MDR tuberculosis ? Tuberculosis bacilli that is resistant to the two most important and formidable drugs like Isoniazid and Rifampicin are known as MDR tuberculosis. They are difficult to treat as they require other antibiotics which are expensive and toxic. The treatment needs to be given for minimum 24 months.
- What are the public health efforts towards tuberculosis? The revised national tuberculosis control program is making herculean efforts to reduce the incidence of tuberculosis by various means. The central government and its health department provides drugs free of cost to all with tuberculosis. These are readily available at all primary health centres and district hospitals.The WHO and Bill and Melinda Gates foundation are also active in this.
Tuberculosis and particularly drug resistant cases provide a huge challenge. Inspite of a sincere and well executed government plan tuberculosis continues to infect many people every day. People at large should adhere to the treatment. Take precautions to prevent its spread and continue the treatment for 6 or 9 months as recommended.
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Author: Dr Jay Deshmukh
Dr Jay Deshmukh is Chief Physician and Director, Sunflower Hospital, Nagpur Honorary Physician to Honorable Governor of Maharashtra and PondicherryCentral. Dr Jay Deshmukh is an M.B.B.S., M.C.P.S., F.C.P.S., M.N.A.M.S., MD From Internal Medicine – Bombay and New Delhi.