Tuberculosis (TB)

Tuberculosis (TB) is an infectious disease caused by a bacterium, Mycobacterium tuberculosis. Each day, over 4000 people lose their lives to TB and close to 30,000 people fall ill with this preventable and curable disease. TB remains the world’s deadliest infectious killer. Each day, over 4000 people lose their lives to TB and close to 30,000 people fall ill with this preventable and curable disease. TB is one of the leading causes of mortality in India. It kills more than 4,00,000 people in India every year. But these deaths can be prevented. With proper care and treatment, TB patients can be cured and the battle against TB can be won.

Transmission

TB is spread through the air by a person suffering from TB. A single patient can infect 10 or more people in a year.

Symptoms

Common symptoms of TB are:

• Cough for three weeks or more, sometimes with blood-streaked sputum
• Fever, especially at night
• Weight loss
• Loss of appetite

Vulnerable population

Those most vulnerable to falling ill with TB include very poor and/or malnourished/ undernourished people, people living with HIV/AIDS, children and women, contacts of people with TB including health workers, migrants, refugees and internally displaced persons, miners and mining-affected persons, persons with diabetes, elderly, ethnic minorities, indigenous populations, substance users and homeless persons.

Strongest risk factors for TB among adults - HIV

The Human Immunodeficiency Virus (HIV, the virus that causes AIDS) is the strongest risk factor for tuberculosis among adults. Tuberculosis is one of the earliest opportunistic diseases to develop amongst persons infected with HIV. HIV debilitates the immune system increasing the vulnerability to TB and increasing the risk of progression from TB infection to TB disease. An HIV positive person is six times (50-60% life time risk) more likely of developing TB disease once infected with TB bacilli, as compared to an HIV negative person, who has a 10% life-time risk.

Tuberculosis in children

Children account for an estimated 11 % of all TB cases in the world. TB in children is often missed or overlooked due to non-specific symptoms and limitation of diagnostic tools. Children at greater risk for Tuberculosis. Some groups of children are at greater risk for tuberculosis than others. These include:

• Children living in a household with an adult who has active tuberculosis
• Children living in a household with an adult who is at high risk for contracting TB
• Children infected with HIV or another immuno compromising condition
• Children born in a country that has a high prevalence of tuberculosis
• Children from communities that are medically under served

Diagnosis

Under Revised National Tuberculosis Control Programme (RNTCP) the following methods are used to diagnose various forms of Tuberculosis:

1. Microscopy
2. Culture (Solid, Liquid)
3. Molecular tests Line Probe Assay (LPA), Cartridge Based Nucleic Acid Amplification Test (CBNAAT)
4. Mantoux Test
5. X-ray and other imaging techniques
6. Histopathology

Treatment

Directly Observed Treatment Short-course (DOTS)  is the strategy followed for treatment of TB. Tuberculosis treatment requires at least 6 months of treatment.

Vaccination - The TB vaccine, BCG, addresses the tuberculosis problem in children to some extent.

TB treatment with DOTS reduces the morbidity and mortality among people living with HIV.

Gaps in TB treatment

“Missed” is the gap between the estimated number of people who became ill with TB in a year and the number of people who were notified to national TB programmes. In 2018, in India 2.69 million people fell ill with TB and about 0.449 million people died. Only 1.99 million people with TB were notified. Every year 7 lakh people with TB are missing out on quality care. The vast majority of people dying of TB are missed.

Extra-pulmonary tuberculosis

Extra-pulmonary tuberculosis (EPTB) refers to disease outside the lungs.

Symptoms

Extra-pulmonary TB may be characterized by swelling of the particular site infected (lymph node), mobility impairment (spine), or severe headache and neurological dysfunction (TB meningitis) etc. Extra-pulmonary TB is not accompanied by a cough because it does not occur in the lungs.

Development of the disease

• Primary infection occurs through blood or lymphatic spread of bacteria to parts of the body outside the lung may occur. When a person has adequate immunity, these bacteria are probably destroyed. If the person has some immune deficit some bacteria may concentrate at a particular site where they may lie dormant for months or years before causing disease.
• Bacteria may be coughed from the lungs and swallowed. By this route they may enter the lymph nodes of the neck or parts of the gastro-intestinal (GI) tract.
• Infected milk from cattle infected with M. bovis, could pass disease to humans..

The commonest sites of infection are:

• Lymph glands and abscesses particularly around the neck.
• Bones and joints. The spine is affected in about half such cases.
• Genito-Urinary tract - In women uterine disease is probably the most common while in men the epididymis is the site most frequently affected. Both sexes are affected by renal , ureteric or bladder disease equally.
• Abdomen - This may affect the bowel and or peritoneum.
• Meningitis - which may be rapidly fatal if not, treated in time
• Pericardium- which causes constriction to the heart
• Skin - which can take a number of forms, most notably

Multi-drug-resistant tuberculosis

Multi-drug-resistant tuberculosis (MDR TB) is caused by strains of the tuberculosis bacteria resistant to the two most effective anti-tuberculosis drugs available - isoniazid and rifampicin. MDR TB can only be diagnosed in a specialized laboratory.

Worldwide 4,84, 000 people were estimated to have fallen ill with multidrug-resistant TB (MDR-TB) in 2018. In India about 1,3,000 people fell ill with drug-resistant TB. 

Multi-drug-resistant Tuberculosis requires at least 18-24 months of treatment with medicines which are 100 times more expensive and often highly toxic.

FAQS

What is the cause of tuberculosis?

Tuberculosis is not a hereditary disease. It is an infectious disease. Any person can get afflicted with TB. Whenever, a patient having active tuberculosis coughs or sneezes in an open manner, bacteria causing TB come out in the aerosol. This aerosol can infect any person who happens to inhale it.

What are the symptoms of this disease?

Characteristic symptoms of TB are persistent cough of more than three weeks duration, cough with expectoration of sputum, fever, weight loss or loss of appetite etc. If any of these symptoms persist beyond three weeks, the person concerned should visit the nearest DOTS TB Center or Health Center and get his sputum examined

What are the investigations done for diagnosing TB and where are they available?

It is essential to get sputum examined on three consecutive days for TB bacteria in order to diagnose TB. DOTS centers have been established at various places. The services provided at these centers are absolutely free.

Sputum for examination should be given after coughing properly. It is important not to give saliva in place of sputum. If saliva is submitted for examination, the disease may not be diagnosed.

What is the treatment of TB?

If a full course of anti-tubercular drugs is taken on a regular basis, this disease is fully curable. A TB patient has to take medicines for a minimum period of six months continuously. The drugs may continue up to on year in some cases. It is important that the drugs are discontinued only on the advice of the doctor. Patients who do not take a complete treatment or take drugs on an irregular basis, their disease turns incurable or even life-threatening.

Is the disease of TB curable?

Yes, this disease is fully curable if the treatment is taken on a regular and continuous basis for adequate duration.

How can we prevent tuberculosis?

The disease of TB spreads whenever, patients cough or sneeze without covering their faces or spit here and there. Hence, patients should always cover their faces while coughing or sneezing. One should not spit here and there and always use spittoon for coughing.

At home also, patients should spit in a box which is covered by a lid. Before disposing off the sputum, it should be boiled.

It is very important not to get scared or to hide the disease whenever someone develops the symptoms of TB. It is necessary that the person concerned may get himself/ herself examined and take adequate period.

What is the diet to be given to a TB patient?

As per one's liking, TB patient can eat any type of food. There are no special diets necessary for a TB patient. One should avoid any foodstuff which causes any problem in that particular individual.

What are the things to be avoided by a TB patient?

A patient of TB should avoid consumption of bidi, cigarette, hookah, tobacco, alcohol or any other intoxicating drug.

What is DOTS?

DOTS stands for directly observed treatment short course, the curative treatment for tuberculosis. It is the name for a comprehensive strategy which primary health services around the world are using to detect and cure TB patients. It combines five elements:

• Political commitment to a National Tuberculosis Control Programme.
• Microscopy services to detect the infectious cases among those people attending health care facilities with symptoms of pulmonary tuberculosis, most importantly cough of 3 weeks duration or more.
• Regular uninterrupted supply of anti-TB drugs. The establishment of a dependable, high quality supply of anti-TB drugs throughout the health system is an essential part of the DOTS strategy to ensure that the treatment of TB patients is never interrupted.
• Direct observation of the treatment for at least initial intensive phase. As a part of DOTS strategy health workers counsel and observe their patients swallowing each dose of powerful combination of medicines.
• Monitoring and accountability system for programme supervision and evaluation of treatment of each patient diagnosed.

What are the advantages of DOTS

• DOTS produces cure rate high as 95 percent.
• DOTS guarantees quicker and surer relief from the disease.
• DOTS has changed the lives of 17 lakh patients in India.
• DOTS is a strategy for alleviating poverty. Saving lives, reducing the duration of illness, and preventing new infectious cases would mean fewer years of employment lost.
• DOTS prolongs survival of HIV-Infected TB patients.
• DOTS prevents treatment failure and the emergence of multi-drug resistant tuberculosis by ensuring patient compliance and uninterrupted supply of anti-TB drug.
• DOTS increases the reach of health services. The DOTS strategy has been remarkably successful in promoting the development of peripheral health services.
• DOTS is available for free at all Health Centres.

How TB & HIV are related?

Anyone can become infected with TB, but people with HIV and TB infection are at greater risk of getting sick with TB disease. Even if a person has only TB infection, the bacteria remains in his / her body and is still a threat to the patient. As the immune system is weakend by HIV, the bacteria can start growing and multiplying. It then becomes TB disease.

Tuberculosis Dos and Don’t’s

Do’s

• Have 2 sputum examinations done if you have cough of three weeks or more. These tests are done free of cost at Government sputum microscopy centers.
• Take all the medicines for the full prescribed period on regular basis.
• Understand that TB can be cured.
• Use handkerchief when coughing or sneezing.
• Spilt in spittoons containing house-hold germicides.

Don’ts

• Don't avoid medical care if you have cough of three weeks or more.
• Don't rely only on X-ray for diagnosis of TB.
• Don't stop medicines before your physician discontinues them.
• Don't discriminate against TB patients.
• Don't spit indiscriminately.

Source : Tuberculosis India

World Tuberculosis Day - 24 March 

World TB Day is held each year on March 24th and aims to build public awareness for tuberculosis. A disease which despite being curable, remains a destructive epidemic in much of the world. On this day, we commemorate Dr Robert Koch’s announcement in 1882 of his discovery of the TB bacillus, the cause of tuberculosis. His groundbreaking research opened the way toward diagnosing and curing this disease.

World TB Day is an opportunity for people everywhere to join this fight by helping to educate others about TB and by urging governments to take action.

Source : World TB Day 2021

Related Resources

1. India Tb Report 2021
2. Guidelines for Programmatic Management of Drug Resistant Tuberculosis in India-2021
3. National Framework for a Gender-Responsive Approach to TB in India
4. Collaborative Framework for Management of Tuberculosis in Pregnant Women
5. Patients Charter for Tuberculosis Care
6. WHO's Childhood TB: Training Toolkit
7. WHO - Global tuberculosis report 2020