Wednesday, November 4th, 2009

Tuberculosis–The New Challenges of an Old Disease



Mankind shares a long association with tuberculosis, an infectious disease that has plagued humans since antiquity. Skeletal remains of Egyptian mummies have evidence of tubercular decay. World TB Day on 24 March, commemorates the day in 1882 when Dr Robert Koch astounded the scientific community by announcing that he had discovered the cause of tuberculosis, the TB bacillus.
For long we believed that tuberculosis was a disease that afflicted only poor. At GHC we thought to demystify these myths. TB can happen to anyone—yes, you heard it right, even affluent people. Pulmonologists say that the bug causing TB is latent in our bodies and our immune system normally suppresses it. However, under distress—read when we are dieting, recuperating from long illness, undergoing long-term stress, during old age and infected with HIV our immunity takes a nosedive. This gives the latent bugs and opportunity to get the better of us and we have a full-blown infection.

Do we really need to worry?
Yes, we do. The disease is silently spreading its tentacles in upper-middle class India. WHO report on South East Asia Region in the year 2005, ranks India number one as far as number of TB cases are concerned. The figures are scarier for women. TB is the biggest cause of death of women in the reproductive age. Though, we take TB as a pulmonary disease affecting lungs, other forms of TB—bone, brain and gland is on rise too. The trouble with these types is that none of them will test positive for sputum test often regarded as foolproof test to detect TB.

How does the disease spread?

Living with or coming in close contact with people who have active TB spreads the infection. When persons with active TB disease cough sneeze, speak or spit, expelled droplets spread TB infection. People with jet-setting lifestyles too can fall prey to the disease. According to WHO, the air circulating in closed spaces like aircrafts and underground trains provide an ideal environment for the spread of TB. Again, the help that you have hired may be harbouring the disease. You can pick up the disease while visiting a sick relative at the hospital. However, getting an infection does not mean you are going to have a full-blown infection immediately. Normally, the disease remains latent in our bodies for a long time and becomes active when our immunity goes down.

What symptoms should I be wary of?
Early symptoms of TB include unusual fatigue, loss of appetite, weight loss and low-grade fever, especially in the evening. A cough that refuses to go is something to watch out for. See your doctor if you have these symptoms. The most common tuberculin skin test is the Mantoux test, which consists injecting a small amount of protein from the TB bacillus in the skin. If there is swelling or reddening of the area in 24 to 72 hours it signals the presence of TB.

What should I do if I test positive?

TB has a whole lot of stigma attached to it, which complicates the treatment. The effort should be to eradicate the stigma because TB is a curable disease. The treatment span of the disease is usually understood as six to seven months; however, you cease to be infectious after a fortnight of medication. The duration can be longer, depending on the dosage of drugs, tolerability levels and the compliance of patient in taking medicines.

What precautions should a patient take while on anti-tuberculosis-treatment?
Patients need to take medicines religiously and refrain from faltering. Though, they may feel better after a month or two of being on medication. Often patients quit taking medication, and resume once they feel unwell, again to quit it later. This is dangerous, as it can lead to Multi Drug Resistant Tuberculosis. Treating MDRT is not only expensive, but has less success rate, and patients have lower levels of tolerability of medication. TB medicines can cause toxicity so drink a lot of water and eat a high protein diet. TB bacteria destroy body’s protein tissues. Get Liver Function Test done to ensure that TB medicines do not harm the liver. Most importantly, it is crucial to complete the full-course of medicines and do not leave medicines unless your doctor advises you to do so.

Based on an interview with Dr. Bobby Bhalotra—Hony. Associate Consultant Department of Chest Medicine—Sir Ganga Ram Hospital

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