Tuberculosis is an infectious bacterial disease which is caused by Mycobacterium Tuberculosis. It usually affects the lungs which is known as pulmonary tuberculosis. When the bacteria spreads to the other parts of the body it is known as extra-pulmonary tuberculosis. Tuberculosis is a Latin word for nodule which means it ‘sticks out’. It is usually a droplet infection. There are almost more than one million cases every year. It is a potentially serious condition but can be cured with timely diagnosis and the right medication. Coughing, chest pain, blood in sputum are some of the major signs and symptoms of tuberculosis.
As per the World Health Organisation, 1.6 million patients all over the world died in 2021 due to tuberculosis. Worldwide it is the leading cause of death and the second leading infectious disease after Covid-19.Multi-Drug Resistant Tuberculosis
( MDR TB) is a major public health concern across all low-income and developing countries. Not everyone with tuberculosis gets sick as it may lay dormant in the body.
There are three stages of tuberculosis:
Primary infection
Latent infection
Active Tuberculosis
The lungs are affected in pulmonary tuberculosis. In extra-pulmonary tuberculosis, systemic miliary tuberculosis manifests itself in the following ways:
- Meningitis: inflammation of the brain
- Increase in the White Blood Cells in Urine leading to sterile pyuria
- Addison’s disease
- Hepatitis, a liver infection
- Lymphadenitis which affects the lymph nodes in the neck.
How is tuberculosis transmitted?
When an affected patient coughs, sneezes, talks, sings or even laughs, the bacteria are diffused into the surrounding air. Since TB is a droplet infection, people with an active infection are usually spreading it through a contagious mode. The symptoms of TB in the lungs are then seen if a person is unhealthy or if his immune system is compromised.
If the person is healthy, even if the bacteria enters into the body, they remain unaffected making it inactive. There is a latent TB infection after exposure. The bacteria will remain inactive forever or if the person’s immunity decreases, the latent infection becomes active.
How does TB affect the body?
Tuberculosis spreads from person to person via the droplet mode of infection.
It spreads through coughing and sneezing and usually requires a prolonged exposure. If you come across a casual acquaintance, it is not going to cause the infection. However, if you come in repeated contact with a close member of your family or a co-worker, there are more chances of developing the infection. Once the person comes in contact with the infected person, the bacteria reaches the lungs. It then requires few days to months for the infection to manifest itself through signs and symptoms. This is known as the incubation period. During an active infection phase, the tuberculosis bacteria multiplies itself in the lungs. It then spreads to the other parts of the body such as lymph nodes, bones, skin, kidneys through the circulatory and lymphatic system.
Symptoms of Tuberculosis in throat:
Tuberculosis in the throat is also known as scrofula or cervical tuberculosis lymphadenitis. They are the same bacteria which cause pulmonary tuberculosis. The bacteria are lodged in the lymph nodes in the neck. Only five per cent of the tuberculosis develops into scrofula. It is more common in children than in adults.
The other symptoms include:
Fever
Malaise
Weight loss
Night sweats.
The treatment usually includes an antibiotic course which runs from six to nine months.
With other immune disorders, a longer course may be needed.
The other treatment modality is surgery.
TB treatment in India
The patient must receive the right course of treatment for tuberculosis.
The treatment depends on the type of patients:
- New patient
- Patient who has previously had an infection
- Patients who acquire the infection from another TB unit or patient.
Treatment regimen for new patients:
For new patients, there is an internationally accepted first line of treatment regimen.
The initial phase consists of eight weeks. It includes Rifampicin, Isoniazide, Pyrazinamide, Ethambutol and Streptomycin.
The continuation phase lasts for sixteen weeks with three drugs Isoniazide, Ethambutol and Rifampicin.
The drug dosage depends on the body weight of the patient.
The patients receive treatment through the DOTS strategy. This means Direct Observation Treatment Strategy. Under this scheme, the patient is asked to take medication under the guidance and observation of a fellow community member or a family member.
Fixed Dose Combination:
Under this strategy, two to three drugs are combined into a pill or tablet and given to the patient. This simplifies the treatment as well as increases the patient adherence.
Daily drug treatment in India
In the start, RNTCP had advised a TB treatment program only for three days in a week. However ,there were several shortcomings associated with that line of treatment. In 2014, they realised the need for daily dosing. In February 2017, the Supreme Court directed that all the patients should be administered a daily regimen of TB treatment.
One important variant to be considered is MDR TB which is Multi-drug Resistant Tuberculosis. It is essential that the right treatment be delivered to the patient under expert doctor’s guidance.In March 2012, a shorter MDR TB regimen was introduced for 9 to 11 months for patients with Rifampicin resistance.In 2018, Bedaquiline was given to the patients across all the states.
Nutritional support is provided to patient under the health scheme which entitles every TB patient to INR 500 (8$) per month for fulfilling his monthly dietary requirements essential for treatment for this disease.
Tuberculosis is one of the major concerns of public health. Earlier the right treatment was not available due to various factors but now the right treatment options are available which are highly effective as well. It is essential that the patient should strictly follow the drug regimen to get better.