Tuberculosis causes 1000 deaths a day in India
World Tuberculosis Day is observed on March 24th, the date on which Robert Koch discovered the Tuberculosis bacterium called Mycobacterium tuberculosis. Since that day 133 years ago, much progress has been made in the understanding of the disease and the treatment. However it still remains, 1000s of years after it started affecting humanity, one of the leading public health problems affecting all nations of the world.
The early 19th century saw the maximum devastation due to the disease but the rates of disease started to drop when sanitation and living conditions improved across the world due to the industrial revolutions. This was much before the first medication, streptomycin, was even introduced.
Currently 1 in 3 people in the world carry tuberculosis infection; an estimated 10 million people become infected every year. In India, about 330,000 people die each year of Tb, about 1000 deaths a day. The incidence of Tb has been reducing since the year 2006, however with the advent of MDR-Tb and now XDR-Tb, the challenge is even bigger. The association of HIV and Tb has made it even more difficult to eradicate.
Tuberculosis is caused by being exposed to infected people for a period of time. The bacilli are released into the air when a diseased person coughs and then enter other people through their respiratory tracts. 90% of the time the disease will be in the lungs, called pulmonary Tb. Sometimes the bacilli spread through the lymph stream or blood stream and cause disease of almost every organ in the body. Widespread disease, called miliary Tb can occur in persons with low immunity, such as people with HIV-AIDS, advanced age and other medical conditions that lower immunity.
The usual symptoms are a cough lasting longer than 2 weeks, weight loss, poor appetite, sweats at night and a low grade fever especially in the evenings. Any of the above symptoms must prompt seeking medical care as soon as possible. There is a certain stigma associated with Tb as it is thought to be a disease of the poor, the unsanitary and of course due to its association with AIDS. People usually shy away from seeking health care due to this. The government’s RNTCP (revised National Tb Control program), covers every nook and corner of the country and provides point of care diagnostic and treatment facilities within the reach of each and every person, free of cost.
Once Tb is identified and treatment is started, patients feel better within 2-3 weeks. However the major pitfall of Tb treatment is when patients stop treatment before the completion of the entire course, which can last between 6 to 12 months. This is the major reason for emergence of drug resistant Tb. Thus the treatment needs to be completed and cure demonstrated before the patient can be released from treatment.
Prevention is better than cure. Sanitary living conditions, precautions when near a possibly infected person, good nutrition and sleep are ways of preventing the infection from either happening or causing disease. A good breakfast alone has been shown to reduce the conversion from latent infection to disease by about 20-25%.
Early diagnosis, prompt treatment from a specialized or government authorized center, compliance with treatment for the entire course and demonstration of cure are the ways to fight the challenges posed by this scourge of humanity. We can fight it by increasing awareness, removing the stigma and following the guidelines laid by the WHO and other bodies. This is one public health hazard that unites everyone, rich and poor, educated and uneducated, rural and urban alike.
Dr. Hemalata Arora
Internal Medicine Specialist
Dr. Hemalata Arora is a Medical Licensure of Medical Council of Greater Mumbai. She is presently working as a Consultant in Internal Medicine, VP Medical Services at Seven Hills Hospital, Mumbai. She has been awarded Paul Bunn award for the most promise in the field of Infectious Diseases, awarded by SUNY Upstate Medical University, 2008.
Dr. Arora’s areas of expertise include all types of infectious diseases like Tuberculosis, HIV-AIDS, typhoid, Pneumonia, high blood pressure, and lifestyle diseases like diabetes, obesity and Stress Management.