HEALTHWATCH
Still to be controlled
DR. R. NARASIMHAN
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With World TB Day on March 24, some of the commonly asked questions about this disease.
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Photo: V. Sreenivasa Murthy
Creating awareness: The main problem for the spread of TB is lack of knowledge.
ROBERT KOCH discovered the TB bacillus more than 100 years ago but the disease is still far from being controlled. We know what causes the disease; the drugs are available yet the disease is rampant. This is because of lack of awareness.
Here are answers to some of the doubts that people often have about this problem.
What Is TB?
TB or Tuberculosis is a bacterial disease caused by Mycobacterium tuberculisis. It commonly affects the lungs. It can affect any part of the body like heart, kidney, brain, bones, lymph glands and skin. The only organs that are not affected by the bacterium are hair and nails.
How does it spread?
TB spreads by air. When a patient affected with TB coughs or sneezes, the bacilli are out in the atmosphere and are capable of infecting others. This means that TB of the respiratory system can spread with more ease than Tb affecting other organs. This is why one should cover one's mouth while coughing — to keep the disease from spreading. This all applies to all respiratory diseases.
Do all people infected with TB suffer?
No. Not all people infected with TB bacteria suffer. After the infection, the bacteria can take two courses. It can cause disease if the person's immunity is low due to various reasons. This is called active TB.
Otherwise the patient convert to Mantoux positives but remain symptomatic, a condition called Latent TB infection
What is active TB?
This is a condition where the disease is active and the bacteria are multiplying and capable of spreading.
How is TB diagnosed?
It depends on the affected organ. If it is lung, which is commonly affected, the patient needs to get sputum test for TB bacillus. Any reasonably good lab can do this. All Government Hospitals are also equipped to do this. If some other organ is affected it is better to do a biopsy and get it examined by a pathologist and a microbiologist.
Is the Mantoux test useful to diagnose TB?
No. Mantoux test is to diagnose infection, not diagnose the disease. In TB, one can be infected but not have disease. The infection becomes disease only when the immunity drops. With the Mantoux, one cannot be certain that one has TB. If the Mantoux test is negative, one can be reasonably certain that there is no infection. In children it is sometimes useful. Even then all efforts should be directed towards getting a definitive diagnosis.
Is TB a lifelong disease?
No. TB is an infectious disease but is eminently treatable if one follows the physician's advice. Once completely treated there is no need for a regular follow up like examination and x-rays.
What is the duration of treatment?
The minimum duration is six months. The physician will decide whether drugs are to be given either intermittently or daily depending on the severity. Both are equally effective. The duration of treatment is sometimes extended to nine months or more in some special situations. The physician in consultation with experts will take that decision.
Can there a relapse of TB?
Yes but it relapses only if one is not regular. For example, if the physician puts the patient on the six-month regimen and advises a review after two months it does not mean he/she should stop treatment and visit him. The patient should be on regular treatment as advised in the beginning. Most relapses are due to stoppage of treatment under the impression that they should see the physician and continue the treatment.
Do the anti-TB drugs have side effects?
All drugs have some acceptable side effects and one has to be on guard. But they are not common and are reversible. The commonest ones are GI upsets, tingling numbness in hands and feet, liver enzyme abnormalities. They can be easily treated if one follows the physician's advice about follow up investigations.
What is MDR TB?
Multi-drug resistant TB is MDR TB. In such a case, the drugs we use for TB cannot be used or will fail if used. This is a man-made problem. If the drugs are not properly used or if the dosage is improper, this problem occurs and it is difficult to treat. Firstly, the treatment is very costly and secondly the required drugs are more toxic; hence it is difficult to maintain the regularity. Lastly the treatment duration is prolonged. The threat would be become a reality only when one is irregular and if there is a coexisting HIV infection.
The writer is a Senior Respiratory Physician based in Chennai.
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