According to the National TB control programme annual status report 2011- 2,200,000 new cases of TB were reported in India, out of 8.7 million cases all over the globe. India is a country with highest number of multidrug resistant TB in South East Asia.
WHAT IS TUBERCULOSIS (TB)?
TB is caused by a bacterium M. Tuberculosis. TB infection may be latent or active. In the latent infection, the person is infected by the bacteria but the body’s immune system is active against it, so the person does not show the symptoms of TB. In most of the people latent infection does not become active. Only 5-10% of people with latent TB who do not receive any treatment may develop active disease sometime in their life. However people suffering from HIV, diabetes, renal failure may develop active TB. Types of TB re pulmonary, skeletal, lymph nodes or it can infect abdominal organs.
HOW DOES TB SPREAD?
TB is an airborne disease; when a person suffering from TB sneezes, cough or spits, the droplets contain TB bacilli. One cough or sneeze of such a person can expel about 40,000 TB bacilli in air. However, contrary to the myths, TB does not spread by water, food, by contact by that is shaking hands or by sharing same toothbrush etc…
SYMPTOMS OF TB
Symptoms of pulmonary TB are chills, fever, persistent cough, coughing of blood, loss of appetite, weight loss. Symptoms of are abdominal TB diarrhoea, stomach ache and bleeding from anus.
If above symptoms appear, the person should immediately see a doctor and get all the tests done.
TB TESTS
Sputum smear microscopy: The primary test for TB is the sputum (cough) test. A sputum sample is collected from the patient, microscopy of the sample tells us for the presence or absence of mycobacterium.
Tuberculin Test: Tuberculin is a protein derived from the bacilli. It is injected in small quantity in lower part of the arm. If there is inflammation at the injection site the patient suffers from TB. However false positive results may appear in following cases:
Although new TB screening tests are becoming available, they are generally too expensive for developing countries with respect to its production cost and the availability of highly trained staff. This results in delays in providing patients with the appropriate drug treatment
BCG VACCINE
ALL THE NEWBORN CHILDREN SHOULD BE VACCINATED WITH BCG VACCINE IN INDIA. It is given anytime from birth to first 15 days of life as a part of EPI schedule recommended by the government of India. (Expanded programme on immunization aims at reducing illness ,disability and mortality from childhood diseases, preventable by immunization.
An organization AERAS (It is a nonprofit organization that develops new TB vaccine and distributes it throughout the world) is conducting a clinical trial on vaccine that can replace BCG, since it will be capable of protecting against multi drug resistant (MDR) bacteria. In October 2012 it was announced that in collaboration with GlaxoSmithKline, AERAS will in 2013 begin a phase IIB study in India. It is planned that this vaccine if successful would add to the armamentum of antitubercular treatment.
MDR TB
People suffer from MDR TB due to lack of proper knowledge regarding the disease and this leads to discontinued treatment due to side effects of antitubercular drugs. Hence, it is important that TB patients should be counseled by their doctors regarding the effects of drug. For instance, person receiving rifampicin may have orange tears, sweat, urine. The patient may feel that this is a side effect of the drug and thus withdraw the treatment and hence suffer from MDR TB.
This not only possesses a threat to the patient’s life but such a person may transmit the infection to others who may also suffer from MDR TB. The cost of treating MDR infection increases while life span of the person and success of cure decreases.
LET US ALL PREVENT TB ACTIONS TO BE TAKEN ARE
In order to reduce exposure in households where someone has infectious TB, the following actions should be taken whenever possible:
While smear positive, TB patients should:
DOT: DIRECTLY OBSERVED THERAPY
Well trained people from public health department provide treatment for TB in DOT centres.
In DOT centres, the patient has to take the drug under the supervision of a doctor/nurse. This has following advantages:
TREATMENT REGIMEN
There are 4 categories of TB patients-
Category 1-Sputum positive and patients with extrapulmonary TB. Category 2-Relapsed and interrupted treatment cases.
Category 3-Less severe pulmonary TB.
Category 4-Smear positive cases after completing fully supervised treatment. When a patient is sputum smear test positive the treatment includes first line agents: isoniazid, pyrazinamide, ethambutol, rifampicin and streptomycin for 2-3 months. These drugs have high efficacy and low toxicity. After the sputum test becomes negative, a continuous phase for 6 months with isoniazid and rifampicin is given. The treatment prolongs for a period of 9 months to 1 year.
Second line agents include drugs like ethionamide, moxifloxacin, kanamycin, amikacin, cycloserine, para amino salicylic acid etc.
WHY IS IT DIFFICULT TO CURE TB?
Recent studies indicate that Mycobacteria divide asymmetrically to give daughter cells of different sizes and different susceptibility to antibiotics. The bacteria mutate very fast to develop resistance.
THEREFORE AS THEY SAY”PREVENTION IS BETTER THAN CURE”-SO BY MAINTAINING A HEALTHY LIFESTYLE,BY NOT SPITTING ON ROAD, FOLLOWING RESPIRATORY ETIQUETTES CAN PREVENT TB EPIDEMIC IN INDIA.
THE SURVEY OBJECTIVES
EXPERIMENTAL METHODS
A survey was conducted on 282 individuals taking into account all age groups and class of people. The questionnaire consisted of 12 questions about symptoms of TB, means of its transmission, individuals attitude towards TB patients, DOT centres, preventive measures.
RESULTS
79% people were aware that air exhaled through coughing or sneezing by infected person is responsible for its spread.
51% of people said that a person suffering from TB will try to hide it from others in fear of losing his Job or because people will avoid him/her.
Only 25% of the people were aware that a persistent cough lasting for more than 85% of the people said that they will take care of their relative who is suffering from TB or has completed antiTB therapy without fear of contracting the disease or for earning a bad name in the society.
67% of the people were not aware about the purpose of a BCG vaccine.
53% of the people were not aware about the prevelance of DOT centres.
SUMMARY
Majority of the people who were surveyed had the basic knowledge about TB. However, there were some people who thought that TB can spread by sexual contact or by skin contact and hence the best way is to avoid TB patients. They were told that their notions were incorrect and were enlightened with facts as described in information brochure above. Since almost 50% of the people thought that person suffering from TB will try to hide it from others in fear of losing his job or because people will avoid him/her.
They were told that it is best to reveal their illness and initiate treatment as soon as possible and that family and friends should be supportive to boost confidence in patients and help in their easy recovery. It is good to know that we are willing to help our relatives who may suffer from TB in every which way possible. People had poor knowledge about
DOT centres and BCG vaccine and were educated about the same by students conducting the survey and by providing above information brochure.
Amongst the people being surveyed, 2 TB patients were encountered. It is good to know that they take precautions so that they do not infect others.
We wish them good health and a speedy recovery.
THE DOCTOR SAYS...MDR TB
Definition
Multi drug Resistant (MDR) TB is defined as TB which is resistant to two major anti tuberculosis drugs isoniazid and rifampicin.
Prevalence
About 1 lakh people are diagnosed with MDR TB in India every year.Government and municipal hospital OPDs often encounter 4 to 5 patients of MDR TB in a day.
Causes of MDR TB
In our country where MDR TB and now extreme drug resistant TB (XDR) and Totally drug resistent TB (TDR) are emerging,the cause is more than a natural disaster! Drug resistent bacilli can be due to poor prescription of drugs such as prescibing only 2-3 drugs in a new case or adding only one new drug in a known patient with MDR TB.At times drugs prescibed are not easily available or at times patients do not buy drugs because of poor financial status. Often poor compliance to therapy and inadequate knowledge add on to the burden of drug resistance.
Treatment
Involves the use of aminoglycosides such as streptomycin, amikacin, kanamycin and capreomycin; quinolones such as ciprofloxacin, ofloxacin, moxifloxacin; ethambutol , pyrazinamide, cycloserine, ethionamide and PAS based on culture and sensitivity reports. The regimen normally involves the use of 6 drugs including a quinolone and an aminoglycoside. The aminoglycoside should be continued for 2 months and the duration of the treatment is to continue for 18 months after seroconversion/ negative cultures.
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