The World TB Day is celebrated on March 24 to raise public awareness about the killer epidemic tuberculosis. It commemorates the discovery of mycobacterium tuberculosis, the causative organism by Robert Koch in 1882. It is a disease affecting most commonly the lungs; but spares no organ except dead tissues like nails and hair. Estimates reveal around one-third of the world population is infected with mycobacterium and 4,000 die of the disease every day.
The theme for the World TB Day 2016 is ‘Unite to end TB. let’s join our hands in the fight against this common enemy of mankind.’
Mycobacterium spreads from the lungs into air when the diseased person coughs or spits. Bacillus gets entry into healthy persons when they inhale this air. One patient can infect 10-15 persons during a year.
Entry of mycobacterium into our body does not always result in disease because our immune system tries to arrest the progression of bacillus and to kill it.
The risk factors that increase the probability of progression to disease include infection with HIV and/or Hepatitis-B virus, diabetes, silicosis, smoking, alcohol, immunosuppression, steroid usage, transplant recipient along with close contacts of a patient who excretes the bacilli in sputum.
A TB suspect is a person having more than two weeks of cough with or without constitutional symptoms like fever, weight loss, hemoptysis (coughing out of blood) or chest pain.
Co-existing illnesses like liver disease, diabetes, kidney disease, sickle cell disease, seizure and HIV affect management and should be considered.
Diagnosis of TB in lungs (Pulmonary Tuberculosis) is mostly by sputum smear examination for AFB (Acid Fast Bacillus) by lED Microscopy from two samples collected on the spot and in morning. This test is done free of cost in DMCs (Designated Microscopy Centres) throughout the country under RNTCP programme every day except Sunday. Our Department of Pulmonary Medicine at SCBMCH has one DMC.
HIV testing at ICTC Centre is mandatory for TB patients and is done free of cost. Diagnosis of tuberculosis outside lungs i.e. extra pulmonary disease is a bit cumbersome resting on symptoms, suspicion, cytology and histopathology.
Revised National Tubercluosis Programme (RNTCP) is the umbrella programme for tuberculosis control in India implemented in 1997 based on the WHO recommended strategy of Directly Observed Treatment, Short Course (DOTS).
Treatment of tuberculosis under RNTCP is divided into two categories ie Category-I and Category-II, for a period of six months and eight months respectively, which is directly supervised by ASHAs and Anganwadi workers.
Under RNTCP DOTS is available free of cost in all designated health centres. Drugs is administered thrice weekly on alternate days (Monday, Wednesday, Friday) thoroughly supervised.
Patient is to consume anti-tubercular drugs preferably one hour after breakfast in the morning with half glass of water. Ideally the drugs should not be swallowed all at a time; but is to be taken one after another over 20 minutes. He/ she should be instructed not to consume food for two hours following intake of anti-tubercular drugs. Thereafter patient should consume 12-15 glasses of water in 24 hours for easy excretion of toxic products generated from medicine. Urine turns orange to red colour as a side-effect. But it is completely harmless and reversible. Patient should be reassured not to discontinue the drug. Sputum is to be re-examined at two months and six months. HIV positive patients should be counselled properly regarding infection, prophylaxis and resistance to drugs. ART (Antiretroviral Therapy) should be initiated as early as possible irrespective of CD4 count. Daily regimen of anti-tubercular drugs is preferred in these cases. Duration of treatment is same unless otherwise indicated.
Prevention of Transmission: Maintenance of meticulous cough etiquette, , use of facemask and proper hand hygiene serve to break the chain of transmission, thereby preventing the disease. Sputum being the main source of infection should not be spitted here and there; rather should be collected in a closed container, properly treated with disinfectants and then disposed of (ideally buried).
Pregnancy: First line drugs are safe in pregnancy except streptomycin and pregnancy should not be a contraindication/obstacle in initiating anti-tubercular therapy (ATT).
Breast feeding is safe. It can be done before morning dose of ATT. But some milk should be expressed before ATT intake and this expressed breast milk should be given to the child afterwards to minimize passage of drugs from mother to child via breast milk.
Extra Pulmonary TB at times requires an extended period of treatment e.g. in TB spine ATT is administered for 9-12 months. With the emergence of drug resistant TB (Multi drug resistant OR MDR TB and extensively drug resistant OR XDR TB) it is need of the hour to create awareness among public regarding various aspects like diagnosis, laboratory facilities and management. Diagnosis of MDR and XDR TB hinges on laboratory tests (CB-NAAT, lPA, liquid Culture and Solid Culture) done on sputum samples in the neighbouring Intermediate Reference laboratory (ATD and TC), Cuttack.
(Dr Mohanty is Associate Professor, Dept. of Pulmonary Medicine, SCB MCH Cuttack & Nodal Officer, RNTCP).