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Timely diagnosis of TB and finding a working treatment for the condition is a challenge. Many people drop treatment prematurely due to high economic burden.
Tuberculosis can be considered a silent and forgotten pandemic. As per WHO, about a quarter of the global population is estimated to have been affected by the bacteria (Mycobacterium) that causes the disease. While most people self-clear the infection but 5 to 10 per cent may go on to develop the disease. The disease is both curable and preventable. Unfortunately, the condition remains a significant cause of illness and death.
Just like COVID-19 (which is caused by a virus), TB also primarily affects the lungs (however, it is caused by bacteria). Both diseases are passed primarily through aerosols when infected people might cough and the germs get into the surrounding air and are inhaled by other people. The trajectory of the two diseases however differs significantly. TB unlike COVID-19 is not extremely contagious and gets hardly gets transmitted in fleeting contact. However, it also doesn’t mean that the disease cannot be passed from one person to another. Early detection and diagnosis of drug-sensitive and drug-resistant tuberculosis are essential for disease control. However, diagnosis of TB and finding a working treatment for the condition is a long journey.
TB unlike COVID-19 takes a long window between a person getting infected and the symptoms showing up. The infection can stay in the body dormant for years before the person starts feeling unwell. Due to the delayed emergence of symptoms and firm diagnosis, the person cannot be isolated from the family and might infect others in the family.
Another blockage on the road to recovery is the time required for treatment which crosses over a year. In the process, many people might change treatments, and abandon older medicines prematurely, thus leading to the emergence of drug-resistant strains. Also, the economic burden of the disease is also worrisome for many. Regular travels to the city, routine visits to clinics and medicine costs might make people abandon or fail treatment and eventually die. Lack of awareness of the disease can also lead to people overlooking symptoms and can fasten the progression of the disease to a stage from which the damage can’t be reversed.
A persistent cough must raise brows, says expert
Our knowledge of Tuberculosis is also evolving with time. Today researchers know that mycobacteria divide asymmetrically, generating a population of cells that might be growing at different rates, have different sizes and might also differ in their response to antibiotics. It means that is possible that there might be no universal treatment for the condition that can be applied to everyone.
Also, the BCG vaccine is a live vaccine and can’t be given to people with compromised immunity such as those having HIV. As per studies, the protective effects of the vaccine also wane with time. It might not be effective in protecting adults from active infection.
So, early detection of the symptoms and a quick course of action is the most effective way in our battle against the disease.
Dr Avi Kumar, senior consultant, Pulmonology at Fortis Escorts (Okhla, New Delhi) informed that a cough that persists for more than 3 weeks must be taken seriously. He said that people must understand that the effects of the disease are not limited to the lungs alone.
Dr Kumar said: “TB generally spreads through particulate material. If one cough or sneezes the particulate material spreads in the air and can spread to another person. It’s very important to prevent TB by having educated respiratory etiquette. The most common symptoms in TB patients are cough with sputum production, fever, weight loss, decreased oral intake, and blood in sputum. If the cough persists for more than 3 weeks, one must try to undergo a TB test. It can affect the brain, lungs, pleura, heart, pericardium, intestine, kidneys, or joints and can affect many organs.”
When TB might be progressing beyond the lungs, it can manifest symptoms like swollen lymph nodes, abdominal pain, joint pain, persistent headaches and even seizures in some cases.
Diagnosis of Tuberculosis
Interestingly, a person can test positive for TB even when the infection might be latent. So, sometimes the blood tests can also be confusing. However, people who might know that they have been staying or working with people who have a history of TB or are in an environment where TB might be present must show extra vigilance. A doctor might also pick up signs by listening to their lungs or observing swollen lymph nodes. Generally, a sputum test and an X-ray are often recommended on suspicion.
Dr Kumar informed about the ways the condition can be diagnosed.
He said: “The most common diagnosis is microscopy, ZN staining to detect the bacteria. Fluorescent microscopy is also being used to detect AFB bacterium. There is a radiological diagnosis in the form of an X-ray or CT scan where we can easily detect the lesions. There are advanced tests in the form of bronchoscopy where the patient is not producing any sputum, and we can go inside the lungs and a respiratory sample can be taken for examination, culture tests can also be done which is the goal standard of diagnosis for drug-resistant tuberculosis. These days multi-drug resistance or XDR TB is on the rise.”
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