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TB spreads through the air. Only lung TB is infectious.
People with extra-pulmonary TB are not infectious to others
Children with TB do not spread it to their contacts
TB is curable with adequate treatment and patient compliance |
Tuberculosis can be described as “the great deceiver,” confounding doctors and patients alike. It appears so slowly and insidiously that the patient is often unable to pinpoint the exact time and date the illness started. The symptoms may be non-specific — a vague feeling of being unwell, tiredness, fatigue, aches and pains, a rise in temperature in the evening, sweating in the night and occasional chills. Symptoms may be present for weeks before the patient or the doctor realises that something is wrong.
When we think of TB patients, we visualise an emaciated — possibly poor — person who coughs up blood. This image is, however, far from the truth. Although TB most commonly occurs in the lungs, it can also affect other organs such as lymphnodes, covering of the heart, bones, brain and spinal cord, urinary tract, abdomen, reproductive system and even the eye.
Only “open” cases of TB transmit the infection, that is, patients who cough or spit out sputum containing TB bacteria. Anyone who inhales the bacteria may get infected. About 40 per cent of the Indian population carries the TB bacteria but not all of them manifest the disease. Once the person’s resistance is compromised, the disease can flare up. Although the initial infection is in the lung, it can spread via the blood to any organ in the body and produce an infection there. Sometimes, particularly in children or immunodeficient individuals, it can produce an explosive illness — a “military spread” that affects all the organs in the body.
TB is more likely in children, those aged between 14 and 20, and the elderly. The risk increases if the person also has cancer and is undergoing treatment for it, has silicosis (an occupational disease affecting people who work in quartz, granite or silica mines) or diabetes, liver or kidney failure, is on steroids or has HIV.
Overcrowding, lack of ventilation and using a wood fire increases the risk. Overcrowding means a person with open tuberculosis has a greater chance of infecting family and neighbours.
Smoking beedis or cigarettes is an independent risk factor. It has been linked to 50 per cent of TB cases in India. Despite treatment, smokers tend to have a higher mortality. The same is true of alcoholics, particularly if liver function is compromised.
Most of the initial exposure to TB occurs in childhood. In an attempt to prevent this, the government administers BCG (Bacilli Calmette-Guerin) immunisation to all children soon after birth. The vaccine does not prevent TB, but it does reduce the severity of the disease, and also prevents TB meningitis (in the brain).
Once the disease has been diagnosed, treatment has to be adhered to. Medication has to be taken regularly and systematically for periods ranging from six months to a year. Usually, a combination of three to four drugs is used. Of them, rifampicin has to be taken on an empty stomach to have maximum effect. It can cause sunlight sensitivity so patients must use sunscreen. Ethambutol can cause blurred vision, painful red eyes and red-green colour blindness. Pyridoxine (a B complex vitamin) needs to be concurrently taken to prevent INAH (isoniazide)-induced nerve toxicity.
The government provides free TB treatment through primary health care settings and non governmental orgnisations. They usually administer DOTS (Directly Observed Tuberculosis treatment Short course). The drugs are administered under supervision to the patient every alternate day. Some schemes give the patient a week or a month’s treatment in hand. The schemes have drawbacks. The distribution site may be inconveniently located, timings of the centre may be inconvenient for working people, strikes and government holidays may interfere with its efficiency. Many people do not know that anti-TB medication can be purchased from private pharmacies with a prescription.
A few weeks after treatment is started, the symptoms disappear and the patient feels better. Unfortunately, at this time many discontinue treatment. Strict adherence to treatment usually results in a cure. Failure to do so can result in relapses or recurrences. These can be expensive, difficult to treat or fatal, as the organism may have developed multi drug resistance.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
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