Tuberculosis

Stalked by TB http://www.telegraphindia.com/1140630/jsp/knowhow/story_18564453.jsp#.U7fQGI2Sx2A

Your Health DR GITA MATHAI

Tuberculosis (TB) is an insidious disease that creeps up on an unwary person. The symptoms are vague — just a feeling of being exhausted and low-grade fever. “Night sweats” can occur, with the person waking up at night drenched in sweat, but in these days of power outages that can be explained away! Even a persistent hacking cough and gradual but perceptible weight loss are such vague symptoms that they are ignored. Eventually, as the disease progresses and sputum becomes blood stained, a physician is consulted. The bacteria that causes TB (mycobacterium tuberculosis) is a very slow growing organism that can hide in the human body without causing disease (latent tuberculosis). The person may never develop the disease (or pass it on) or TB may rear its head if the body’s immune system is ever compromised. Typically, we connect a hacking cough with blood-stained sputum to TB but it takes a long time for the disease to progress to this level. Also, the disease can manifest itself anywhere in the body — the covering of the brain, the heart, eyes, ears, throat, bones, urinary tract, any of the abdominal or pelvic organs or the reproductive system in males and females — and not only in the lungs. If left untreated, it can cause complications such as paralysis, coma, heart failure, intestinal obstruction and sterility. TB spreads through breathing in or swallowing the air-borne bacteria. So only if a person has lung TB does the infection spread. If such a patient is left untreated, he or she can infect 10 people in a year. Children suffer from a form of the disease called “primary complex” which is non infective. India (closely followed by China) has the highest number of persons with TB. The World Health Organization estimates that 3.1 million people have the disease while it is latent in 4 per cent of the population. They can either remain in that state or progress to active disease. Our body’s immune system attacks the tuberculosis bacteria and prevents progression of the disease. If immunity is compromised — as can occur in diabetes, cancer, medications (steroids), organ transplantation with follow up immunosuppressant medication, HIV infection, long-term regular alcohol or tobacco use — the risk of developing the disease increases. It spreads when there is overcrowding and lack of ventilation and fresh air. Diagnosis of tuberculosis is easy if the bacteria is found in the sputum or body fluids. Otherwise, based on the symptoms, a series of diagnostic tests, skin tests, blood tests, X-rays and scans have to be done to establish the diagnosis. The good news about TB is that it is treatable. The government provides the medication for free. It places patients on a supervised programme called DOTS where the medication is administered by a government health care worker. The medicines can also be purchased with a prescription. A combination of drugs has to be used for six months or longer. The medicine has to be taken daily, regularly and never “forgotten.” For maximum effectiveness, one of the drugs, rifampicin, needs to be taken on an empty stomach. The medication can produce side effects such as nausea, vision disturbances, photosensitivity and tingling of the hands and feet. These can be tackled effectively if reported immediately. If medication is taken irregularly, discontinued or “stopped and restarted” there is a high possibility of the bacteria becoming resistant to the medicine. This MDR (multi drug resistant) tuberculosis requires prolonged treatment with powerful, expensive medication. It is better to take the medicine properly the first time around. Scientists are working on a vaccine to prevent TB. The BCG (Bacille Calmette-Guerin) vaccine available now is administered to all children at birth, free of cost, by the government. It was developed to prevent the spread of tuberculosis but is only partially effective. It does prevent progression to serious life-threatening forms of the disease. A healthy lifestyle with nutritious food, a well-ventilated home or working environment, avoiding tobacco and alcohol and exercising regularly in the fresh air will go a long way to maintaining a healthy immune system and preventing disease. 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