Tuberculosis

TB (Tuberculosis) is as dangerous as HIV and one of the leading cause of death worldwide Even though there are impressive efforts by WHO (World Health Organization), in 2014 around 96 lakh people fell ill with TB and from that 15 lakh lost their lives. In India alone, there were around 19 lakh cases of TB reported in 2014.

TB (Tuberculosis)

TB is an infectious disease caused by pathogenic bacteria, Mycobacterium tuberculosis which affects respiratory system of human being by infecting their lungs. There can be two form of TB disease

:

a)   Latent TB: This is an asymptomatic TB (where you don’t see prominent disease symptoms) in which you are infected with bacterium, however your body’s immune system keeps a strong check and doesn’t let the TB bacteria grow. This state has no symptoms of disease and is also non-infectious. However, they are at constant risk to re-activation of disease and can fall ill

b)   Active TB: This is contagious and symptomatic state which might occur several weeks later than after first infection. At this stage, you are at risk of spreading disease via coughing and sneezing. You get symptoms like intense coughing, rapid weight loss, fever, night sweats, loss of appetite, etc.

A person with weaker immune system is more prone to catch the disease as body doesn’t fight back the TB bacterial infection. Therefore, people with HIV infection possess higher risk of developing active TB (e.g. out of 96 lakh TB cases, around 12 lakh were carrying HIV) and it is a leading cause of death in HIV-positive people. It also has been reported that people with diabetes, malnutrition and tobacco-addiction are in high risk category of developing active TB.

Diagnosis and medication

Primary diagnosis includes physical examination, skin test (tuberculin) and blood test.  Further, chest X-ray, sputum test and other blood-related advance test can also be performed to check the TB and its state. Importantly, it is also necessary to conduct drug-resistance test in order prescribe proper medication. Treatment of TB includes intensive administration of isoniazid, rifampicin, pyrazinamide and ethambutol followed by mild-administration of isoniazid and rifampicin for four months.

Although due to continuous efforts by WHO, TB incidence rate is falling at 1.5 % each year since 2000, situation still far from under control. One of the main reason which impairs the disease control is drug-resistance.

MDR-TB (Multi-drug related tuberculosis):- A big concern

The pervasive development of antibiotic resistance is a major concern in the treatment of TB. This happens because TB bacteria becomes un-responsive against multiple drugs (MDR-TB), and therefore patients cannot be treated effectively which ultimately leads to their death. According to the WHO, in 2014 around 4.8 lakh people developed TB which doesn’t respond to rifampicin and isoniazid (most powerful first-line drugs for TB treatment). Though in such cases, TB can be tackled using second line drugs (e.g. fluoroquinolones, kanamycin, amikacin), however in some cases, TB bacteria is even get resistant to these drugs and develop

XDR-TB (extensively drug-resistant tuberculosis) which puts these patients under high-risk group and they are difficult to treat.

There are several reasons which leads to such high resistance and a general awareness can help to prevent  developing such high resistance against drugs. One of the main reason is not taking the full-course of drugs. A lot of people have habit of stop taking drugs as soon as they feel slightly better, even though doctors have prescribed full-course. This allows bacteria grow again in body and slowly they become resistant against the drugs. Another reason is self-medication and wrong-doing of drug stores to prescribe drugs without even concerning doctors. This leads to the use of improper, bad quality and wrong drugs which might not be effective against the disease and which allow bacteria to become resistant to the drug.

Since TB is an infectious disease, by not taking proper and prescribed medication people not only affect themselves but also contributes in spreading such resistant forms of TB in the society. Therefore more awareness about TB and drug-resistance is required for the better treatment and stopping the spread of disease.

Dr. Sandeep Ameta, PhD,

Senior Research Scientist,

ESPCI ParisTech,

10 rue Vauquelin,

75005, Paris, France

ametasandeep@yahoo.com

sandeep.espci@yahoo.com

References:

1.        Global tuberculosis report 2015, World Health Organization (WHO) (http://www.who.int/tb/publications/global_report/en/)

2.        Centers for Disease Control and Prevention Division of Tuberculosis 
(http://www.cdc.gov/tb/topic/default.htm)

3.        Zumla et al., Current concepts Tuberculosis, 368, 2013, The New England Journal of Medicine.

4.        WHO guidelines on tuberculosis (http://www.who.int/publications/guidelines/

Tuberculosis/en/)

5.        WHO: Drug resistant TB (http://www.who.int/tb/areas-of-work/drug-resistant-tb/en/)