According to the World Health Organization (WHO), tuberculosis or TB is among the most dangerous and infectious diseases worldwide, ranking alongside HIV/AIDS as a cause for death. In observance of World TB Day 2019 with the theme ‘It’s Time’ today, March 24, NT BUZZ reports on TB within the state
RAMANDEEP KAUR | NT BUZZ
Tuberculosis is a global problem and approximately 2.8 million TB cases occur every year in India. In Goa there are around 2000 cases annually. Last year 2118 cases were registered in Goa, of which 1569 cases in the government sector and 549 in private sector were diagnosed and notified under Nikshay, a tuberculosis control programme. Every case irrespective of the sector has to be notified under Nikshay for the central government to know about the incidence of TB cases in India.
Tuberculosis is an infectious disease caused by bacterium called mycobacterium tuberculosis that spreads from human to human – when a TB patient coughs or speaks, bacteria is spread in the environment. Those in close contact with infected individuals over long periods of time may get tuberculosis. Associate professor in Pulmonary Medicine and nodal officer for tuberculosis in Goa Medical College, Bambolim, Sanjivani Keny says the patient has to be diagnosed and treated as soon as possible so that he/she does not spread the disease to others, adding that if left untreated the patient can go on to spread the disease to another 10 to 12 individuals in a year. Hence, it is very important to diagnose the cases early and start treating them.
TB can affect many organs and the common organ that is affected are the lungs. Other parts that are affected include the liver, intestines, brain, bones, and kidneys.
There are a lot of tests available to diagnose TB. First the patient’s sputum is examined under the microscope to see if it contains TB bacteria. Keny says that if they cannot see any TB bacteria under the microscope they perform a molecular test which is the latest test also called as CB-NAAT test. The test provides instant results and additional information on whether the patient has drug sensitive TB or drug resistant TB. “Within two hours we get to know whether the person will need normal treatment or other drugs to be treated,” adds Keny.
Types of tuberculosis (TB)
Tuberculosis can be called as pulmonary TB and extra pulmonary TB (wherein it affects organs other than the lungs). Keny informs that as per the treatment they offer, “there are patients who sometimes respond to drug sensitive TB. Also there is drug resistant TB which means the patients do not respond to normal drugs. Thus, they have to be treated with other drugs and for a longer period of time.”
Initial symptoms are mainly cough, fever, loss of appetite, loss of weight, and sometimes coughing out blood sputum.
In case of an infectious case health professionals wear masks and provide patients with the same to avoid spreading the bacillus when they cough. “In the early stage we give patients masks to wear at home,” says Keny.
TB stigma and myths
Keny says the stigma has reduced to a large extent as members of the affluent society are getting affected with tuberculosis. “The stigma is decreasing but it is not totally gone. It is still there amongst women who take a lot of time to come for treatment. They think they will be thrown out of the house if they come forward,” adds Keny.
People believe TB is not curable or that they may end up with other debilitating illnesses. However, Keny says there is nothing as such and explains: “The earlier the diagnosis, the higher the chances of being cured. If one does not seek treatment early then complications may start developing and then it becomes difficult to cure. Once the person is diagnosed, he/she is put on treatment and within a short period of time, about four to six weeks, the patient becomes non-infectious and there are no chances of spreading the disease.”
How people react when they know they have TB
When you get to know you’re suffering from any disease, it is obviously depressing and one takes time to accept it. Similarly, Keny shares that initially TB patients take it very negatively and so they are counselled as nowadays TB can be treated within a short period of time if the patient takes treatment regularly. The drugs are available and are free of cost. She says: “All the diagnosis is free of cost. If they take the treatment regularly for a period of six months there are high chances that they will get cured. Once we tell them these things, they start taking the treatment properly. However, they require psychosocial support, the family members have to be told about the treatment and they also need to be counselled.”
Cold does not develop into TB
Cough does not cause TB. The TB bacillus enters our lungs when we breathe or when we come in contact with a patient. If one’s immunity is compromised, for example: if one has uncontrolled diabetes or is an HIV patient, if the person is malnourished or suffering from any other diseases like cancer there are higher chances of getting TB.
There is a 7 per cent chance of a TB relapse.
It is usually adults and young adults who are the most affected and as Keny informs they are bread winners of the family. She says: “The family has to suffer because TB patients are the earning members. Young men are more likely to get TB. In a country like ours, the diabetic population is also increasing and they are prone to TB.”
TB incidences are decreasing annually by 2 per cent. In our country, incidences are gradually decreasing, even the mortality in our country is reducing. Keny says the reason for this is because of the Revised National Tuberculosis Control Program. She adds: “Earlier every patient had to come on their own to the hospital but now we are trying to go to the periphery to find out where these TB patients are. We are actively looking for cases. Doctors and health workers go to remote areas to enquire about individuals and symptoms.”
She further informs that they also hold medical drives where there are no health facilities. “In the past there was a shortage of drugs but that has been solved. Once the patient is diagnosed, a full course of treatment is kept aside right from day one so that there is no shortage of medicine,” says Keny.
Directly observed treatment (DOT) or supervision of treatment is carried out to ensure patients take their medicines. Each patient has a treatment supporter to supervise his/her treatment.
The duration of treatment has also decreased. TB treatment used to go on for a year but now with regular medication one can be cured within six months. Keny says: “TB incidences are reducing and mortality is reducing because of the total change in the programme strategy.”
No more TB sanatorium concept
Only patients with severe complications like coughing out blood or breathlessness are admitted. Diabetic patients with very high levels are admitted for a few days and are then discharged. “TB sanatorium treatment is not recommended as there is no difference in keeping the patient in the sanatorium or at home. Thus, we don’t keep them in the hospital, we give them medicines to take home so they can spend time with their family,” says Keny.
She adds that patients stick to the treatment when they are surrounded by their family. They can even go back to work within a month and half as they are non-infectious.