Tuberculosis in Today’s Society

Tuberculosis (TB) is an old but familiar foe to mankind, ranking second to HIV as the infective cause leading to the most number of deaths. Tuberculosis (TB) is an infectious disease caused by the bacillus Mycobacterium tuberculosis. It primarily affects the lungs (pulmonary TB) but can affect other sites as well (extra-pulmonary TB). It is transmitted from person to person by transmission of airborne droplet nuclei. The statistical figures of infectivity and subsequent disease progression has remained unaltered over a period of decades inspite of developments of newer diagnostic and therapeutic modalities. The disease is still looming large in view of emerging drug-resistant strains due to poor handling and inadequate treatment. Moreover increased longevity, chronic diseases, increasing incidence of diabetes mellitus, more use of immunosuppressive drugs and organ transplantation has changed the spectrum of this disease.

About 30% of the world’s population has latent TB, which means people have been infected by TB bacteria but are not symptomatic with disease and cannot transmit the disease to others. People infected with TB bacteria have a lifetime risk of developing TB disease in about 10 %. However, people with compromised immune systems, have a much higher risk of developing symptoms. Tuberculosis mostly affects young adults, in their most productive years. However, all age groups are at risk. Over 95% of cases and deaths are in developing countries in view of overcrowding and multiple other factors. People who are co-infected with HIV and TB are 21 to 34 times more likely to become sick with TB.

According to WHO, each year an estimated 9.4 million new cases of TB are detected leading to nearly 2 million deaths. In India, the numbers of TB patients are 1.96 million per year, and among them, 0.8 million are new smear-positive cases comprising of 75 new sputum smear-positive cases per lakh annually with 0.33 million deaths per year. There is a rising trend of drug-resistant TB in different parts of the world, India being next only to China, both contributing more than 50% of global multidrug-resistant (MDR-TB) cases. The frequency of Multidrug-resistant TB (MDR-TB) is less than 3.6% in new cases and 12% to 20% among re-treatment cases as per recent studies.

In Venkateshwar Hospitals, Diagnosis of TB has evolved rapidly over the years. Sputum microscopy still holds its place as a screening tool, followed by radiological support and the ever-evolving molecular diagnostic tests which help in identification and detection of resistance simultaneously.

The management of TB includes holistic approach including early diagnosis, formulating an effective drug regimen (Anti Tubercular Therapy, ATT) according to the weight and resistance pattern of the patient and timely follow up. Since years RNTCP (Revised National Tuberculosis Control Programme) has a methodological approach in all aspects of tuberculosis. DOTS (Directly Observed Treatment Short course) played a huge role in tackling the disease over the past few decades. However more aggressive approach with more funding is needed to contain this disease.

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