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Submitted by PatientsEngage on 24 March 2018
Image: WHO End TB campaign WorldTBDay2018

With nearly 5 lakh Indians dying of tuberculosis every year, India is labeled the Tuberculosis capital of the world. Dr Shet Masih, molecular biologist with Core Diagnostics, says that the best way to prevent contracting this life-threatening disease is to avoid unhygienic, congested areas and lead an active lifestyle.   

Efforts are being made to make India Tuberculosis (TB)-free in the near future, and yet there’s been an increase in the number of TB patients recently. Why is that so, according to you?

According to the 2017 Annual Status Report of the Revised National Tuberculosis Control Programme under the Ministry of Health and Family Welfare, incidents of TB were estimated at 28 lakh by the end of 2016 while the mortality was reported as 4.8 lakh. At the same time, HIV and TB co-infected combination patients were reckoned at 1.1 lakh and multi-drug-resistant-TB (MDR–TB) at 1.3 lakh. However, there has been some noted decrease in TB incidence since 2015.

There is no doubt that drug resistant strains of Mycobacterium Tuberculosis Complex (MTCB) are proliferating all over the world. This might be due to any of the plethora of factors or a combination of factors including under-supervised treatment and self-medication that leads to incorrect dosages.

What are the symptoms of TB one should watch out for?

Tuberculosis is a debilitating disease caused by one of the several pathogens classified as Mycobacterium Tuberculosis Complex (MTBC) and typically affects the lungs and immune system in our body. If left unchecked and untreated, the infection can spread to the brain and spinal cord.

Tuberculosis also has a latent form, the condition in which the disease will not manifest itself outwardly with visible symptoms such as cough that lasts longer than 3 weeks, chest pain or cough with blood and sputum. Other symptoms include weight loss, fever, fatigue, weakness, night chills or undue sweating and so on. The disease reaches other hosts through breathing in the vicinity of the air exhaled by a carrier. Alcoholics, those suffering from diseases that affect the immune system such as HIV/AIDS and narcotic dependents are at greater risk of contracting active TB.

How severe can TB get and what are some of the dangerous signs that one should watch out for?

Those with latent TB do not display any outward symptoms, don’t feel of sick and do not spread the disease, but they might be positive for PPD skin test. Those with active infection are usually affected by pulmonary TB, i.e. the pathogen affects the lungs of the host by attaching itself to the alveolar surface. From the lungs, the bacteria may travel through the bloodstream and spread to other organs. They multiply quickly in organs that maintain high oxygen pressures such as the lungs, kidneys, bone marrow and the meninges. Although a large proportion of people are able to fight off the infection with medication and treatment, those with weakened immune systems will succumb to it. If TB is not treated appropriately, it can be fatal.

What is the treatment procedure for TB?

The treatment for Tuberculosis entails a prescribed course of medication. You are unlikely to be admitted to a hospital or be advised extensive bed rest but the medication and advise must be duly followed for 6 to 9 months.

The treatment takes this long because the disease-causing bacteria (MTB) grow and die very slowly. A combination of multiple drugs may be used to reduce the resistance of this bacterial strain.

What are the tests one should get done for detecting TB? How frequently should these tests be done?

Conventionally, TB diagnosis involves a simple physical examination with a stethoscope where pulmonary rhythms and lymph-node swellings are screened for the presence of infection. Infection is confirmed by chest X-rays and/ or CT scans, followed by sputum samples for microscopic study and breeding of bacterial culture to identify the strain as all antibiotics cannot work on every strain.

The commonly conducted Mantoux skin test involves injecting the person with PPD tuberculin in the forearm. If the spot swells to a circumference after 48 to 72 hours, then the person is assumed to have TB. Some Nucleic Acid Amplification tests (PCR/Real-Time PCR), which can identify small amounts of RNA or DNA of the pathogen (TB) in test samples of body fluid are a good indicator of positive TB infection.

Another test available is the QuantiFERON Assay–TB Gold Test. Doctors incubate the patient’s blood with antigenic proteins from TB bacteria. The cells of immune system respond with the production of a substance called IFN-gamma which can be identified and quantified by the procedure.

Increasingly modern molecular diagnostic techniques and statistical disease stratification are being employed to pinpoint incidents of TB and strains with precision and accuracy. Clinical Pathological laboratories such as CORE Diagnostics are pushing the boundaries of genetic techniques to identify risks and supporting to meet the most probable treatment line to combat the virulent pathogen strains.

What are the measures you can take to prevent the onset of TB?

Maintaining basic hygiene, avoiding crowded places, avoiding alcohol, smoking and leading an active lifestyle are excellent ways to stay healthy and avoid any disease. Tuberculosis (TB) bacteria spread through inhaling the air around a person who has the disease, latent or active, be it through a cough or sneeze.

How do you lower the risk factor of contracting TB?

TB bacteria spread in unhygienic surroundings, therefore, crowded places of work and residence increase the chances of TB infection. Municipalities and governments must ensure cleanliness to be maintained in both residential and official localities. Policy initiatives must be addressed actively to reduce the stress on urban centers which lead to people living in congested and unhygienic conditions

Healthcare practitioners can assist by contributing to Universal Health Care access through proper pricing and facilitating availability of services. Only a concerted effort by both healthcare policy makers and medical professionals will be able to complete the TB eradication programme of India by 2025. 

Dr. Shet Masih is a Molecular Biologist with CORE Diagnostics. He has completed his M.Sc. Biotechnology from Punjab University, Chandigarh and Ph.D in Molecular Immunology from PGIMER, Chandigarh. He completed his postdoctoral fellowship from Harvard University, MA, USA and Drexel University, PA, USA. His main areas of interest are Molecular Diagnostics, Vaccines and Immunotherapy for Cancers, Infectious Diseases and Genetic disorders.