In 19th Century, King George V asked “If preventable why not prevented”, when informed that Tuberculosis is a preventable disease. In 21st century, the question still remains unanswered. The impact in terms of death and disability it causes worldwide is significant. Sample this:
- Globally, 8.8 million infected with Tuberculosis and 1.2 million deaths in 2010,
- Over 95% of deaths occur in low and middle income countries
- Every 3rd person in world carries the infection with him/her. The risk of developing active TB is 10 % but increases if immunity is compromised due to Diabetes, HIV, or smoking .
(Source : WHO factsheet-2010)
The good news is that deaths due to this disease came down 40 % between 1990-2010 .The bad news is that the spectre of drug resistant tuberculosis is looming large. Drug resistant Tuberculosis is one which does not respond to standard anti tuberculosis treatment.
How is it caused?
The basic cause is inappropriate treatment or inadequate doses. The spread is through air. A drug resistant TB patient sneezing, coughing or spitting, releases the organisms, and anyone in vicinity can get infected. The risks in our environment with national penchant of spitting everywhere can well be imagined. Unlike Flu or viral diseases it does not spread so fast, and spread depends upon time spent with patient, own immunity, ventilation and circulation of air.
How does one suspect that he may be infected?
Usually Lungs are affected. However, germs can also be found in Kidney, Bones, Spine, Skin, Intestine or may affect number of organs, called miliary tuberculosis. Chronic unexplained fever with evening rise of temperature, chronic cough, blood in cough, pain in chest, weakness tiredness, losing appetite, losing weight without working on it or the symptoms concerning the affected organ, you should suspect TB.
Drug resistant TB may be suspected if:
- After diagnosis and treatment , patient does not improve
- Patient develops TB again after being treated
- History of inadequate treatment in past.
Treatment of Drug resistant Tuberculosis:
Treatment consists of second line drugs. However they have more risk of adverse effects, may be costly, and sometimes may not be easily available. The disease which does not respond to even these drugs is called Extreme drug resistant tuberculosis(XDR TB), and requires expert care in specialised institution.