Tuberculosis is one of the oldest human diseases; its history is as old as mankind. TB has been a major cause of suffering and death, with enormous social and economic implications. It is a major public health problem in India and is the most common cause of death due to a single infectious agent in adults.

It has been estimated that one person in the world is newly infected with TB every second. Nearly one percent of the world population is infected with TB every year, and overall one-third of the world population is infected with TB. For women, it is one cause of death.

Tuberculosis is a bacterial infection caused by Mycobacterium tuberculosis. The disease usually affects the lungs, but can spread to other parts of the body in serious cases. An individual can become infected with TB when another person who has active TB coughs, sneezes, or spits. Not all people who get infected with TB develop symptoms. Those who do not become ill have latent TB and cannot spread the disease to others.

Mostly it is silent disease & can infect any organ.

HIV-POSITIVE individuals have a very high risk of developing active TB (30%) as compared to HIV-negative persons (5-10%). DIABETICS AND IMMUNOCOMPROMISED PATIENTS also frequently develop pulmonary TB. THIS DISEASE KILLS MORE YOUTH THAN ANY OTHER INFECTIOUS DISEASE – IT KILLS NEARLY 1 LAKH CHILDREN EVERY YEAR.

Decades ago, it was mandatory to admit a TB patient in a sanatorium for up to a year. Patients were confined to bed in airy, well-ventilated, clean wards. Later, the Madras study proved that sanatorium treatment was in no way superior to home (or domiciliary) treatment.

TB is curable only with combination chemotherapy, in which anti-tubercular drugs (ATT) are administered together. The first-line ATT drugs are – Isoniazid, Rifampicin, Ethambutol, Pyrazinamide, and Streptomycin. The treatment is streamlined over a period of 6 months – the patient receives 4 drugs during the first 2 months; and 2 drugs for the next 4 months; depending on his clinical improvement. In rare cases (eg spinal TB or TB meningitis), the treatment is extended for up to 9 months or a year.

DOTS (Directly Observed Treatment Short-course) is being followed in India and all over the world; it has been very effective in controlling the spread of TB. Under this scheme, the government provides free ATT to all TB patients in the country; irrespective of their age, socio-economic status, or type of TB.

The patient falls under one of the following categories –

• Category A is smear-positive Pulmonary TB
• Category B is smear-negative but X-ray positive pulmonary TB
• Category C includes extra-pulmonary cases.

The patient has to report to the primary health centre thrice a week (on alternate days), and swallows his medicines in the presence of the social worker. In case he defaults, the workers trace him and sometimes even visit his residence to motivate him to stick to the treatment regimen. The DOTS strategy is known as the Revised National TB Control Program(RNTCP) in India.

Surgery is indicated in MDR-TB for removal of a diseased lobe (lobectomy) or a destroyed lung (pneumonectomy). The aim of surgery in TB is to remove all the disease-bearing lung tissue, preserving as much normal lung tissue as possible. Patients with persistent cavities (despite medical management) are ideal candidates for surgical resection.

Newborns receive BCG vaccine; which may protect against TB in infancy. However, it does not prevent adult TB or primary complex in older children. Hence, all close contacts of a TB patient must be screened and given INH prophylaxis. Also, if a mother is on ATT, all her children must be given INH prophylaxis in a dose of 5mg/kg daily for 6 months.

A patient with active smear-positive TB must be taught proper sputum disposal (in a phenyl can). He must cover his mouth with a towel while coughing or sneezing.

There are 2 new and dreaded forms of TB – MDR-TB and XDR-TB; these have flourished due to misuse / wrong dosage of anti-tubercular drugs. MDR-TB or Multi-Drug Resistant TB is when mycobacteria develop resistance to at least 2 of the first-line drugs-namely Isoniazid and Rifampicin. XDR-TB or Extensively-Drug Resistant TB is when mycobacteria develop resistance to even the 2nd-line drugs – hence is very difficult to treat.

The social stigma associated with TB in India earlier is no longer evident. Public awareness about the disease has increased in recent years, thanks to active campaigning and patient education programs by health workers. People are aware that TB is no longer a killer disease and is easily curable.