Tuberculosis- The clock is Ticking

Tuberculosis, Rajaykshma or Kshya rog, is an ongoing menace even in 21st century.  Greeks named it as “phthisis” which literally means to rot, decay or putrefy. In the year 1882, 24 march German microbiologist Dr Robert Koch announced the discovery of causative bacteria. Since 1995 WHO started commemorating this day to emphasize public health challenge due to tuberculosis. In 2015, WHO recognized TB as global epidemic and major health concern clamming millions of lives every year. Therefore came up with “End TB” program”. Proposing 95% reduction in deaths due to TB by 2035, 90% reduction in TB incidence  and Zero-TB affected families facing catastrophic treatment cost by 2035.

In our country the burden has been enormous and to address the problem we have a national health program to focus on TB since 1962. IN 1997 it was renamed to RNTCP as Revised national tuberculosis Program simultaneously revising the strategy to combat TB. In 2020 govt. of India re-organized this to  NTEP national TB elimination  program to achieve “End-TB targets “ 5 year earlier to WHO time-line.

With emergence of HIV infection, lead to tuberculosis re-emergence, a difficult scenario to treat. IN the year 2020 world saw new pandemic of COVID-19 SARS-2 . This led to  global lock-down bringing down the entire world, public health and economies to lowest nadir. This has affected drastically to public health program for Tuberculosis also. According to an estimation through modelling work a 25 % reduction in TB detection during lockdown due to COVID pandemic, would cause 4million excess deaths due to TB. COVID-pandemic threatens to unwind all efforts and achievements to control TB in last few years.

COVID-Pandemic led to:

Reduced reporting and case detection

Mobilization of health workers to COVID-care from TB program

Fund transfer from TB program to Pandemic care

GeneXpert and lab-machines utilized for COVID rather than TB

Access to TB drugs effected

Stigma of TB complexed with Stigma of COVID led to further lowering case-detection.

In resource -poor countries like ours , practically all major health care resources were diverted to control Pandemic compromising other health programs. This might put us back in achieving End-TB-Goals”

TB is still one of the top 10 causes of death worldwide. Despite the fact that it is a curable and preventable disease , it is estimated that 10 million people fell ill due  to TB and almost 1.2 million lost their life to TB globally in 2019.An additional 2lac people died of HIV-TB dual infection. India accounts for ¼ cases of TB cases globally and of all MDR/R-R TB 27 % cases are from our country (this is highest in world).

Remember, TB is curable and preventable disease therefore if diagnosed early and properly managed lives can be saved and so are families , economies. Stigmatizing and hiding such disease would prove to be havoc. Same stands true for COVID disease. Despite all odds, Government is committed to public health goals and entire treatment is available free at DOTS -centers, DOTS-Plus centers and govt. hospitals.

Fact to remind, TB can affect any body system like brain  , meninges, eyes, skin, Pulmonary, Pericardial ,pituitary gland, Lymph nodes, larynx or voice box, abdominal TB,  TB of genital organs,  Urinary tract, TB of prostate, testicular TB etc. Low fever, cough, weight loss, loss of appetite are common symptoms and other symptoms can vary according to organ involvement. At times patient may deny any symptoms. Genital TB might present with infertility.

Symptomatology, radiology or Imaging might be misleading and therefore evaluation of each and every case is must. Cure will certainly  depend upon definitive diagnosis. Many diseases might mimic like TB and even cancer can present like Tuberculosis.

Diabetes, HIV, poor nutrition, are risk factors for developing tuberculosis. Other causes like over crowding , poor hygiene and sanitation, ill treated cases, not following Cough protocols lead to spread of infection.

During lock-down , social distancing and face-mask usages have helped breaking the transmission chain of Tuberculosis too. In fact all respiratory infections were cut down.

Clock-is Ticking, time is on the move and so is Tuberculosis. While you read this people are getting infected, falling sick to this microscopic monster, lives are lost  due to this pre-puranic microbial disease even in mars mission age. Wake-up , know your enemy, enemy of healthy human life and  society, combat at all level. The fight is not of any individual or the Government but for every one of us.

Foremost step,   Stop coughing and spitting openly. Our ex-president and missile- man late shri APJ kalam said once, “ my country is my home” and we should not litter or spit in public places, its not a garbage box. Single step can significantly cut down spread of TB.