Tuesday, March 26, 2013

TB - The Killer Disease and India

Centre for Disease Control and Prevention - Chest X-ray of a person
with advanced tuberculosis. Infection in both lungs is marked by white
arrow-heads, and the formation of a cavity is marked by black arrows


TB - short form for Tuberculosis - was just a name of disease in Biology text, which could give me half mark in exam. This changed when TB conquered the body of one of my friend's father. Fortunately, doctors identified the disease quickly followed by treatments. After suffering for a number of months, he recovered slowly but steadily and now leading a life free of TB. However, all are not so lucky.

TB is second only to HIV/AIDS as the greatest killer around the world due to a single infectious agent. According to WHO in 2011 alone, around 8.7mn people fell ill with TB and it killed the dreams of 1.4mn people permanently. Almost 95% of TB deaths mainly occur in low and middle income level countries. This deadly disease not only kills people but also destroy the life of many more millions. In 2010 alone there were about 10mn orphan kids, whose parents died because of TB. We all know that AIDS is a deadly disease, but how many of us know that one quarter of all HIV deaths are due to TB.

TB (Tubercle Bacillus)

This air borne disease usually affect the lungs and spread to air, when people with lung TB cough, sneeze or spit. Inhaling a few of those germs (Mycobacterium tuberculosis) can create infection. According to reports, people with TB can infect up to 10-15 others in a year through close contact.

Main symptoms of TB are "persistent cough, usually for more than three weeks, night sweats for weeks or months, weight loss, fatigue, high temperature, shortness of breath etc" - WHO


Early diagnosis is very important in TB cure. This deadly disease can be cured with a treatment of four anti-microbial medicines (isoniazid, rifampicin, streptomycin, ethambutol) over a course of six months. If not diagnosed early, disease will not only spread to many others but can mutate into deadly forms.

India and Tuberculosis

India is home to largest number of TB patients. According to WHO's latest estimations 2.2mn patients out of 8.7mn are Indians. Not only that, 2-3% of TB patients carries it drug resistant verity. New diagnostic tests suggest a rate of 6.7% in 18 sites; as high as 28% at a clinic in Mumbai.

Out of 310,000 cases of Multi Drug Resistant TB (MDR-TB) in 2011, 60% were in India, China and Russia. Around 9% of MDR-TB cases had XDR-TB (Exclusive Drug Resistant) as well.

Victims of a controllable disease

Mycobacterium tuberculosis
What make such high rates of death particularly unacceptable is, TB is not an incurable disease. With early diagnosis and proper intake of medicine we can save millions of souls. Just imagine how tragic it is, to see people suffer and die when we have the means to cure it.

Normal drug sensitive TB can be cured using four medicines (antimicrobial) over a course of six months. Even MTR-TB is curable using second line drugs, though it is costly and may produce adverse effects.

If we can diagnose the disease in time, if we could offer treatment in time, then we may be able to save lakhs of people who may die otherwise. In 2011 alone, about half a million children aged between 0 and 14 years old came under the deadly clutch of TB; out of those 64,000 kids died.

Drug Resistance

Antibiotics are one of the most prized treasures of humanity. Penicillin "saved the lives of an untold number of servicemen and civilians wounded in World War II; in earlier wars, people died by the thousands from bacterial infections resulting from their injuries" - NYT

However, antibiotics are not an answer to all the diseases. I often see people simply taking antibiotics when they feel a little bit fever. If I told someone, I am feeling a little bit high temperature; friends will immediately come with the suggestion of some medicines.

The main problem is, due to unnecessary and indiscriminate use of antibiotics, bactierias can become resistant to antibiotics, viruses to anti-virals and parasites to drugs like anti-malarials. This often makes those drugs useless.

Remember, "no new classes of antibiotics had been introduced since 1987; whereas new pathogens were emerging every year, and existing bugs were developing resistance to current treatments" - Dam Sally.

One of the main reasons for lesser number of antibiotics under development is, Research and Development in antibiotics are not considered as profitable. So, as more and more pathogens become drug resistant, we will loss a big treasure of one of the most wonderful achievements of humanity- antibiotics.

Multi Drug Resistant TB (MDR-TB)

Robert Koch - Discovered TB Bacteria
These types of TB bacteria “do not respond to, at least, isoniazid and rifampicin, the two most powerful, first-line (or standard) anti-TB drugs."

The main reason for MDR-TB is inappropriate treatment, incorrect use of anti-TB medicines, poor quality drugs etc, which will make these bacteria’s immune to conventional treatments. However, this can be cured by second line treatments - up to two years. Second line drugs are costly and its usage may create adverse effects.

"The number of laboratory-confirmed cases of MDR-TB around the world has gone from 12,000 in 2005 to 62,000 in 2011. However, the real figure is thought to be closer to 300,000". According to WHO 150,000 deaths a year are attributed to multi-drug resistant tuberculosis.

Extensively Drug Resistant TB (XDR-TB)

Some variants of bacteria are resistant to more number of antibiotics, this version - called as Extensively Drug Resistant TB (XDR-TB) - is detected in 84 countries.  These types of bacteria respond to fewer available medicines. Some of the effective second line drugs are useless in front of this new treat.

Government programs for the eradication of TB

GOI allocated 710 crores for fighting this disease in 2012-13 (80% increase over last fiscal). Till now, "RNTCP (Revised National Tuberculosis Control Program) has evaluated over 44mn people for TB and initiated treatment for over 12.8mn patients. It has also saved more than 2.3mn lives. In 12th Plan, Indian is looking forward to treat 83 lakh TB patients, including 1.2 lakh MDR-TB. Among HIV-infected TB patients, 90% will be provided ART during TB treatment to reduce mortality. 12th Plan document for TB control [states that], Annual Risk of TB Infection (ARTI) has reduced from 1.5% to 1.1% and prevalence has also reduced from 316/lakh in 2007 to 266/lakh in 2010." - TOI

"Anti-TB drugs alone are projected to cost Rs 1,797 crores, of which 62% is for costly second-line MDR-TB drugs that such patients are otherwise unable to afford themselves." - TOI

RNTCP provides, free of cost, quality anti-tubercular drugs across the country through the numerous Primary Health Centres and the growing number of private-sector DOTS-providers


If someone is no diagnosed properly, then it may not only affect him/her but many others as well. So it in everyone’s interest to make sure that, people knows about the treatment and get equal chances for the same.

At the same time, unnecessary use of antibiotics will make a good verity of drugs impotent in fighting against TB. Each time you use antibiotics unnecessarily, using self prescription or force your doctor to give antibiotics to you, or your doctor itself giving antibiotics unnecessarily; there is a chance that humanity may lose that drug forever. So it is important to avoid self treatment and unnecessary antibiotic intake.

"Since 1995, over 51mn people have been successfully treated and an estimated 20mn lives saved through use of DOTS and the Stop TB Strategy recommended by WHO...TB death rate dropped 41% between 1990 and 2011."

On this TB day (24th March), lets join hands with government and other NGOs to create a TB free world. If we can beat polio, then there is no doubt that combined strength of us can beat back TB as well.


Note 1: Tobacco use greatly increases the risk of TB disease and death. More than 20% of TB cases worldwide are attributable to smoking. 


1. Plan to Fight Deadly TB Strain Gains in India - WSJ
2. Antibiotics resistance 'as big a risk as terrorism' - medical chief - BBC
3. Sale of anti-TB drugs without doctor's prescription faces ban.
4. World Health Organization - India
5. 'Visionary' leadership needed on TB - BBC
6. Tuberculosis - World Health Organisation (WHO)
7. Anne Miller, 90, First Patient Who Was Saved by Penicillin - NYT

Photo Courtesy: Wikipedia

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