TB is invading our homes

When Mr Randeep (name changed), a 55 year old industrialist and politician, who came to see me for crampy abdominal pain and weight loss over 6 months, was found to have an ulcer in the intestine due to tuberculosis, he reacted with shock and disbelief.  To him, TB was an infection that happened to remote “others” in slums and villages.

With 2.6 million Indians estimated to be suffering from TB, we account for one of every 5 across the world. And with 3.87 lac people acquiring the infection every year, India is emerging as an epidemic bed of TB, claiming a life every 2 minutes.

The disease is now invading our homes, with people from the middle and upper classes no longer being able to remain immune from it. In fact a large number of people coming to me from well-off homes with the infection are surprised how they contracted it.

The infection gets into our body though the air we breathe. The germ, Mycobacterium tuberculosis, spreads through droplets that a person with TB of the lungs coughs or spits, and sprays into the air. Further, once coughed out, the germ tends to hover around in the air for long periods, allowing us to inhale them unknowingly.

Most infections therefore occur in public places: buses, metros, trains, railway stations, crowded classes and offices. Family members of an infected person are more likely to inhale droplets at home,the chances increasing with crowding and poor ventilation.

Tuberculosis of the lungs is easily diagnosed in a person who has been coughing for over a month, running a low grade temperature especially in the evenings and losing weight that a chest X-ray and sputum test help confirm.

The problem however is that most patients do not necessarily present in this classical manner. A person may be running low grade fever for weeks and losing weight for instance, but his chest x-ray may be normal, a situation that happens with infection of other organs. How does one diagnose extra-pulmonary TB?

Blood tests for diagnosis of TB, such as ELISA, are extremely unreliable and have therefore been banned by the government. A skin test called PPD, also tells about a past exposure to the germ that most of us have had, and does not tell about an active disease. Scans such as ultrasound or CT scan may show glands and shadows but does not tell their nature, adding to the diagnostic challenges faced by the clinician.

Another cause for concern is that the germ is showing resistance to commonly used drugs. In fact it has metamorphosed from being resistance to a single drug, to MDR (Multi-drug resistance) and now to a one called TDR (total drug resistance), posing a major threat to all of us.

The germ that was discovered by Robert Koch in 1882 has indeed given mankind a long run, and does not seem to be in a relenting mood in coming times either. TB is indeed lurking around.

As published in HT City ( Hindustan Times) dated 18 August, 2013.