Contagious but curable

Tuberculosis is contagious disease which can affect anyone and takes months to heal. The disease afflicting millions throughout the world can be tackled with an early diagnosis and taking medicines properly for the prescribed duration. Aliya Bashir reports.

More than 26221 tuberculosis patients have been detected in the last six years in Kashmir. While 20288 TB patients have recovered fully, 3105 patients were taking the medication till the end of December 2010. There are many more patients seeking treatment from private practioners or nursing homes or undetected cases.

“TB is a curable disease, if detected on time and managed properly. Although, the standard recommended length of drug therapy is six months, but in some cases it may extend to eight months. And, if there is any delay in diagnosis, a patient is prone to major damage,” says a doctor at Chest Disease Hospital, Srinagar.

Tuberculosis is considered to be one of the deadliest diseases as it kills more than 18 lakh people every year globally and four lakh people in India alone. In India, two persons contract TB every minute.

“This year 262 new cases of TB were identified in the valley. We feel this is the success of our different awareness programs where we had been able to detect these cases, which if not treated on time could have spread the disease to others,” says an official wishing not be named in the health department.
The typical symptoms of T.B are chronic cough with blood-tinged sputum, fever, night sweats, fatigue, chest pain, loss of appetite, pale complexion and weight loss.

Most people develop a latent or ‘sleeping’ infection, which is not contagious but can still develop TB in later stage. Those who develop tuberculosis face an exhausting disease which may lead to loss of income and isolation.

“How do you keep going when you’re afraid to hug and kiss your own children because you could infect them? This is the most painful feeling that I am living with,” says a TB patient pleading anonymity. “Whenever I had coughs, mild chest pains and evening fever, my in-laws used to ignore it”.
Tuberculosis, (T.B), is an illness that affects the respiratory system. It is caused by the airborne bacterium -Mycobacterium tuberculosis (MTB) and it usually affects the lungs but can affect any part of the body.

The bacteria enter a person’s respiratory tract via the nose or throat and then travel to the lungs, where they multiply within the tiny air sacs known as alveoli. In the alveoli, the bacteria are picked up by cells that carry them to nearby lymph nodes in the chest cavity. The TB bacteria can then spread into the bloodstream and other organs or tissues.

The disease can be treated by taking medicine regularly. However, some patients stop taking medicine once they feel that they are cured or forget taking it, reducing their chances of timely recovery, say doctors.

To overcome the problem of patients not taking the medicine regularly, DOTS (Directly Observed Treatment, Short Course) programme was launched in 2004 under RNTCP (Revised National T.B Control Programme) in Srinagar and Pulwama districts. Later it was implemented in whole Kashmir division.
Under this scheme if a patient test positive for TB, he or she is referred to the nearest DOT centre for treatment, where the medicine is administered daily under supervision.

“The DOTS strategy represents the most important public health breakthrough of the decade, in terms of lives that are being saved. The patients are given anti-tuberculosis drugs under the supervision of DOT providers,” says Imtiyaz Ahmed, a DOT provider in Pulwama District. “We had number of instances where people find it difficult to remember to take their drugs every day for such a long time. Others, stop treatment as soon as they feel better, resulting in high vulnerability towards the bacterium.”

Since the inception of RNTCP, 1325 DOT Centres have been established where 1640 workers provide free of cost medicine to the patients at a small distance. Around 25 TB units have been established in all the districts in order to provide effective supervision at sub-district level. Many diagnostics labs have been established across the valley to help early detection of the disease.

“In order to conduct sputum examination of the patients with chest problem, 92 Designated Microscopy centres (DMCs) have been established where 243054 sputum examinations have been conducted free of cost by the end of Dec last year,” says an official at the STB Cell.

Apart from patients discontinuing the treatment or forgetting to take medicine the other area of concern, health officials say, is the rising number of Multiple Drug Resistant Tuberculosis (MDR-TB), which they attribute to usage of fake drugs.

The MDR-TB is resistant to first line anti-TB drugs. It develops during treatment of fully-sensitive TB when the course of antibiotics is interrupted and the levels of drug in the body are insufficient to kill 100 per cent of bacteria. MDR-TB most commonly develops due to doctors giving inappropriate treatment, or patients missing doses or failing to complete their treatment.

Statistics available with the Chest Disease hospital in Srinagar reveal that 2.45 per cent of the TB cases registered with the hospital are of MDR TB.
The doctors at Government Medical College, Srinagar echoed that due to lack of facilities to detect MDR-TB and absence of any drug testing facility for quality testing of drugs in the state is contributing to the rise of these cases in the valley.

“Although, the medicines given under DOTS are of high quality but a number of TB patients prefer private practitioners, who administer them with alternate drugs available in the market, whose quality is always doubtful,” says a doctor at the Microbiology department of the Government Medical College Srinagar.
“40 per cent of the all the population in the world are thought to have a dormant (latent) tuberculosis infection which can aggravate any time due to various reasons. Weak immune system is one of the major causes to get infected,” says a senior pulmonologist at SKIMS.

People who have HIV or AIDS, drug or alcohol abusers, malnourished, smokers, persons with low immunity to diseases, patients being treated for cancer with chemotherapy, or who have received organ transplants, those that work or live in hospitals, nursing homes, prisons, people with low socioeconomic status are at higher risk to develop the disease.

 “If AIDS patients become infected with MTB, they have a 5 to 10 per cent chance of developing active disease each year. In contrast, those who have latent tuberculosis but do not have AIDS have only a 5 to 10 per cent chance of developing active disease during their lifetime,” the doctor explained.

IF ANY PERSON HAS COUGH FOR TWO WEEKS

Keep mouth covered with clean cloth while coughing or sneezing.

Attend nearest government health institution.

Get two sputum examinations done.

Do not depend on X-ray only for diagnosis.

Diagnosed TB patients should take DOTS regularly at their DOT centre.

Should get their contacts examined for sputum.

Should get his follow up sputum examination conducted at DMCs after two and four months.

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