Much has been said and shown about tuberculosis (TB) with several films having shown people constantly coughing and being diagnosed with the condition. It is preventable and treatable, yet the condition of tuberculosis ( TB) continues to be a major health threat, because of growing drug resistance and spiralling costs of treatment. That apart, fears and stigmas around the condition are abound. The TB scenario has only left doctors perplexed. "India is a heavy TB burden country. In urban settings , the problem is more severe compared to rural settings as the rate of transmission is higher due to overcrowded spaces. Patients from lower socio- economic status cannot afford diagnostic tests and anti- tubercular drugs, thus are diagnosed later and continue to spread the disease. Also, improper medication (irregularities in taking medicines by the patients or incorrect treatment regimen by private medical practitioners), leads to emergence of drug- resistant TB strains. Thus, worseningthe situation," says Dr BR Das, president, research and innovation, SRL Diagnostics. Drug resistance: major threat Rising drug incidence happens to be the biggest threat to TB control and cure. Drug resistant TB happens when the bacteria develops resistance to the most commonly used drugs in the first line of treatment regimen, leading to multidrug- resistant TB ( MDR- TB) and in extreme cases, extensively drug resistant TB ( XDR TB), where the bacteria fail to respond to even second line drugs," says Dr Chandan Kedawat, internal medicine specialist, PSRI Hospital. The other problem is that of patients not sticking to their drug regimen. " They end up discontinuing it because they feel better within a few weeks whereas the medicines should be taken for six months," points out Dr Kedawat. Poor drug regulation TB control has also become a challenge because of poor drug regulation and spiralling treatment costs. " Poor drug regulation has fuelled drug resistant TB, along with lack of discipline when it comes to TB regimen. There is no accountability, when it comes to adhering to proper diagnostic and treatment rules," says Dr Swati Sharma, New Delhi based internal medicine specialist. According to experts, lack of drug regulation has made even basic treatment of drug- sensitive TB difficult to monitor. " There are so many different formulations of TB drugs sold across and absolutely no monitoring," adds Dr Sharma. Irrational prescription and indiscriminate use of non- WHO recommended drug regimens has become a huge problem. " It is the patients who suffer the consequences of poor regulation of TB drug formulations in India. An increasing number of our patients are being diagnosed with drug resistant TB ( DR- TB). We encounter a spectrum of resistance patterns which range from mono- drugresistant TB all the way through to extensively drug- resistant TB ( XDR TB)," says Dr Simon Janes, medical coordinator, Médecins Sans Frontières ( MSF) India. Hence other diagnostic tests need to be performed to consider initiating antitubercular treatment. There are also other conditions, symptoms of which are familiar to TB. " Conditions like amyloidosis and sarcoidosis, have symptoms similar to TB too. And often it is too before the correct diagnosis happens," says Dr Kedawat. Say TB, and the first thing that might strike you is a cloudy chest X- ray. But there are several other forms of TB which affect other organs of the body like that of skin, intenstinal, lymph nodemusculoskeletal, central nervous system, gastrointestinal, skin, pericardial, among others. Way forward Apart from systemic policy changes, there is much that can be achieved by individual efforts, which are as simple as sticking to your medicine regimen beginning with the first line of treatment. " It is important to follow proper guidelines, avoid using anti TB medication for any other purpose other then TB, stick to total duration of care as treatment being of longer duration there is the tendency to default which leads to treatment failure and building up of resistance," says Dr Mansoor. While most of us are exposed to TB during our lifetime, those with low immunity are more likely to contract it. So one of the ways to keep it off you and combat this condition when it strikes, is to build your immunity; gradually and naturally.
