When my friend took her father to a doctor for a check-up, the general physician told her that her father's weakness and persistent cough might be due to tuberculosis. She consulted her siblings and the family decided to go for a second opinion from a chest physician before the 83-year-old was put on medication. The family was worried about the long drawn process of treating TB and its effects on his health.
Until the second opinion materialised, my friend had to contend with her worries. Would her father agree to the treatment which could last months? And how would he cope with it given his weak health? Luckily for her and her family, it turned out that her father was merely weak and needed nourishment but did not have TB.
“Relief all around,” she messaged me. And indeed, it was.
Statistics say that 40% of India's population is infected with the tuberculosis bacillus. In such a context, it is natural if a doctor's suspicions are triggered by say, a patient suffering from persistent cough and fever or smoking or even living in the same house as a TB patient. But, say experts, identifying TB can be a tricky exercise, one that involves a variety of factors. Tuberculosis is an opportunistic infection that strikes when a person's immunity is low. So when doctors begin treatment, they look for several symptoms. Pulmonologist V. Gangadharan, who is with the Government TB Hospital in Otteri, says: “What is necessary is culture and pathological tests. Sometimes, I may start medication based on clinical findings.”
The clinching evidence comes from the patient, he adds. “We ask patients who complain of fever to record temperature and check for weight loss periodically.” By putting together all the evidence, a doctor is certain that medication is needed. “Immunological evidence is only an added confirmation. It is always better to have one or two evidences,” Dr. Gangadharan says. And, when the patient begins responding, the doctor heaves a sigh of relief.
If diagnosis and treatment is the easy part, then ensuring that those diagnosed with TB continue their medication is the challenge. TB is curable provided a person takes medication regularly. When a person discontinues medication mid-course, the bacteria return with more vigour and the disease becomes difficult to treat. Such persons are put on stronger drugs which may however result in serious side effects. The patient becomes unable to lead a normal life and if he is the sole wage-earner of the family, the family's struggle to survive is that much more difficult. While doctors concentrate on curing TB, researchers are also exploring the connection between diabetes and TB. A pan-India study in six centres has been launched in the country to understand this relationship. The study done by the State TB department in Tamil Nadu has revealed that around 25 per cent of those with TB have diabetes. The figures for the study done by the Kerala TB department are higher, says Vijay Vishwanath, managing director of M.V. Hospital for Diabetes, Royapuram, which was part of the study.
According to him 24 per cent of those studied were in the pre-diabetes stage with impaired glucose tolerance and impaired fasting glucose levels. “When you have diabetes, you are already prone to infection. Also, when you have TB you could be prone to diabetes,” Dr. Vijay says.
Given that a double burden is staring us in the face, it rests on each of us to try our bit and stop TB in our lifetime. For, the statistics are alarming: a patient who remains untreated for the infection could pass on the disease to 15 others. And, every three minutes two persons are dying of the disease.
R. Sujatha writes on health for The Hindu.
