Tuberculosis: An Ancient Foe
By Vignesh Narayan
D
eepti was sixteen years old,
writing her board exams,
when she developed a
cough that just wouldn’t go
away. After conventional treatment for
a month, her doctor advised her to get a
chest x-ray which revealed that she had
contracted tuberculosis (TB). Despite
treatment, Deepti’s condition continued
to worsen. She had contracted a strain
of TB that was resistant to multiple
drugs (MDR or multi drug resistant)
and would need surgery to remove part
of her decaying lungs. She was given
six months to live. In stark contrast to
the lifestyle of Deepti; Salma, a resident
of the Dharavi slums nearby, had gone
to twelve different doctors searching
for a cure for this disease. The strain
she had contracted has been dubbed
TDR or totally drug resistant and was
resistant to 12 different anti-TB drugs.
The disease ravaged her for two years,
costed money she didn’t have and
finally, claimed her life.
India bears the dubious distinction of
having the world’s largest number of
deaths due to TB; 423,000 people in
India succumbed to the disease in 2016,
accounting for a third of the entire world’s
TB mortality. These TB related deaths
that have been identified and reported,
the real numbers may be far graver. India
has an estimated 1.3 million “missing”
TB patients, who may not have been
diagnosed or who have not returned for
a follow-up post diagnosis, untreated
and potentially spreading TB to others.
In addition, WHO estimates that India
saw 2.7 million new TB cases in 2016.
When compared to the 6.3 million new
cases worldwide, Indians accounted for a
whopping 25% of all new TB infections.
This is because of the singular and unique
ability of the TB bacterium to hide inside
the human body in a dormant state
without causing the disease or revealing
any outward symptoms. Such cases are
classified as latent TB infections and can
be revealed by diagnostic tests in healthy
seemingly uninfected individuals. Studies
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Volume 4 | Issue 1 | January-March 2019
indicate that close to 40% of the Indian
population is positive for latent TB and
without treatment 5%-10% of these will
develop active TB at some point in their
lives. Unfortunately, due to the high
burden of TB in India, the detection and
treatment of latent TB is not prioritized,
resulting in a huge reservoir of dormant
and potentially infectious bacteria primed
to emerge under favourable conditions.
In 2017, 10 million people were infected
with TB and 1.6 million died worldwide,
surpassing AIDS as the world’s leading
cause of death due to an infectious disease.
WHO has designated March 24t has the
World TB Day to raise public awareness
about TB and its deleterious effects on
health, society and the economy. In 2015, it
began to implement the ‘End TB Strategy’
which envisions a world free of TB with
zero TB related deaths and zero incidences
of the disease. In order to do this, WHO
aims to support and promote a patient
centric approach to care and prevention,
encourage proactive policies and support
systems by involving the government
and private sector healthcare and finally