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Worl TB Day: - FROM THE EDITOR’S DESK

Tuberculosis is also known as Koch’s Disease named after Robert Koch - the discoverer of the bacilli causing tuberculosis. Only about 10% of the infected people will develop tuberculosis at some point in their lives either immediately after infection or sometimes after years later. Someone who has been infected may also just remain infected without becoming ill or contagious.

Tuberculosis is not a hereditary disease though studies indicate that inherited susceptibility is an important risk factor. It is an air borne disease that is transmitted from person to person through the air during coughing, sneezing, and talking. The tiny germs enter the air when an infected person coughs or sneezes and from there they are inhaled by those around them and some of them may develop TB.
Humans have no inherited immunity against tuberculosis. It is acquired as a result of natural infection or BCG vaccination. Past infection with atypical mycobacterium is also credited with certain amount of naturally acquired immunity.
BCG is the abbreviation of the ‘bacille Calmette-Guerin’ vaccine named after the inventors - Albert Calmette, a French bacteriologist, and his assistant and later colleague, Camille Guérin, a veterinarian, were working at the Institut Pasteur de Lille in 1908. BCG vaccine is administered in the newborns to prevent TB disease. In India, BCG vaccine is administered to majority of the infants at birth or in the neonatal period. The main reason for this is a good rate of compliance. The BCG scar is seen on the upper portion of the left arm.
The tuberculin skin test only confirms the exposure to the disease, not the presence of disease as this test indicates only whether the patient has been infected with a strain of Mycobacterium or not.
A positive tuberculin skin test is determined by measuring the size of the induration and not by any redness or warmth. The size indicating a positive result will depend on the patient's health status (Is he/she at high risk or has he/she been recently exposed to a person suffering from active tuberculosis?)
A person with TB disease may have any or all of these symptoms:
- A cough that will not go away
- Feeling tired all the time
- Weight loss
- Loss of appetite; fever
- Coughing up blood
- Night sweats
These symptoms can also occur along with other diseases so it is important to see your doctor and to let your doctor decide if you have TB. It is also important to remember that a person with TB disease may feel perfectly healthy or may only have a cough from time to time. The affected person may sometimes show no symptoms at all. So if you think you have been exposed to TB, then consult your physician.
After someone tests positive for infection then he/she will have to undergo additional tests like chest X-ray to determine if tuberculosis has developed. If the chest X-ray is abnormal then serial sputum testing is done. If these tests are negative, the doctor may prescribe a course of preventive medication for 6 to 12 months. Medications may include: Isoniazid (INH), Rifampin (RM), Pyrazinamide (PZA), Ethambutol (EMB) and Vitamin B6 (which is prescribed for alleviating numbness and tingling in the hands and feet). This strategy greatly lowers the risk that tuberculosis will develop later.
Treatment for TB includes antibiotic drugs. It may also involve admitting the patient in a special isolation room to prevent the spread of infection. In such cases a mask must be worn by the person treating or visiting the patient
If the drugs are not taken in proper dosage then drug-resistant tuberculosis can develop which is very difficult to treat. Multidrug resistant TB (MDR-TB) is resistant to first line treatment antibiotics (rifampicin and isoniazid). This requires using other drugs (second line drugs) with more side effects.
Extensively drug-resistant tuberculosis (XDR-TB) is a form of TB which is caused by bacteria that is resistant to the most effective anti-TB drugs. It has emerged from the mismanagement of multidrug-resistant TB. It can spread from one person to another just as tuberculosis spread. It is extremely difficult to treat XDR-TB.
Tuberculosis can be contracted by anyone and not just people living in lower socioeconomic areas. There are some people who are at a greater risk of contracting tuberculosis than others.
Smoking increases the risk of tuberculosis infection and the risk of death among TB patients. Smoking reduces the lung’s natural defenses against tuberculosis and therefore, the risk of prevalence of TB is higher among smokers and ex-smokers than in people who have never smoked.
People with weakened immune systems such as those who are very young or very old, people suffering with cancer or HIV infection are more likely to develop active tuberculosis disease once infected
TB is the leading infectious killer in people with HIV/AIDS. Due to the weakened immune systems, HIV/AIDS patients are up to 20 times more likely to develop TB than people without HIV. TB is graver in HIV/AIDS patients with up to half of all deaths of HIV/AIDS patients due to TB.

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