World TB Day 2019: How is this disease diagnosed?

24th March of every year is dedicated towards spreading awareness about TB in a bid to bring down its incidence and control it better. Better disease management requires early detection. Here is a low-down on how tuberculosis can be diagnosed, drug regimen and the role of Ayurveda in TB management.

Early diagnosis is the cornerstone of managing any condition. Timely detection becomes even more important for conditions like TB that are tough to treat. Tuberculosis is primarily a lung or pulmonary disorder that is caused by airborne bacteria called the Mycobacterium tuberculosis bacteria. When a TB-infected person coughs, sneezes, talks or laughs, the air around him may get contaminated and a healthy person can catch the germs from the affected air. However, tuberculosis may attack your other body parts as well apart from the lungs. This is known as extrapulmonary TB, a condition in which your lymph nodes, kidneys, uterus, bones, central nervous system, gastrointestinal (GI) Tract may be affected. Extrapulmonary TB is mainly found in HIV patients and children.

Tuberculosis bacteria attack your your immune system and widen their base inside your body. If your immune system is weak, then are likely to develop TB the moment you inhale the bacteria. However, if your immune cells are strong enough, you may not get the disease, even if the bacteria exist in your system. TB can be classified into two categories depending on how they are present in your body. If the TB bacteria are asleep and do not give you any symptom, the condition is known as Latent TB. A person with Active TB will experience symptoms and may pass on the disease to others as well. He may be drug sensitive or drug resistant. A drug sensitive TB patient is one whose condition can be treated with the usual TB drugs. A drug resistant TB patient, on the other hand, is someone whose body doesn't respond to one or more TB medicines. On this World Tuberculosis Day, we tell you how the condition is diagnosed and treated.

Diagnosis

A Latent TB Infection (LTBI) cannot be detected by chest X-ray. Currently, there are two tests to detect this TB infection: Tuberculin skin test (TST) and interferon-gamma release assays (IGRA). However, these tests are not foolproof ways to diagnose LTBI. Both are incapable of differentiating between Active and Latent TB accurately. The chances of inaccuracy increase in case of HIV patients. Moreover, they are dependent on indirect markers of TB bacteria exposure. So, their prediction about the possibility of an LTBI becoming active is, in most cases, inaccurate. According to the WHO guidelines, patients suffering from HIV, end stage renal failure, silicosis (a lung disease caused by a mineral called silica), people who are in touch with other TB patients or are preparing for organ or blood transportation, have a high propensity to develop active TB from the latent versions of the bacteria. So, they should be tested for LTBI from time to time. You may need to undergo a battery of tests to detect Active TB. The tests include TST, sophisticated blood test to observe the reaction of your immune cells to TB bacteria, imaging tests like chest X-ray or a CT Scan, and sputum tests.

High risk group

Healthcare professionals, caregivers of TB patients, HIV patients, people suffering from diabetes or silicosis are at a greater risk of developing Active TB. It affects all age groups. However, children are more susceptible to tuberculosis as their immune systems are under-developed.

Treating TB

The treatment of drug sensitive Active TB patients may continue for six months including a wide range of medicines including Isoniazid (H/Inh), rifampicin (R/Rif), pyrazinamide (Z/Pza), and ethambutol (E/Emb). The dosage varies on the basis of body weight. According to the 2018 WHO guidelines, the drugs that should be used for the treatment of drug resistant Active TB should include fluoroquinolones, bedaquiline and a linezolid in addition to the other drugs mentioned above. The treatment duration ranges between 18 to 24 months.

Latent TB can be tackled with a single medicine. The recommended drug options include isoniazid, rifapentine and rifampicin. Your pulmonologist may ask you to be on isoniazid for 6-9 months, depending on your condition, or rifapentine plus isoniazid for 3 months. The 3-month regimen could also be isoniazid plus rifampicin or only rifampicin. Another important aspect of tackling LTBI is creating patient awareness about the necessity of this treatment and ensuring drug adherence.

Ayurveda and TB

Ayurveda can play an active role in helping you control the symptoms of tuberculosis alongside your prescribed medication. However, do not self-medicate. Consult an Ayurveda expert and your pulmonologist before taking to Ayurvedic medicines. Bhringarajasava can be a good option for you to try if you are suffering from TB. In Ayurveda, Bhringrajasava is considered to be a rasayana or rejuvenant and kasahara, an effective element to tackle respiratory infections. It also helps in bringing down your body's toxin levels. Bhringrajasava can rev up your energy levels, blood and fluid production, while protecting against liver damage. There is clinical evidence that this ayurvedic formula helps you in managing breathing difficulties, cough and cold, the prominent symptoms of TB. Another effective option could be Ashwagandha (Withania somnifera). It can be effective in tackling malnutrition issues, a potential trigger behind tuberculosis. You couls also try chyawanprash. It will rev up your immune function.