World Tuberculosis Day 2018: Why India is under the threat of Multi-Drug Resistant TB?

Experts tell us why we need to worry about primary MDR TB which is spreading like an epidemic.

By: Debjani Arora | | Updated: March 23, 2018 7:17 pm

24th March 2018 is World Tuberculosis Day.

Recently the government has announced that it is on a mission to eradicate tuberculosis from the country by the year 2025. Tuberculosis is a potent bacterial infection that can affect almost every part of the body. However, it is the tuberculosis of lungs which is more common and contagious too. This bacterial infection spreads easily from an infected person to another healthy person by just inhaling the bacteria. The bacteria spread easily when the infected person coughs, speaks or opens his mouth. It is an airborne disease and is highly contagious too. Here are few signs and symptoms of tuberculosis that you should know.

According to a WHO report, India is the country with the highest burden of tuberculosis and there were around 2.76 million cases of tuberculosis in India in 2016. The report also mentions that 10.4 million people were affected by TB and 1.7 million people died. More than 95 percent of TB related deaths happen in low- and middle-income nations. Around 1 million children fell ill due to TB and 250,000 children died, in 2016. TB is a major cause of death in HIV-positive people, accounting for 40 percent of TB-related deaths in 2016.

But this is not all that we need to ponder on and take necessary steps to reduce the number of incidences. The statistics also revealed that the growing number of multi-drug resistance (MDR-TB) is a huge cause of concern for the country. In 2016, there were 600,000 new cases with resistance to rifampicin, the most effective drug to treat TB; of this, 490,000 had MDR-TB. Here are few facts about tuberculosis that you need to know.

‘Earlier when a TB case would be detected it wouldn’t be an MDR-TB in the first screening itself. The infection would be treated with antibiotics and a detailed follow-up was needed to ensure that the infection is eradicated completely. Of course, the treatment for tuberculosis takes anywhere around six months to a year and this is a reason why many people fail to stick with the regimen. But these days we see more cases of MDR-TB in the first incidence, which means people who never had TB before showing drug resistance which makes it difficult to treat and creates a challenging situation for the physician,’ says Dr Arvind Kate, Chest Physician and Pulmonologist at Zen Hospital, Mumbai.

‘Since treatment for TB spans over months this is why most people drop out of the treatment and then there could be a relapse of the same. However, initially, we saw people getting an infection, dropping out of treatment, getting it back and starting the course again. These days the first representation of TB is MDR TB and the treatment for the same can go up to one to two years,’ says Dr Sandeep Tilawe, Pulmonologist, SRV Hospital, Mumbai.

Of course, non-adherence to TB treatment and overuse of antibiotics have long been cited to be reasons for TB relapse and increase in the number of MDR-TB, but the question also arises that why India is under the threat of MDR-TB.

Here are few reasons cited by experts:

Population size: Given a densely populated country like ours, it is only obvious that an airborne contagious infection like TB can be spread so easily. ‘In a country like ours where we are living and breathing in overcrowded places, we should be aware that getting any kind of airborne infection isn’t impossible. In fact, the TB bacteria when expelled in the air either by coughing, sneezing or just opening the mouth by a TB-infected person stays in the atmosphere for too long. So, when a healthy person inhales air from the same area and gets the bacteria into his system he gets easily infected. Since these days people get infected with MDR-TB in the first instance chances are more than other people might acquire the same if the infected person fails to take precaution,’ says Dr Sandeep. Here is how tuberculosis is diagnosed?

Not taking the right precaution: Prevention and precaution aren’t terms that spell importance to the Indian public, in general. Either we are too lenient with our existing health condition or we are ignorant in preventing the spread of an acquired infection. ‘One way to stop the spread of MDR-TB is by taking the right precaution, like, covering the mouth while on treatment to prevent the bacterial spread. But people do just the opposite keep the mouth bare, cough and spit at open places. This makes the society vulnerable to a TB or MDR-TB infection,’ says Dr Sandeep.

Less follow up: ‘The issue with MDR-TB treatment is that it is lengthy and spans across two to two-and-half years. Also, the average expenses for the treatment per month would escalate as the treatment prolongs. However, to eradicate this public health menace, steps are taken by the government to ensure everybody gets access to treatment and medication. But still, when people see that the symptoms of the condition are suppressed with medication they drop out of the treatment without completing the course. This is treating an MDR TB becomes more challenging when it resurfaces,’ says Dr Arvind.

Side-effects of tuberculosis medications and dropouts: Yes, there are side-effects of tuberculosis drugs but what the public fails to understand is that result of the treatment will, in the long run, outweighs these side-effects. ‘Some common side effects of the drugs prescribed are jaundice, joint pain, itching and rashes on the skin, changes in blood parameters, etc. Many people who suffer from primary MDR-TB and stop treatment mid-way fail to understand that this makes them vulnerable to the infection. Treating the condition again might not show promising results and can be life-threatening if the infection to other parts of the body,’ says Dr Arvind. Here is how tuberculosis is treated.

Compromised immunity: The threat of this disease is more in people who have compromised immunity like people suffering from diabetes, are on an immunosuppressant, have HIV infection and others. ‘For people who have a compromised immunity are vulnerable to a TB infection. This is why it becomes necessary to screen people for TB in the entire family if one acquires the infection, more so, if there are people suffering from diabetes or any other condition which suppresses immunity. In this way we stand a chance to treat MDR-TB early,’ says Dr Arvind. Falling to which it can be difficult to control the menace of MDR-TB.

Antibiotic resistance: This, for long has been cited the reason for drug-resistance TB. So, misuse of antibiotics which is still rampant in the country is one reason why we are failing to get a rein on the condition.

Image source: Shutterstock

Published: March 23, 2018 1:35 pm | Updated:March 23, 2018 7:17 pm

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