Sunday March 24, 2019

India is Ground Zero for TB: Number of cases much higher than reported

The study published in Lancet found that in 2014, the private sector treated double the cases handled by government-run hospitals depicting the failing battle against TB

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TB Patient. Image Source: Wikimedia Commons.

INDIA, September 5, 2016: : Ground zero of the global battle against one of humankind’s deadliest diseases, India could have between two and three times more Tuberculosis(TB) cases than currently assumed, said a recent paper released in ‘Lancet’, a medical journal.

The study found that in 2014, the private sector treated between 1.9 million and 5.34 million cases — or about double the cases handled by government-run hospitals.

Before this study, India was believed to have about 2.2 million TB cases, a quarter of the global TB burden, thus far estimated at about 6.3 million.

However, the private sector both helps and hinders TB treatment, the study implies.

Although standardised Tuberculosis treatment in India is delivered by the public sector, early diagnosis and treatment are hampered by the presence of a vast and unregulated private health-care sector, said the study, whose eight authors come from a variety of institutions, including London’s Imperial College, the Indian government, the World Health Organisation and the Bill and Melinda Gates Foundation, which funded the study.

“Poor diagnostic practices in this sector prolong Tuberculosis transmission by delaying diagnosis, whereas a general lack of counselling and support of treatment adherence hampers successful, relapse-free cure,” said the study. “Moreover, most cases treated in the private sector are never notified to public health authorities.”

Tuberculosis Diagram. Image Source: Wikimedia Commons.
Tuberculosis Diagram.
Image Source: Wikimedia Commons.

Analysing sales patterns of 189 drugs containing rifampicin — a key anti-TB formulation — over 2013 and 2014, the researchers estimated how many were sold to the private sector. In 2014, the WHO estimated that 800,000 TB patients escaped public-sector diagnosis, but these statistics were mostly compiled from expert opinion. So, the new study provides an empirical estimate that is independent of such opinion.

“This study illustrates the need to address the burden of Tuberculosis treated by the private sector and improve surveillance,” the researchers wrote, acknowledging the paper’s limitations, including the failure to capture TB patients who do not approach a doctor, use the informal sector or are being treated for multiple-drug resistance.

“This study also raises an urgent need to revise current estimates of Tuberculosis burden, informed by more systematic evidence relating to Tuberculosis management in the private sector,” the researchers wrote.

Although the incidence of TB in India has been declining, drug resistance and its interaction with other diseases, such as HIV, have slowed progress.

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Throughout history, TB has killed more humans than any conflict, disaster or disease known to mankind. In the 5th century, Greek philosopher Hippocrates advised doctors to stay away from TB patients, since there was no cure. In the 17th, it was called the great white plague of Europe, as it swept the continent, killing thousands over 200 years. In the 21st Century, it infects 10 million people every year, killing a fifth of those.

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TB bacteria have in-built armour, acids that protect them against the body’s cellular defenders. Most people infected with it have latent tuberculosis, where the bacteria are walled off in clumps by the cells of the immune system. Sometimes, the containment fails, particularly in people with weakened immune systems. If a drug doesn’t kill the bacteria completely, it becomes immune to that drug and can eventually overwhelm the immune system. (IANS)

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Health Experts Claim, Tuberculosis Can Reduce Chances Of Pregnancy

"It is also important that people thwart the factors that contribute to TB by making their living conditions more hygienic, improving immunity, and having better access to nutrition,"

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To combat the disease, it is essential that diagnostic facilities reach the farthest areas and people made aware of the consequences of contracting TB, said Rajkumar, Consultant Internal Medicine at New Delhi-based Indian Spinal Injuries Centre. Pixabay

Tuberculosis (TB) bacterium primarily affects the lungs, but can also spread and cause secondary infections to the uterus and even the fallopian tubes, which can reduce chances of pregnancy, health experts warned ahead of the World Tuberculosis Day that falls on March 24.

Usually caused by Mycobacterium tuberculosis (Mtb) bacteria, TB is the top infectious killer worldwide, claiming around 4,400 lives a day.

When the bacteria attacks the uterus, it causes uterine tuberculosis (also known as pelvic TB) which mostly affects women during the child-bearing period and is usually diagnosed during an infertility check-up.

pregnancy
“Also, with medication, women can be helped to conceive through ART, either IVF of or IUI, where intervention can be done to repair the after-effects.” Pixabay

“Women are more often affected than males and due to uterine tuberculosis, two out of 10 females are unable to bear a child,” Shweta Goswami, Infertility Specialist at Jaypee Hospital in Noida, told IANS.

“In extreme cases, the uterine lining become so thin that it is unable to bear an implantation resulting in miscarriage,” she added.

Mtb bacteria is transported by blood to other organs including reproductive organs and causes infection in fallopian tubes, uterus or in endometrial lining.

“Tuberculosis has the ability to severely damage the fallopian tubes, if not treated at the initial stage.. it can further lead to serious health complications and also result in infertility,” Goswami said.

Symptoms of TB in uterus include irregular menstruation, pelvic pain, continuous discharge which is stained with blood or without blood with a foul smell and bleeding after intercourse.

A 2018 study by the Indian Council of Medical Research (ICMR) showed that over 50 per cent of female patients in India coming for IVF procedure have been reported to have genital TB.

The prevalence of genital TB among Indian women has increased from 19 per cent in 2011 to 30 per cent in 2015.

In over 95 per cent of the cases, the infection was found to affect the fallopian tubes, in 50 per cent the endometrium and 30 per cent the ovaries.

Moreover, nearly 75 per cent of women with genital TB were found to be infertile, and 50-60 per cent of women with infertility were found to have genital TB, the report stated.

“Treating uterine TB should be of the utmost importance as soon as it is detected. There is social stigma attached with TB which makes it difficult for people to come openly and talk about it,” said Shobha Gupta, Medical Director and IVF Specialist from Mother’s Lap IVF Centre, New Delhi.

There are combined tests which are used to investigate whether a person is suffering from TB which are a combination of AFB smear, culture and PCR for tuberculosis.

TB
When the bacteria attacks the uterus, it causes uterine tuberculosis (also known as pelvic TB) which mostly affects women during the child-bearing period and is usually diagnosed during an infertility check-up. Pixabay

“Also, with medication, women can be helped to conceive through ART, either IVF of or IUI, where intervention can be done to repair the after-effects,” Gupta noted.

According to the World Health Organization’s (WHO) ‘Global Tuberculosis Report 2018’, India accounted for 27 per cent of the 10 million people, who had developed TB in 2017, besides making up 32 per cent of global TB deaths among HIV-negative people and 27 per cent of combined TB deaths.

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To combat the disease, it is essential that diagnostic facilities reach the farthest areas and people made aware of the consequences of contracting TB, said Rajkumar, Consultant Internal Medicine at New Delhi-based Indian Spinal Injuries Centre.

“It is also important that people thwart the factors that contribute to TB by making their living conditions more hygienic, improving immunity, and having better access to nutrition,” he added. (IANS)