Common Myths About Tuberculosis And Facts That Dispel Them - Dr Chetankumar Jain

Tuberculosis (TB) remains a formidable global health challenge, affecting individuals across all age groups. In 2023, India reported 25,37,235 TB cases, an improvement over the number reported in 2022. Specifically, 16,99,119 TB cases were notified in the public sector, with 8,38,116 cases notified in the private sector.

Moreover, the country also faces the dual challenge of drug-resistant TB, which complicates treatment and control efforts. The Government of India has implemented the National Tuberculosis Elimination Programme (NTEP), which aims to eliminate TB by 2025. Despite significant advancements in medical science, TB continues to be surrounded by myths and misconceptions.

Myth 1: Tuberculosis is incurable.

Fact: TB is curable with a correct diagnosis and treatment. Diagnosing TB involves a multistep process to confirm the disease and assess its extent. TB is classified into two main types - Pulmonary TB, which affects the lungs (with or without other organ involvement), and Extra-pulmonary TB, which affects other organs.

Diagnostic methods include microbiological testing and clinical diagnosis. In the presence of appropriate clinical scenarios, microbiological testing, radio imaging findings and HPE or Cytology are recommended.

Sample (Sputum Fluid Tissue etc.) Microscopy and Nucleic Acid Amplification Test (NAAT) are used to detect the DNA of the TB bacteria, while radiology helps identify the associated structural abnormalities. This comprehensive approach ensures accurate detection and effective treatment planning, leading to a successful cure.

Myth 2: TB can spread through clothes, utensils, and Fomite, and people with TB require complete isolation.

Fact: TB spreads through airborne droplets when an infected person coughs or sneezes, not through clothes, utensils, or Fomite. Complete isolation is not necessary, but patients should follow medical advice and practice good cough etiquette. TB bacteria do not survive long outside the body due to their susceptibility to environmental factors.

UV radiation from sunlight is highly effective at killing TB bacteria, and humidity levels can also impact their survival. These conditions prevent TB bacteria from spreading through clothes, utensils, or Fomite, making airborne droplets from coughing or sneezing the primary mode of transmission.

Patients with Pulmonary TB should practice good cough etiquette to prevent droplet infection. It includes covering their nose and mouth with a tissue or their elbow when coughing or sneezing, wearing masks, and ensuring proper disposal of used tissues. Following these practices helps reduce the spread of TB and protects others from infection.

Myth 3: TB Patients need to have only animal sources of protein.

Fact: While a high-protein diet is beneficial for tuberculosis patients, it does not have to come exclusively from animal-based sources. Both animal and plant sources of protein are equally effective, but the proportion may vary. It is crucial to adjust the protein intake according to the patient's weight and follow medical advice to ensure optimal nutrition and recovery.

Myth 4: People with low incomes or lower strata of society are the only ones affected by TB.

Fact: Tuberculosis can affect individuals from all walks of life, regardless of socio-economic status, age, or gender. However, certain groups, such as those living in densely populated areas, people with weakened immune systems, and extreme age groups, may be more vulnerable.

Effectively managing TB relies on recognizing symptoms like persistent cough, fever, night sweats, decreased appetite, and weight loss, followed by early detection, microbiological confirmation for drug resistance patterns and ensuring the completion of treatment. This comprehensive approach is essential in controlling and ultimately eliminating TB.

Myth 5: TB only affects adults.

Fact: TB can affect people of all ages, including children. It is a common myth that TB usually affects only those who are immunocompromised and adults. However, paediatric TB is also on the rise, especially when there is an index patient at home.

Both drug-sensitive and drug-resistant paediatric TB cases are increasing. Diagnosing TB in children can be challenging due to difficulties in obtaining samples. Just like in adults, persistent symptoms for two or more weeks warrant suspicion of TB in the paediatric age group also and need further investigation and search for the source of disease in close contact.

Myth 6: TB treatment is unaffordable.

Fact: In India, the Government of India provides free TB diagnosis and treatment through the NTEP, making it accessible to all patients. These services are available free of cost at Government centres across the country, standardizing care as per the guidelines across the country.

Additionally, Ni-kshay Poshan Yojana, a Direct Benefit Transfer scheme under NTEP, provides financial assistance to all notified TB patients to support their nutritional needs during the treatment. This initiative aims to ensure that TB patients receive adequate nutrition crucial for their recovery and overall health outcomes.

Diagnosis and Treatment

As stated above, it is firstly important to understand that TB is curable if diagnosed and properly treated. The first step in managing TB involves screening suspected patients, particularly those with symptoms such as fever, unexplained weight loss, decreased appetite, night sweats, cough lasting more than two weeks, or bodily swelling.

Diagnosis of tuberculosis involves various modalities tailored to the type of TB suspected. For Pulmonary TB, primary tests include sputum microscopy, NAAT (molecular testing), and culture, complemented by chest X-rays to assess lung involvement.

Extra-pulmonary TB may require additional USG, MRIs, or CT scans depending on the affected area and diagnostic procedures such as biopsies from suspected areas, which can include sites like lymph nodes, abdomen, or spine. It is recommended to refer to official guidelines from the Central TB Division's website for the most current diagnostic protocols.

Once the disease is localized, microbiological confirmation is essential through biopsies or sputum samples using tests like CBNAAT (GeneXpert) or TrueNat. These tests detect the presence of TB bacteria and provide information on primary drug resistance, particularly Rifampicin resistance.

Additional diagnostic tools such as Line Probe Assays (LPAs) and culture are employed to establish comprehensive drug resistance patterns, including pre-extensively drug-resistant (pre-XDR TB) or extensively drug-resistant (XDR-TB) classifications.

This classification guides healthcare providers in tailoring appropriate treatment according to government guidelines, ensuring effective management of TB cases.