TB Management in High-Risk Groups: Prevention, Treatment and Care - Dr Revathy Kodakkal

Tuberculosis (TB) is a contagious infection that is caused by Mycobacterium tuberculosis, most commonly affecting the lungs but also capable of infecting other organs. In spite of being preventable as well as treatable, TB remains a health challenge in India, especially for high-risk groups, due to its slow growth cycles.

Overview and Contributing Factors

Pulmonary TB is an airborne disease and can be contracted if an infected individual coughs, speaks or sneezes. Individuals that are exposed to the bacteria may not fall sick immediately, but may lie dormant in the system for years.

Some of these high-risk groups include:

People living with HIV/AIDS, Healthcare workers, Elderly individuals, people with poor nutrition intake including alcoholics, people with chronic disease like uncontrolled diabetes, kidney diseases, or cancers. People in prisons and shelters or crowded cities such as Mumbai or people with a family history of TB may have a higher risk of contracting the disease.

LTBI or latent TB infection can lay dormant for years without developing a disease.

Management and Treatment of TB

Managing TB in high-risk groups requires a comprehensive approach involving early detection, prompt treatment, and ongoing monitoring:

Screening and Diagnosis:

High-risk individuals should undergo regular TB screenings. In cities like Mumbai, cough lasting more than 2 weeks with symptoms of weight loss and evening rise of temperature should prompt a suspicion of tuberculosis.

Screening tests for active Tb may involve a battery of blood tests, Chest X-ray and a sputum test to prove the presence of the bacteria. Extra pulmonary lesions may warrant a biopsy.

Medication and Treatment Adherence:

The microbiologic tests confirm the presence of TB and the presence of drug resistance too. These tests are mandatory prior to starting treatment as drug resistant tuberculosis is a problem that Mumbai physicians face as a challenge.

Drug Sensitive Tuberculosis is treated with a combination of antibiotics over a period of at least 6 months. Common first-line drugs include Isoniazid, Rifampicin/rifapentine, Ethambutol, and Pyrazinamide. Treatment adherence is crucial to prevent the development of drug-resistant TB strains (MDR-TB and XDR-TB).

Directly Observed Treatment, Short-course (DOTS):

The Indian Government led DOTS programme ensures patients take their medications correctly, provides medications for free and other assistance too.

Managing co-morbid conditions:

Co-infections like HIV or conditions like diabetes must be managed alongside TB treatment to improve recovery chances.

Nutritional support:

Adequate nutrition and exercise are essential as it can boost immunity and aid in recovery.

Strategies for Prevention

Routine check-ups or frequent screening for comorbid conditions can significantly help with maintaining the overall health of the individual. These regular health assessments ensure that any underlying conditions are detected early and managed appropriately, reducing the risk of complications.

Additionally, wearing masks is an effective preventive measure that can make sure the transmission of infections is decreased, especially in high-risk environments. Ensuring that there is enough ventilation in crowded areas is equally important to minimize the spread of airborne diseases.

Furthermore, practicing cough etiquette plays a vital role in preventing the spread of infections, particularly respiratory illnesses like tuberculosis (TB). Prophylactic Treatment- To prevent the development of active TB, people with latent TB, particularly those in high-risk groups, can be considered.

Controlling the spread of tuberculosis involves educating people about its symptoms, available treatments, and the significance of finishing the course of treatment.

Tuberculosis is a social and medical problem, which needs to be dealt with empathy; Removal of the social taboo around the disease diagnosis is important too.