Dr Gyandeep Mangal is not one to hold the view that tuberculosis (TB) spares the middle and upper class. The senior consultant in respiratory medicine at the capital's Sri Balaji Action Medical Institute recalls a 22-year-old call centre worker who came in for treatment a few months ago. The patient had taken antibiotics for a persistent cough but had not got better. The latest coughing fit, in fact, had brought out sputum with blood in it. "He was diagnosed with TB in the lungs," says Dr Mangal.
A bad cough may well be due to a throat infection, but it is best not to take chances. The same holds for symptoms such as unexpected weight loss, persistent fatigue, fever, shortness of breath or sweating at night - they may have other causes but they should not be ignored. There is infection all around - one-fifth of the world's tuberculosis cases occur in India, about two million people being affected every year, of which around 870,000 are infectious ones, says the World Health Organization (WHO). Around 330,000 Indians die of TB every year.
Watch out for
- Persistent cough, usually for more than three weeks
- Weight loss
- Persistent fatigue
- Blood in sputum
- High fever
- Shortness of breath
- Sweating at night
The disease, caused by a bacterium called mycobacterium tuberculosis, is not, contrary to popular perception, confined to the poor. "It is not restricted to any class or stratum," says Dr Vivek Nangia, Head of Department, Pulmonology, at Fortis Hospital in New Delhi's Vasant Kunj. He makes particular mention of one section. "Middle-aged executives are very vulnerable because of their stressed lifestyle," he adds. "Their immunity levels tend to go down when they don't have enough sleep and good eating habits. The chances of TB [incidence] increase if they are smokers too."
Nor does it affect only the lungs, though that organ is most frequently hit. It can occur in most parts of the body. It spreads whenever someone carrying the infectious variety coughs or sneezes or even speaks. "The chances of contracting TB are definitely higher for those who work in fully airconditioned offices if the airconditioning duct is just recirculating air," says Dr M.S. Kanwar, Senior Consultant, Respiratory Medicine, Indraprastha Apollo Hospital, Delhi. It also spreads easily in enclosed public spaces such as a movie hall or a bus or a train.
Fortunately, TB is usually easily curable, given the right drugs, primarily Isoniazid and Rifampin. But a new variety resistant to these drugs has lately been seen as well. According to WHO, around 18 per cent of TB cases reported in 2010 were those of multidrug-resistant TB (MDR TB), which needs more specialised treatment.
"This is increasing in India, too," says Dr Kanwar. "The treatment has to be carefully followed up with continuous tests. But it is curable." However, testing facilities for MDR TB are still limited worldwide - only 20 of the 36 countries with a high burden of TB have at least one laboratory capable of carrying out 'culturing' of sputum specimens, to pinpoint whether the TB is the MDR variety or not.
In some cases, there are even more severe drug-resistant strains of TB. Extensively drug-resistant TB (XDR-TB), for instance, has high chances of mortality among patients. The only way to prevent TB is to build up immunity to it
. Proper diet and sufficient sleep are essential. "Milk, yoghurt, paneer and soyabean are good sources of proteins, which in turn increases immunity," says Dr Kanwar.