The White Plague

Let's join hands in the campaign to fight tuberculosis, which plagues 23 million people in the world today

TB patientIf there is one disease on which we can only write gloomy portents, then it is undoubtedly tuberculosis. This white plague has been known to mankind since antiquity and today, more than 23 million people suffer from the active disease, with one person getting infected every second and five infected dying every minute.

With the spread of HIV/AIDS, cases of tuberculosis have also started increasing. Tuberculosis tends to get reactivated in immune-compromised HIV/AIDS patients and it is an infection that can spread from the HIV-infected to the non-HIV-infected population. In recent years, as high as 20 per cent of tuberculosis cases have been found to be resistant to many first-line anti-TB drugs [Multi Drug Resistant or MDR TB].

Emergence of resistance to even second-line drugs is also being increasingly reported [Extremely Drug Resistance or XDR TB] from many parts of the world, including India. It is estimated that about two per cent of cases may harbour the XDR TB bacilli and most cases die within months as it is not yet known how to tackle this problem.

India accounts for nearly one-third of the global TB burden with about 8.5 million active cases. It kills about 3,65,000 people every year [1000 deaths a day], more than any other infectious disease, and the annual economic burden is estimated at Rs 1,20,000 crore.

How it spreads

This debilitating, chronic illness is caused by the bacteria Mycobacterium tuberculosis, which was first identified by Robert Koch in 1882. The microbe spreads through air when an infected person coughs. The chances of getting the infection increase with increased proximity and longer duration of exposure to the infected person.

In many, the primary infection of the lungs resolves by itself, but the bacteria may remain dormant in the body. It is estimated that almost half of India’s population have been infected with the tubercle bacillus. In about 10 per cent of such infected people, the disease makes a comeback due to either a reactivation of the dormant bacteria or fresh exposure to infection. Depressed immunity due to aging, diseases such as HIV/AIDS, diabetes mellitus and smoking can increase the risk.

This secondary tuberculosis is what generally causes the classical disease, characterised by low-grade fever and weight loss, developing gradually over a period of some weeks to months. It can affect any organ in the body other than the muscles, but almost 90 per cent of the cases involve the lungs. Lymph glands, intestines, bones and joints, the genitourinary systems, brain and the meninges, the pericardium [the covering of the heart] and the skin can also be affected. Tuberculosis of the lungs results in destruction of the lung tissue and formation of a cheesy material studded with bacilli. When the person coughs, these bacilli get sprayed into the air, spreading the infection. If left untreated, a person with active tuberculosis can infect 10-15 others in a year.

Big ticket symptoms

Tell your doctor if you.

  • have no appetite
  • feel sick [nausea]
  • are being sick [vomiting]
  • have a fever for three days or longer
  • have pains in your tummy [abdominal pain]
  • have tingling in the fingers or toes
  • develop a rash on your skin
  • start to bruise or bleed easily
  • if your joints ache
  • if you fell dizzy or light-headed
  • if you get tingling or numbness around the mouth
  • if you cannot see properly [blurred or altered vision]
  • if you can hear ringing in your ears
  • if you can’t hear properly
  • if your pee [urine], tears or sperm turn orange [this isn’t dangerous, but can be strange so speak to you doctor for reassurance].

Overcoming Tuberculosis, A Handbook for Patients, Stop TB Partnership

Symptoms and detection

In many cases, tubercular infection may remain without symptoms. As the disease progresses, a low-grade fever can occur, particularly in the evenings. Some may wake up with the body soaked in night sweats. Involvement of the lungs can cause cough, with or without phlegm and sometimes result in coughing up blood. Enlargement of the glands in the neck, loose motions, back ache, blood in the urine and head ache can be the various manifestations of tuberculosis in organs other than the lungs.

In a country like India, where tuberculosis is common, the disease is often diagnosed on the basis of clinical symptoms. Anyone with persistent cough lasting more than three weeks is advised to get the sputum examined for the presence of tubercle bacilli and if needed, an X-ray of the chest. Presence of the tubercle bacilli in the sputum indicates an active, infectious disease in the lungs. Confirmation of tuberculosis in other organs may require invasive tests such as biopsy, needle aspiration or endoscopic examinations. Newer methods such as Polymerase Chain Reaction [PCR] tests may be of limited value.

The cure

Tuberculosis is completely curable if treated adequately and properly. As it is a disease which progresses slowly, the treatment is administered over a period of 6-8 months or more depending on the site and type of infection. Treatment is initiated with four drugs and after two months, 2-3 drugs are continued for the rest of the course. This is done to improve the efficacy and prevent development of resistance to the drugs in the bacilli. It is advisable to take all the anti-tubercular drugs as a single dose in the morning, preferably on empty stomach, so that all the drugs reach their peak levels in the blood at the same time.

The infective bacilli are rendered non-infective within two weeks of initiating the treatment and this fact stresses the importance of early diagnosis and treatment of the disease in preventing its spread in the community. This has also obviated the isolation of tuberculosis patients in sanatoria, practised so widely in the earlier days.

More than half of the tuberculosis patients would die if untreated. If the treatment is not done regularly or is not completed, the disease remains uncured or can recur soon. Incomplete and irregular treatment also increases chances of drug resistance. Treatment of MDR TB is possible, but difficult. Second-line anti-tubercular drugs, chosen after culture and sensitivity test of the sputum sample, have to be taken for two years or more.

Tuberculosis has become a global crisis and is threatening to grow into catastrophic proportions if urgent action is not taken. Controlling tuberculosis is the equal responsibility of individuals, families, the community at large, the government and the medical profession. Without a concerted effort, this old scourge of mankind is sure to become uncontrollable monster.

Helpful foods

Eating foods high in vitamin B12 may help prevent TB. These include:

  • Meat
  • Fish
  • Eggs
  • Dairy products
  • Wholegrain cereals
  • Beans
  • Wheat-germ
  • Green vegetables
  • Yeast extracts
  • Fortified breakfast cereals
  • Whole grain breakfast cereals [check label]
  • Some soy milks

Overcoming Tuberculosis, A Handbook for Patients, Stop TB Partnership

Srinivas Bevinje
Dr Srinivas Kakkilaya Bevinje, MD, is a Mangalore-based consultant physician. His areas of interest include metabolic medicine, infectious diseases, and community health.


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