From the World of Medicine
FREQUENTLY ASKED QUESTIONS ON TUBERCULOSIS
Dr. Christi Dominic Savio, Head, Department of Pediatrics

The World TB Day was observed on 24th March 2005 all over the world. The slogan for this year is Fight AIDS, Fight TB, Fight now highlighting the alliance formed by AIDS and TB in the infamous task of killing people in their prime and the urgency required in stopping this unholy alliance. The following are some of the most commonly asked questions regarding tuberculosis in general and specifically in children.

Fight AIDS!

Fight TB!

Fight now!!

§   2 Million people die from TB every year.

§   One-third of the human race – 2 billion people - are infected with TB bacillus

§   More adults die from TB than from any other infectious disease in India.

§   More than 1000 people die of TB every day (one person every minute) in India.

§   TB is the commonest cause of death in people with AIDS.

What are the common symptoms of tuberculosis?
The common symptoms of tuberculosis of the lung are cough lasting for more than 2 weeks, fever, night sweats, loss of appetite, loss of weight and coughing of blood. However, not everyone who gets infected with tuberculosis show the symptoms. The infection can remain silent or latent for many years.

What causes tuberculosis and how does it spread?
Tuberculosis is caused by a bacterium called Mycobacterium tuberculosis. It is spread through droplets that come out when people with TB of the lung cough, sneeze or talk. These droplets contain the TB germ and when other people breathe in this infected air the TB germ enters their lungs establishes the infection. People in the same household are more likely to get infected since they are exposed to these infected droplets for more prolonged periods.

What is primary complex?
Primary complex is the term used to describe the commonest form of TB seen in children. This occurs when the child is exposed to the infection for the first time.

Can a child with primary complex spread the infection to other children?
NO. The number of TB germs present in a child with primary complex is very less. Hence the chances of the child spreading the infection to other children is extremely small. Usually the child gets the infection from an adult who has TB of the lungs.

Does a child with primary complex need treatment for TB?
Yes. The child with primary complex needs to be treated for a minimum period of six months. If left untreated the TB can spread within the lungs causing a progressive disease an more importantly can spread to other parts of the body including the coverings of the brain which is very dangerous form of tuberculosis.

What are the dangers of not completing the full course of TB treatment?
There are two dangers associated with not completing the course of treatment. One obvious effect is that the patient does not get cured of the disease. The disease is suppressed for sometime because of the initial treatment. But when the treatment is stopped prematurely the disease comes back with a vengeance. The second and a more serious and disastrous effect is the danger of emergence of multi-drug resistant tuberculosis.

What is Multi-drug resistant tuberculosis (MDRTB)?
This is a form of tuberculosis caused by TB germs that are resistant to commonly used anti TB drugs. Hence this type of TB does not respond to many of the commonly used anti TB drugs like Isoniazid and Rifampicin. This type of TB requires treatment with second line drugs that are prohibitively expensive and far more toxic. Most of us will be unable to afford treatment with these drugs. Thus for the common man infection with MDRTB is tantamount to receiving the death sentence.

What is DOTS?
DOTS stands for Directly Observed Treatment - Short Course. In the past the responsibility for treating TB rested on the patient and his relatives. The patient had to come to the hospital or the health center and obtain the TB medicines which were often in short supply or were of dubious quality. Also the duration of treatment was long – as long as 18 months. All this resulted in the patient not completing the full course of treatment with disastrous consequences as outlined above. But the establishment of DOTS programme has revolutionized the treatment of TB. In this programme, treating the patient becomes the responsibility of the health system. The health worker gives the patient high quality TB medicines and makes him or her swallow the tablet in his presence thus ensuring that the patient takes the treatment. The duration of treatment is also reduced to just about 6 to 8 months. This ensures that the patient completes the full course of treatment. DOTS has been a great success and has become the most cost-effective way of eliminating TB from the population.

MAKE EVERY MOTHER AND CHILD COUNT

This is the theme for the World Health Day 2005 which will be observed on 7^th of April. More than half a million women die during pregnancy and child birth every year throughout the world and nearly 11 million children die before celebrating their fifth birthday. The WHO wishes to make the world aware of this grave problem and find out ways of reducing it on a war footing.