Health: Pulmonary t.B. – A preventable malady

She was a young woman who came to the hospital with high fever, breathlessness and cough. The next day when doctors saw her, she was gasping for breath. The chest X-ray was done by that time and it showed both lungs damaged due to tuberculosis. It is unfortunate to see people suffering and dying with advanced tuberculosis (T.B for short) which is an entirely preventable and curable malady. T.B. is a communicable disease caused due to infection by a tiny germ called mycobacterium tuberculosis. The microbe enters human body through droplet infection. Anybody suffering from T.B. will bring out the microbes while coughing and talking. It can enter the body of a person sitting opposite, via the nose through breathing. Development of the disease and its severity depends on concentration of germs inhaled and resistance of the person. A person of any age or gender can develop pulmonary T.B. Those with reduced resistance like people with diabetes, HIV/AIDS, chronic renal failure, cancer, e.t.c., are more prone to have T.B. People whose lungs are damaged due to chronic exposure to smoke and dust like smokers and mine workers are also more susceptible. Persistent cough not responding to antibiotics, low to high grade fever more so in the evening, loss of appetite and weight loss are the cardinal symptoms of pulmonary T.B. If a blood vessel of the lung is eroded by the lesion of T.B. one brings out blood along with cough and sputum. Breathlessness occurs due to damage to the lung parenchyma thus impairing the ventilatory ability of the lungs. A person with advanced pulmonary T.B. can die due to respiratory failure. Untreated, the disease can spread to the entire lung, the other lung and other parts of the body, notably intestines, brain, bones, e.t.c. directly or via blood or lymphatics.Pulmonary T.B. should be suspected if one has the cardinal symptoms of T.B. A blood test showing high lymphocyte count and X-ray chest showing typical lesions support the diagnosis. It can be confirmed by demonstrating the mycobacteria in the sputum by microscopic examination. Treatment involves chemotherapy, i.e. taking a combination of drugs as per a fixed schedule for 6 months. 6 months is a long duration for many people to comply. Once they start feeling good after 4 to 6 weeks, they give up drugs thinking that they are alright now. The germs persisting in the body of these individuals become resistant to the prescribed medicines. Rise in multidrug resistant (MDR T.B), is a growing concern for W.H.O. Alternate or second line drugs are expensive and not easily available in small places. The concern is if people become resistant to second line drugs, what else to use for treatment? Apart from this, persistence of the infection causes further damage to the lungs. The affected individual will continue to spread the germs in the environment, thus spreading disease to any susceptible person. Adverse effects of drugs also make some persons stop their treatment or take it irregularly.Considering these problems in management and the amount of morbidity and mortality caused due to pulmonary T.B., it is important to emphasize on preventive measures. People should be sensitized about it so that out of ignorance they do not acquire or transmit the disease.Keeping a good health helps in boosting the body’s resistance. In this case even if one is exposed to mycobacteria, body’s immune system will help in containing the infection and avoid development of illness. Covering the mouth while coughing, is a simple measure which minimizes the risk of transmitting or acquiring infections like T.B.Good sunlight should be allowed inside room of the sick person as the germs are destroyed by sunlight in 30 minutes. Adequate cross ventilation in homes and work places helps to minimize concentration of mycobacteria in the environment. In case somebody is suffering from pulmonary T.B. in the house, other family members should be very particular about these hygienic measures. They have to be vigilant enough to see that the patient takes his treatment regularly. Sputum brought out by the patient should be cleaned with disposable tissue. Any soiled clothes and linen should be washed and ironed thoroughly or dried in good sunlight to kill them. All these measures taken can help keep the prevalence of T.B. in a community. E- mail-rachna212002@yahoo.co.uk