One cannot remain complacent to dreaded disease like tuberculosis that has the potential to wipe out the entire population. One cannot remain complacent to dreaded disease like tuberculosis that has the potential to wipe out the entire population.

Some time back, wife of a physician friend of mine coughed out massive amount of blood from her lung that left her choked to death in no time. This lady had received a full course of supervised treatment for pulmonary tuberculosis almost 15 years ago and was apparently normal without any forewarning of an impending doom. This is not an isolated incidence of tuberculosis striking a fatal blow like a bolt from the blue. In India, TB kills more adults than any other infectious disease with reported 2.2 lakh deaths in 2014 and one death occurring almost once in 1.5 minutes. These unfortunate ones succumb unheralded while few selective deaths in the country due to other reasons become breaking news. Tuberculosis, known to mankind since antiquity is the Captain among men of death even in this era. This consumptive disease, a slow killer, mimics many diseases and can remain undetected with a propensity to sting lethally while silently infecting many in the community.

For several centuries TB remained a mystery to the mankind and affected all strata of the society including some famous artists, thinkers and philosophers with consummate ease. Unfortunate victim then was condemned to solitude of sanatorium far away from one’s kith and kin while spending rest of the life in repentance for alleged wrong karma that attracted King’s curse or wrath from the heaven, that was presumed to cause this deadly scourge in those times. The discovery of a tiny bacillus namely, mycobacterium tuberculosis as a causative agent for TB, by the famous German Scientist Robert Koch in 1882 not only demystified the disease but also laid the scientific foundation for developing precise diagnostic methods and potent chemotherapeutic agents during last century which continue to remain the mainstay of the treatment even today. Remarkable discoveries of potent anti-TB drugs by many scientists including Dr. Waksman who used streptomycin in the treatment of TB in 1944, saved millions from jaws of death and enabled them to be back in the main stream from the stillness of sanatorium with a renewed vigour. It became amply clear by the latter part of the last century that only proper treatment by anti TB drugs matters and the deadly disease can be effectively cured by regular intake of some potent anti-TB drugs given in combination under the direct supervision for 6 months (DOTS).

As we celebrate World Tuberculosis Day on 24 March each year to mark Robert Koch’s epoch making discovery of tuberculous bacillus, there is a great deal to ponder about our failures to stop TB from spreading despite several path breaking advancements in the diagnosis and therapy, before we embark upon the herculean task to eradicate it totally from the community. After the initial scientific triumph came a doom due to a dramatic change in the behaviour of tuberculous bacillus hitherto fore malleable and highly susceptible to scientific onslaughts. It became wild, potent and mighty than before to survive and spread with impunity owing to the development resistance to potent anti- TB drugs. This rabid immunity of the bug to anti-TB drugs in the affected patient is virtually a death warrant with stark realities of an impending doom of pre-chemotherapy era.

Occurrence of drug resistant tuberculosis is essentially a man- made disaster that is contributed mainly by the complacency of the health care provider and fueled by HIV pandemic, that compromised body immunity to fight TB. The deadly duo of TB and HIV that affected mostly youths spread like a wild fire to engulf the entire community in a short time in several parts of sub Sahara Africa in late eighties and nineties. These dramatic events sent alarming signals to the world community to wake up before it became too late to salvage from a point of no return. WHO in 1993 declared TB pandemic a global emergency and warned the world that the time bomb was tickling fast for the massive explosion to happen unless urgent measures were undertaken to diffuse the crisis. Despite these red alerts and concerted efforts by public agencies to control TB by augmenting resources including incorporating latest diagnostics and potent drugs in their control programme, TB continues to be here, there and everywhere.

India is the undisputed global capital of TB with an estimated 2.2 million cases of active TB out of an annual incidence of 9 million cases globally and 40% of her population harbouring latent TB infection including an estimated 2.5 million HIV cases who can develop the most dreaded drug resistant disseminated TB at any time and succumb to it in no time. What is a matter of extreme concern is that TB accounts for majority of HIV deaths and there is a large pool of drug resistant cases that can potentially infect large numbers of people in the community each year if they are not insulated and rendered non-infectious by effective chemotherapy. India with a dubious distinction of harbouring a large pool of tuberculosis including HIV co-infection and an estimated 70,000 cases of multidrug resistant tuberculosis(MDR-TB) , many among them extensively drug resistant(XDR-TB) out of half million cases globally, can become an epicentre of TB explosion in the world if urgent measures are not instituted to make TB control really effective. In this regard, Revised National Tuberculosis Control Programme (RNTCP)that was initiated by the government to cover most of the country has met with partial success in the incidence, prevalence and cure rates of tuberculosis. There is still a substantial population in this country who have no access to quality TB diagnosis and treatment.

One cannot remain complacent to dreaded disease like tuberculosis that has the potential to wipe out the entire population. Poor TB control is essentially a reflection of systemic failure to implement strictly standard scientific guidelines of diagnosis and therapy. Urgent measures are needed to reach out to everyone in the community for early detection and appropriate therapy for ensuring a cure if this disease is to be eradicated from the society, one of the millennium goal.

The recent initiative by the government of India to call to action for TB free India by involving various stake holders such as public, civil society, academia, private sector and corporate sector for reaching out to each and every one in the community is a welcome step in the right direction. This will facilitate to put in to place necessary resources for ensuring universal access to quality diagnosis and therapy at the community level. Strengthening the existing system to make it full proof to ensure an early diagnosis and cure of the disease occurring in the community is the need of the hour.

India endowed with vast technical and human resources can take a lead by making available requisite technology, drugs and human resources at the gross root level to fight TB. Make in India policy for molecular diagnostics like Gene Expert(for early diagnosis and monitoring response to therapy including resistant ones), quality TB drugs (for therapy including resistant cases)and smart phones (for creating health awareness and monitor treatment) can go a long way in augmenting TB control in India so also involving private health care for early case detection and therapy. Even in this era of XDR TB,there is no need to despair as some of these cases have responded to personalised and promotional care given under supervision in the hospitals. The existing strategies for management of drug resistant tuberculosis is to be strengthened by providing access to quality laboratory for culture and drug susceptibility testing, steady availability of quality anti TB drugs and treatment in specialised TB treatment centres. It is the time to go back to sanatorium not only for fresh air and idyllic surroundings but also for therapy under supervision till cure is achieved as being practiced even today in Indian Armed Forces. Excellent treatment outcomes observed in Indian Armed forces, comparable to the best in the world only reinforce the fact that for the cure of tuberculosis, all-encompassing personalised care is highly essential.

TB is still curable and eradication from the globe is a possibility, though appear distant with despair and gloom in some parts of the world. As so called miracle drug namely “Bedaquiline” (trade name Sirturo) has been approved by the government of India to treat MDR-TB and XDR-TB, it is now high time to realise that TB cannot be fought by drugs alone but requires comprehensive approach to address all factors related to the disease including many social issues such as alleviation of poverty, overcoming illiteracy and universal access to primary health care. Unflinching resolve to fight TB unitedly by all-encompassing approach through private and public participation is the only way forward. The failure to achieve cure is not due to science but in the art of its application.

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