Does TUBERCULOSIS Always Lead to Death?

A middle aged thin, lean, weak, lethargic and feverish man (who is mostly ‘the only’ earner of a large poor family) lying in a corner of the courtyard of house, coughing with short intervals and spitting sputum around which is often blood stained, is usually a constant character of the most of our low socio-economic families. The symptoms are clearly pointing towards tuberculosis; though confirmation of diagnosis needs isolation of Mycobacterium tuberculosis in specimen from patient.

Mycobacterium tuberculosis most commonly affects the lungs but it can affect almost any tissue of body like spine, kidneys, brain and intestines; irrespective of gender. It is the leading cause of death worldwide from a bacterial infectious disease.

The disease affects 1.8 billion people per year, which is equal to one-third of the entire world’s population. WHO states that in 2010, 8.8 million people fell ill with TB and 1.4 million died from TB. Over 95% of deaths related with TB occurred in low- and-middle-income countries.

It is transmitted from the throat and lungs of people with the active respiratory tuberculosis to others via air-borne droplets. When affected people cough, sneeze or spit, they propel the TB germs into the air. A healthy person needs to inhale only a few of these germs to become infected.

LATENT TB

The disease might also exist in many people in the latent form; which means people have been infected by the TB bacterium but have not fallen ill as yet. This protection comes from a healthy immune system of the person which effectively walls off the causative organism. The efficient immune restricts the multiplication of the organism as a result of which, the person with latent TB cannot transmit the disease to others.

ACTIVE TB

The other form of the disease is active one. When a person develops active TB, the characteristic symptoms as mentioned at the outset (cough, fever, night sweats, weight loss etc.) develop, but they may remain mild for many months. This can lead to delays in seeking care, and results in transmission of the bacteria to others. People ill with TB can infect up to 10-15 other people through close contact over the course of a year. Risk factors that enhance the chances of contracting this infection include poor nutrition, alcoholism, drug abuse, other systemic diseases like diabetes and specially AIDS. Without proper treatment up to two-thirds of people ill with TB will die.

TREATMENT

Fortunately this debilitating disease is treatable and curable. For Active tuberculosis, drug-sensitive TB disease is treated with a standard six to nine months course of four antimicrobial drugs that include isoniazid, rifampicin, pyrazinamide, and ethambutol; where all the four drugs are taken for initial two months and isoniazid and rifampicin alone for a further four months.

For Latent tuberculosis, the standard treatment is six to nine months of isoniazid and rifampicin.

To complete the course with proper dosage of drugs is very important; deficient dosage or irregularity can leave viable drug resistant bacteria behind in the body. A large number of pills to be taken simultaneously for such a long duration definitely reduces patient’s compliance and it really needs proper supervision and support yet treatment adherence can be difficult and the disease can spread.

Myrin-P is the formulation that combines recommended doses of the aforementioned four drugs in a single tablet. It markedly raised the compliance and hence curability of the disease. Yet the long duration is a problem.

Health care providers in the United States have outlined a new way to treat Latent tuberculosis infection. According to recommendations released by the Centers for Disease Control and Prevention administration of a new 12-dose regimen for TB preventive therapy will significantly shorten and simplify the course of treatment from about nine months to 12 weeks.  The recommendations are based on the results of three clinical trials, as well as expert opinions.

The new regimen consists of 12 once-a-week doses of rifampicin and isoniazid.  This shorter and simpler regimen has been found as effective in preventing and curing the disease as the older nine months course. Yet the doses should be taken under the supervision of a health care worker to ensure completion of doses.

There is hope that such simpler and better regimens might be designed for Active form of TB too in near future and that the affected poor population of the third world countries might be having easy access to those regimens for a better and healthier life.

The writer is an assistant professor of Anatomy at King Edward Medical University, Lahore.
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