Tuberculosis remains one of the most important and leading causes of morbidity and mortality throughout the world and is often termed as the disease of the poor.
It is caused by a bacterium called Mycobacterium tuberculosis and it spreads from person to person. There are active treatments but if left untreated it can be fatal.
The fate of tubercular infection into disease depends upon the person’s immunity. About 75 percent patients are in the age between 15 and 54 years.
About 40,000 persons are newly infected each day of which 5,000 become diseased and about 1,000 die. A sputum positive lung TB patient who is not taking treatment produces 10-15 new TB patients in a year, if left untreated.
To control this deadly disease, efforts are going on by World Health Organization (WHO), The Union, TB partners, other international agencies and the countries’ national programmes.
India also has the Revised National TB Control Programme (RNTCP). After its inception in 1997, it has covered the whole country in 2006 with the aim to stop the morbidity and mortality, to reduce the development of resistance (MDR-TB and XDR-TB), to stop the chain of transmission of aerosol infection and hence to control the disease.
To achieve the aims and objective of the national programme, it should run in an effective and strict manner.
New case detection rate more than 70 percent and cure rate of more than 85 percent remain the important objective.
That is achieved with the Directly Observed Treatment, Short-Course (DOTS) with adherence.
Every patient should be properly counselled regarding disease transmission (airborne infection) and at any level of default, either by health workers, technicians, drug supply or by the patient, which lead to development of failure to treatment and development of resistance.
The resistant tuberculosis is a real challenge that has emerged these days across the world and WHO data of multi-drug-resistant tuberculosis (MDR-TB) and extensively drug-resistant TB (XDR-TB) throughout the world is very much alarming.
According to WHO global TB report 2014, there are 5 percent TB cases that are estimated to have MDR-TB with prevalence, in new cases of 3.3 percent and previously treated patients 20 percent.
An estimated 210,000 people died of MDR-TB in 2013. However, the highest level of MDR-TB is found in Eastern Europe and Central Asia.
About 60 percent of MDR-TB cases occur in Brazil, China, India, Russian Federation and South Africa. XDR-TB has been reported by 100 countries. On an average, 9 percent of MDR-TB has XDR-TB.
The resistance to Rifampicin along with Isoniazid is MDR-TB and when resistance to any fluoroquinolone and any one of the second-line injectable drug is also present, and then it is called XDR-TB.
Standards of TB care in India guidelines have to be followed strictly when the patient is managed outside DOTS programme.
After the infection, its progress into disease depends upon person’s immune status. If the immunity is less at any point of time in life, the TB infection progresses into a disease.
Diabetes, if, is persistently uncontrolled, causes decline in immunity and increase the probability of TB infection into disease. Diabetes is a non-communicable disease ranking 5th in the world.
This disease is rapidly increasing in the developing world, including India and the total number consists of 366 million in 2011 which is expected to rise to 522 million in 2030.
Out of all, 80% diabetics come from lower and middle-income countries. The majority of patients are of age 40 to 59 years.
China ranks number one, comprising 90 million patients while India holds the second position with 61 million. America comes third. 90 percent are type II diabetics (maturity onset).
The reason of diabetes in India is the change of lifestyle and food habits particularly in middle-class population and also predisposed by Asian-Indian phenotypes.
In uncontrolled diabetes, the immunity declines due to decline in function of monocytes, macrophages and lymphocytes and defective granulocyte chemotaxis and phagocytosis.
So chances of getting infected with TB increase by 2.5 times. So every patient with diabetes and TB should have strict sugar control for successful treatment outcome of TB disease.
This is also seen throughout the world that the patients suffering from TB also have increased tendency to develop diabetes mellitus. So during the treatment of TB, regular monitoring of blood sugar levels is mandatory.
In uncontrolled diabetes, the treatment duration of tuberculosis is prolonged and the TB is difficult to treat, leading to increased morbidity and mortality.
(Dr. Tariq Mahmood, MD, is an associate professor and head of the department of pulmonary medicine at Moti Lal Nehru Medical College, Allahabad. Email address: firstname.lastname@example.org )