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Beating the Bacillus - World Tuberculosis Day
By Dr Edmond Fernandes
Dr Edmond Fernandes is a House Surgeon and Medical Journalist at Father Muller Medical College Hospital, Mangalore. He can be reached at: edmondvirgo@gmail.com

March 24, 2013

24th of March is known as World Tuberculosis Day, but the effort to communicate ways and means to comprehend how this disease affects us and what are the ways in which we can prevent the spread on a larger scale has to be magnified. Have you come across some people coughing in the bus or train while travelling? This question does not raise a pointer to suggest that the person may be suffering from Tuberculosis, but nevertheless it cannot be absolutely ruled out. It is true that common cold and cough is perhaps the last thing medical science will ever conquer, but it’s always good to be sound about the possibilities within.

Tuberculosis as a disease has many dimensions and often so it creates a scenario where complications occur. But it fascinates to know and realize that there are treatment protocols which simply need to be followed and it is because of this protocol following failure which increases the disease burden and causes treatment failure. Patient compliance plays saviour during the treatment too. A study thesis of a person known to me, pointed out that in a small defined area of Udupi, there are more than 38 regimens of treatment being followed by different doctors. This is a matter of growing concern to the medical community and also it’s something the patients should be aware of. There are other contributing factors of why it happens, but the fact that the guidelines laid down by RNTCP( Revised National TB Control Program) is being ignored paints a sorry shape to the whole story, in the bargain we sometimes may lose the battle against Tuberculosis.

Tuberculosis is caused by the infection Mycobacterium Tuberculosis of which the majority of cases occur in developing and poorer nations of the world. It is important to note that this infection occurs by inhalation of droplets from infected patients. This triggers series of changes in the lungs and begins the war towards destruction. The starting symptoms may be evening rise of fever associated with cough; there could be weight loss and general debility. Often it may go unrecognized for some days and may remain without any symptom which makes the diagnosis difficult. The global burden of Tuberculosis is more than one third of the world’s population and the efforts to reduce this are becoming a difficult battle. The complexity of this disease manifesting with other diseases is on the rise and it is seen in patients suffering from HIV and other immune-compromised states.

Dr Prashant Bhat, World Health Organization, RNTCP Consultant says that,  “Tuberculosis is  a major cause of worry and studies point to suggest that TB care is abysmally poor in meeting international standards protocols. There is a need for private practitioners to stick to set treatment pattern rather than give treatment as they feel like.”

The moral of the story which I intend to tell you is that Tuberculosis as a disease is perfectly and completely curable provided the medications are taken strictly without any compromise. It is requested not to follow Dr Google in this day of information overload as it may only end up confusing you more than convincing you.  A safe bet is to approach your doctor and stick to the advice he has to say.

It is my belief that if we stick our neck deep with RNTCP laid down guideline protocols and not experiment with the guidelines, we may not be able to wipe out Tuberculosis burden and its complications completely, but we can certainly create a better world to live in.

 

 

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Comments on this article
Clifford, MangaloreFriday, March 29, 2013
Congrats Edmund ! Well written !! God bless !!!
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Rudolf Rodrigues, Mangalore/MumbaiFriday, March 29, 2013
@Sammy you are very right a good nourishing diet along with the requisite treatment is a must in driving away this disease!! Also, TB has no chance to attack a healthy person only when his immunity weakens due to unhealthy diet, stress, etc. does it gain entry into the human body just like any other infection!! If it was to be acquired so easily as mentioned then every second person in a highly cramped city like Mumbai would have fallen to TB!!
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Sammy, MangaloreFriday, March 29, 2013
Just to add on to the discussion....Someone had mentioned nourishment and immunity.......a highly nourishing diet is a must for TB patients-you have to literally pull out all the stops and not worry about trivial issues such as weight gain. Eggs, milk, fish, meat, fruits and vegetables on a daily basis is a must. The more high protein the better.Also patients exposed to Vitamin D recover much faster so at least half to one hour of daily sunshine exposure is a must. And there's another aspect that many patients don't talk about-depression. Every patient faces it at some point or the other. Involving yourself with work and family and friends can avoid this. I was lucky to experience all this but its really hard to imagine a patient from a BPL family able to afford even a single nourishing meal.
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Jessy Rodrigues, Milagres/DubaiThursday, March 28, 2013
Well Done Dr. Edmond. Very informative article. Keep writing more and more. God bless U
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Dr. Prashant Bhat, Thursday, March 28, 2013
Dear Rudolf,

Yes, zoonotic vectors are sources of bovine tuberculosis. But mostly these result in extra-pulmonary TB which are usually not infectious, low on incidence and prevalence, hence not of public health importance. Also most of the time these are non-tuberculosis mycobactial diseases (TB like disease but not TB) resulting in much complexities in diagnosis as well as treatment.

Edmond, good article again! cheers!!
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Irene, BangaloreWednesday, March 27, 2013
Good article Dr. Fernandes.But sad part is people do not know that TB is curable, once they come to know of sickness they run from pillar to post, from one doctor to another and the doctors too do not give proper advice to the patient. May be because they do not want to loose the patient. Govt hospital in Udipi is doing a wonderful job. I know someone was referred there by looking at the news item in the news paper and that person is completely cured.I can say for sure RNTCP regime is surely working, thanks to the staff at Udipi Govt hospital. Their doctors, their follow up staff are excellent.
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Rudolf Rodrigues, Mangalore/MumbaiWednesday, March 27, 2013
Very informative article by Dr. Edmond, but nowhere the mention of zoonotic vector which is one of the most important factor?? Also on nourishment and increasing the immunity to prevent?
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Sammy, MangaloreWednesday, March 27, 2013
Thank you for this article Dr. Edmond. I have had this disease but have recovered from it so yes it is 100 percent curable. It took a period of nearly one and a half years though. One should remember that the cure is worse than the actual disease itself but the end result is amazing. Come what may strict drug compliance is a must. At one time I remember driving around town at 10 pm searching for a particular drug because I had run out of it. Looking back,it was all worth it and I'm glad I didn't miss even a single night's dose.
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Dr Roshan Pinto, Mangalore/ NiddodiWednesday, March 27, 2013
Good article Dr Edmond and it gives good awareness regarding treatment protocol to eradicate TB. All the best.
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Blaan Mendonca, USATuesday, March 26, 2013
Majority of the people in India are Positive to TB Test. This is an infectious disease and can be easily transmitted from one person to another without any signs and symptoms for a long period of time. The health care workers such as nurses, doctors, caregivers, house keeping, food suppliers are the most who are infected who do not wear mask, gown while giving care to the patient. The rooms are not isolated. Visitors have no knowledge or education of TB disease. Patients who are admitted to hospital are not screened for TB and get admitted in the General Ward with other patients. TB disease is so infectious that it can be transmitted so easily through lets in the air when the TB patient talks, shouts, screams, laughs, coughs. People who work in tobacco industry are highly vulnerable because of the radiation in the tobacco and the whole family gets infected. Infection caused by TB Patients who travel with the other passengers in any mode of transport.
Prevention is the only solution by Mandatory screening of health care workers every year, Employers who recruit employees must ask mandatory TB Test. Education and spreading knowledge in schools, colleges, hospitals, movie theaters, work place, Worship places, tourist spots, transport system and ration stores is very important to make the public aware of TB disease.
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Ravi Kotian, PadubidriTuesday, March 26, 2013
The article is great. But I note that TB is not 100% curable. It can only be managed. I'm I right ?

Do the Govt. Hospitals like Wenlock manage poor TB patients free with medicines ?
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Dr.Nagesh.KM., Kolar/UKTuesday, March 26, 2013
This is very nice article. It is very true that RNTCP guidelines are rarely practiced by Pediatricians in a private sector to treat the childhood tuberculosis. Many of them are not convinced with DOTS,hence sticking to the old and personalized regimens. This is the reason for the lack of uniformity in TB treatment in children.The RNTCP sould come up with accuate data and studies about efficasy and safety of DOTS in children to convince all to maintain uniform treatment,a big leap towards eradication.
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Dr Edmond - Rejoinder note, MangaloreTuesday, March 26, 2013
Ronny,

Sputum analysis is a mandate and a mantoux test could be done, but it would not be advisable to do a blood test b4 you visit your doctor, unless you wish to make the path labs rich. for all you know, it may be a simple viral fever and cough . go stepwise. should you need anything , feel free to shoot a mail
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Edward, MumbaiTuesday, March 26, 2013
Cong. Good Article on TB.
wish you all the best n keep writing more and more
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Gilroy, MangaloreTuesday, March 26, 2013
TB is caused by Mycobacterium Tuberculosis, which is a bacterium not infection. MDR TB is caused not only by abuse and misuse of antibacterials, but also not using the antibacterials for the recommended period of time.
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Ronny Crasta, MangaloreTuesday, March 26, 2013
Is there any particular blood test to be done before visiting a Doc for possible TB ? This could same some time.
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Dr Loreene Kish, UKMonday, March 25, 2013
wonderful article to educate the readers, Good work Dr Edmond.keep writing, God Bless you always
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Dr. Vivian R. D' Almeida , assistant professor , dept of orthopaedics , FR. MULLER MEDICAL COLLEGE, , MangaloreMonday, March 25, 2013
Good job doc. Keep it up. The medical world is way different from how we professionals see and how the lay people see, so it is upto us to take the responsibility to educate the people about the truths and myths of medical science . Cheers!
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Sr.Hilda Albuquerque, Nympha SadanMonday, March 25, 2013
Dear Dr.Edmond,
Congratulations! Very good article which creates awareness and a new hope in the lives of the people.

All the best.God bless you in all your programmes.
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Ivan Saldanha-Shet, Mangalore-RosarioMonday, March 25, 2013
Namaskar Dr.Ed! Good effort keep it up and move forward. Don't neglect people contact in this process.
ALL THE BEST! -ijss.
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Rajesh Kumar, UdupiSunday, March 24, 2013
Thanks Dr Edmond , I always look forward to your writings. nice to know that you are educating citizens on medicine and please begin giving talks too, my suggestion.
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Preethi, Sunday, March 24, 2013
Hello Dr. Edmond,
Very well article on TB. Health awareness building articles are required Today...
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Dr.Rouchelle Tellis, Assistant Professor, Microbiology, Yenepoya Medical College, Deralakatte, Sunday, March 24, 2013
Congratulations Dr.Edmund, as you have aptly said strict adherence to RNTCP both by the treating physician and the patient can cure TB. Currently problem of Multidrug resistant TB (MDR)has gained momentum mainly due to antibiotic misuse and abuse. Patients with respiratory symptoms are OFTEN put on a course of antibiotics without complete evaluation, some of them which are actually the second line drugs for treatment of TB. This will naturally perpetuate resistance among TB bacilli. I feel there is a need to time and again educate the general public and the medical fraternity about the importance of adhering to the RNTCP regime.
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Dr Urban D'Souza, Udyavar/MalaysiaSunday, March 24, 2013
Congratulations to Dr Edmond. Around 2 billion people in the World are estimated as TB carriers. Korea has the highest incidence of TB. Korea has initiated a zero TB movement in the World under the organization, “GENERAL HEADQUARTERS OF THE WORLD FOR ZERO TUBERCULOSIS MOVEMENT”, named it as ZERO TB WORLD. The main office is located in Seoul, Korea and it has branches home and abroad. It was established on November 22nd, 2004, focusing on North Korea. They also support lot of research related in eradicating it from South East Asia. Here in Malaysia my medical school received funds from Korea to take up research in villages and it is under progress with good results.
Dr Edmund keep up the educational write up to the society and God bless
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