A friend of mine was recently told by her doctor to get tested for tuberculosis, or TB. Though the result came out negative, it elicited shock and disbelief from her group of friends. How can an upper middle-income individual in a metropolitan city be infected by TB?
Doesn’t TB affect people from lower income groups, especially those who are severely malnourished? But doctors, including those in private hospitals, are seeing an increased incidence of the disease in people from the affluent classes. “The number of patients from the richer classes has doubled in the last five or six years,” says Vikas Maurya, consultant, respiratory, allergy and sleep disorder at New Delhi’s BLK Super Speciality Hospital.
The reason for this, doctors believe, is the unhealthy lifestyles that people lead. Their eating habits, with the inclination for fast food, are especially flagged, for such food can compromise their immunity levels. “TB is an endemic disease — nearly 80 to 90% people in this country have a latent infection. So when the immunity levels dip, the infection becomes active,” explains Maurya.
Nevin Kishore, head of bronchology and senior consultant, department of respiratory medicine at New Delhi’s Max Super Speciality Hospital, agrees. “It was thought that TB only spread through droplets in the air. But it is important to understand that the bacteria are already inside you and only strong immunity can keep it in check,” he says. While TB has become more democratic as a scourge, it has also become harder to treat.
Almost 3% of the cases today are of the multi drug-resistant, or MDR, type, where the infection does not respond to the usual course of anti-tubecular antibiotics. V K Arora, vice-chairman at the Tuberculosis Association of India, says that it’s a myth that the rich and famous are not affected by TB.
“Look at Kamla Nehru! This disease was prevalent across classes, but yes, more prominent in lower income groups,” he says. He attributes the resurgence to negative lifestyle habits like stress, unhealthy food and smoking. “Besides, people become resistant to drugs when they don’t follow the treatment plan properly,” says Arora.
But instead of getting anxious over this troubling trend, doctors advise that certain basic steps can help reduce your chances of contracting the disease, and, if you contract it, manage it well for complete recovery.
Making matters worse
Pre-existing, chronic disorders can increase one’s chances of getting infected with TB. Diabetes patients face a high-risk of developing TB. “The poor sugar control in diabetes patients makes their bodies a breeding ground for bacteria,” says Kishore. He adds that in such cases, TB can affect other parts of the body like bones and nerves too, though pulmonary TB is most common. Maurya adds that conditions like HIV positivity, renal disease and heart irregularities can also precipitate one’s chances of being infected with TB. “Like most diseases, smokers are highly susceptible to TB and should get any persistent cough checked,” he says.
Kishore adds that young adults, especially women who go on a crash diet before their weddings, weaken their immunity and contract TB as a result. “Even students who are stressed about exams and working professionals with demanding jobs can be at a greater risk of re-activating the TB strain already present in their bodies,” he says. Sometimes, those on a weight-loss programme mistake the loss in appetite and weight as being a result of their diet plan and TB goes undetected.
A healing plan
TB can be prevented with a proper diet that helps improve immunity. “Even if people choose to diet, they should have protein-rich meals, both to prevent TB and cure it,” says Kishore. Maurya adds that any change in lifestyle that negatively impacts one’s body structure should be avoided to prevent TB. “There is a lot of stigma attached to TB and despite the disease being curable, many people delay visiting the doctor until it is too late. For this, the role of the media and community initiatives are very important,” says Arora. Doctors advise patients to visit a physician if they are suffering from persistent cough, low-grade fever, blood in the sputum and unexplained weight loss.
“Getting the patient to accept the he or she has TB can sometimes be a difficult task. Even if that happens, getting them to stay true to a treatment plan is tough,” adds Kishore. For successfully curing TB, it is imperative that there is no break in the medicine regime. “Many patients stop taking medicines once they feel slightly better.
This makes it more difficult to cure a disease that can be easily controlled,” says Kishore. It can take up to six months for the infection to be completely wiped out. For this reason, many specialised TB clinics, like the government-run DOTS programme, ensure that the patient swallows the pills given to him in front of the doctor. Those who have severely compromised immune systems should avoid crowded spaces so as to not get infected with TB, suggests Maurya.
Room for improvement
For Maurya, it is important that MDR and extremely drug-resistant TB strains be detected early. “Currently, the equipment at government clinics is not adequate for proper testing and diagnosis,” he says. “Instead of large hoardings that mostly go unnoticed, the government should involve celebrities and create awareness through mass media channels.”
Arora adds that the equipment and medical supplies at peripheral health centres needs to improve. “In order to reduce India’s TB burden on the world, we need to ensure that there be a public-private partnership to contain this endemic.” Kishore emphasises the need for adequate nutrition and awareness about food to prevent the number of TB cases from going up.