TB cases rise in Pune, need to look beyond lungs to eliminate TB, say experts
Extra Pulmonary Tuberculosis (EPTB) cases constitute 40% of the total Tuberculosis (TB) cases reported in the city in the past four years
As Extra Pulmonary Tuberculosis (EPTB) cases constitute 40% of the total Tuberculosis (TB) cases reported in the city in the past four years and the number continues to rise, it is high time for the health department of the Pune Municipal Corporation (PMC) to look beyond just lung disease to eliminate TB from Pune. The importance of this cannot be emphasised enough given that the Government of India (GoI) is working towards eradicating TB by 2025 with newer vaccines and shorter courses of treatment, and a rise in EPTB cases will only jeopardise these efforts.
Dr Prashant Bhote, chief Tuberculosis officer, PMC, said that there has been a surge in EPTB cases but it is also because CT scan and MRI tests are now used for diagnosis. “Most of the EPTB cases are constituted by TB of the spine and lymph nodes. However, the momentum was lost due to the Covid-19 pandemic. Now, we must focus on prioritising the health system and investing in TB prevention, detection and treatment,” Dr Bhote said.
Tuberculosis is an infectious disease caused by Mycobacterium Tuberculosis, which spreads when an infected person expels the bacteria through the nose or mouth. The disease mainly affects the lungs but can also affect other parts of the body. When the bacillus affects other parts of the body, it is called EPTB and in fact, EPTB can infect virtually every other organ in the body. Of the 28,373 TB cases reported in Pune in the past four years, 11,318 are EPTB cases, according to the PMC. According to the World Health Organisation (WHO), India is one of the countries with the highest burden of TB in the world. At PMC-run hospitals, treatment for TB is provided free-of-cost. All TB patients diagnosed at government or civic hospitals are included in the National Tuberculosis Elimination Programme (NTEP). As poverty and malnutrition are significant risk factors for TB, these patients get Rs500 per month for nutritional support during the treatment period under the Nikshay Poshan Yojana.
Dr Bhagwan Pawar, health officer, PMC, said that TB is curable with medicine, but can be fatal in people with poor immunity like patients suffering from Diabetes, Kidney disease and HIV among others. “Lack of awareness about the social stigma attached to TB is one of the significant challenges for TB control and we are working on it. Drug-resistant TB, a severe form of TB, is another challenge which requires prolonged treatment and many patients stop taking medicines in between which is wrong. People should go for a few routine tests if they suspect any abnormal weight loss, cough, night sweat and fever. All tests and treatment are provided free-of-cost at PMC hospitals,” Dr Pawar said.
Dr Bhote further informed that EPTB among the upper-middle class has emerged as the newest health challenge as members of this class remain in denial about TB, contracting the infection mostly from a migrating population. “These people take treatment in private hospitals. In urban cities like Pune, upper-middle class populations that are healthy and have good immunity do not show early signs and symptoms of TB. In such cases, maids, house helps and cooks are the source of infection. The reason for rapid transmission of TB among members of this class is that they live in congested apartments, closed spaces and housing complexes that are poorly ventilated,” Dr Bhote said.
Whereas health activist Sharad Shetty said, “When it comes to the EPTB challenge, there is a need to bring in experts from different specialties such as Orthopaedics, Ophthalmology, Neurology, Gastroenterology etc. to work together. Otherwise, specialised doctors remain restricted to their own specialties and rarely get a chance to interact with each other when it comes to TB. Each specialty remains oblivious of the insights gained into the diagnosis and management of EPTB by other specialties. Bringing these specialists together will help in early diagnosis and treatment of TB and eventually prevent further spread of the disease.”