Urban life, a cause of TB?
Films reflect the times, which is why heart attacks have replaced tuberculosis (TB) as Bollywood’s most popular killer disease. I can understand why directors don’t bother to think beyond the two. Both diseases kill lakhs in India each year and provide filmmakers the added bonus of a dramatic end.
So, instead of the old, wasted mother coughing blood before collapsing, now we have the not-so-old father clutching his chest before being declared dead — “He is no more. I am sorry” — by a solemn doctor, who surprisingly, still does home visits clutching his black doctor’s bag. (Strangely, the only celluloid heart attack I clearly recall is the very undramatic demise of Vito Corleone in his tomato garden while playing with his grandson in The Godfather).
The shift from TB to heart disease does not mean that TB is less deadly, it just indicates that it can be treated far more easily. While anti-TB drugs are all you need for treating the infection, heart disease require more a complex treatment involving medication, diet changes, and exercise, which does not go down well with most people.
Even though TB drugs are easily available — they are given free at government centres — India accounts for 3.7 lakh of the 20 lakh deaths worldwide, infecting 18 lakh people in the country each year, which is roughly two new infections every three minutes.
The reason why the Mycobacterium tuberculosis, the bacteria that causes tuberculosis, continues to thrive is because it can evade the immune response, making eradication near impossible, reports the June 2009 issue of The American Journal of Pathology. The journal reports that immune responses to tuberculosis rarely result in killing the infection as the TB-infected immune cells promote the formation of granulomas, which are areas where the bacteria are contained but not destroyed. So, despite treatment, infections exists in a latent form.
One in 10 people have latent TB infection that does not have symptoms, but may develop into full-blown disease — with symptoms of cough, weight loss, appetite loss and low-grade fever — whenever the immunity is suppressed and the body cannot fight infection. Among the leading causes of low immunity are stress, sleepless nights, smoking and crash dieting.
Over the past five years, TB in urban 18-35 year olds has shot up, with young, urban professionals accounting for over half of TB infections being treated in upscale clinics and hospitals in the metros. The disease shows a clear gender bias, with two in three patients with TB being young women, a trend doctors blame on crash diets and jobs with long and erratic timings, such as those at BPOs, hospitality and airlines.
A number of other factors also weaken the immune system, including chronic infections such as HIV, diabetes or cancers, and drugs such as corticosteroids, arthritis medications or anti-cancer drugs. Smoking is also a TB risk factor with some studies showing it can double the risk of infection.
Often, the classic symptoms of TB, such as a racking cough accompanied by sputum, is missing and people only report weight loss, loss of appetite and low-grade fever, so anyone with sudden weight loss and low-grade fever that lasts for over a month should get screened and treated for TB.