Early detection of TB is key to epidemic management

After running a fever for over a month, Seher Mohammed, 25, was asked to undergo a test for tuberculosis (TB) by her physician. When she tested negative in the sputum test, the Jogeshwari resident heaved a sigh of relief, and thereafter refused to undergo further tests to confirm she doesn't have the bacterial infection.

“I tried to convince Mohammed to get a chest X-ray done to completely rule out TB, but she would not listen. Finally, when an ambulance from a charitable trust was taking sick people from the area for tests, she decided go along for an X-ray,” said Namrata Ranpise, a health worker with the Rangoonwala Trust, an NGO that assists TB patients. Mohammed’s X-ray confirmed that she had TB, and she was immediately put on treatment. Diagnosing TB is one of the biggest challenges, according to public health officials. Last year, only 60% of those put on TB treatment in Mumbai tested positive for the disease in sputum tests, according to annual report of the Revised National TB Control Programme (RNTCP). A sputum test is normally conducted twice. “Sometimes both tests are negative. We then start treatment based on symptoms. If none of the other antibiotics or anti-malaria drugs are effective, a doctor can start TB treatment as per the RNTCP guidelines,” said Dr Yatin Dholakia, technical advisor and honorary secretary, Maharashtra State Anti TB Association, Sewree.

“A pulmonary TB patient can infect 15 others, but once a patient is put on treatment, the infection does not spread. So, it is important to detect the infection as early as possible for effective epidemic management and prescribe specific medication as the treatment is quite painful [owing to side effects],” said Dr Bobby John, executive director, Global Health Advocates India, a network of medical professionals.

Since the sputum tests are not 100% accurate, doctors use other diagnostic methods such as chest X-rays, bronchoscopy and culture tests. However, one test that has drawn the ire of health activists is the serology (blood) test, administered to 1.5 million suspected TB patients every year in India, according to a notification issued by the Central TB Division. In July last year, after the World Health Organisation (WHO) declared that these tests are unreliable, the division issued a notification stating they should not be used for TB diagnosis. However, doctors say they are routinely conducted.

Serology tests can falsely show a patient to be positive for TB. “This can lead to needless medication. It can also be false negative, which is worse as patients then go untreated and infect others,” said Dr Shelly Batra from the Stop TB Partnership, a non-profit organisation.