“A 37-year-old male with complaints of extreme fatigue, night sweats and weight loss with chronic cough and breathlessness.”
“68-year-old patients with high blood sugar, complain of fever, headache, neck stiffness and repeated attacks of loss of consciousness.”
“A 34-year-old male patient presented to the medicine OPD with the lower backache and paralytic features, who was recently treated for the chronic cough and weight loss”
No matter how different they may sound from each other, these can be the natural history of progression of the single disease called “Tuberculosis”. The only difference lies in the detection and treatment required in the above three cases. While the 37-year-old gentleman requires just ATT drugs, diabetic patients may need more potent and intravenous therapy owing to the diagnosis of tuberculosis meningitis.
Tuberculosis is one of the most commonly occurring diseases in the world especially in developing countries, thus causing maximum morbidity and mortality. Thus we need effective treatment modalities and vaccines so that we can eradicate the disease. But till now we have not been able to achieve total eradication of tuberculosis, which may be attributed to various causes. Three factors that are responsible for the effective eradication of any disease are, the first being the epidemiologically vulnerable disease and TB owing to its high transmission rates and non-cyclical nature, it's a non-vulnerable disease. Second is the effective treatment modalities and therapeutic
interventions that are present. As we all know that one of the factors which were responsible for the eradication of smallpox was effective vaccination against the same, but we do not have an effective vaccine against tuberculosis because, over time, Mycobacterium tuberculosis has evolved different mechanisms to invade the immune system of the host, thus decreasing the efficacy of vaccines. The widespread and unscientific use of various antitubercular therapy (ATT) may add to the resistance that is already considered one of the major factors that cause relapse in TB patients and thus aid in their persistence in nature. (1) while one reason may be the excessive use of TB drugs, other reasons can be the very expensive drugs and drugs with high toxicity that are beyond the reach of common people. Latent tuberculosis, which can become active at any point in time, also adds to the bulk of TB cases. They are even difficult to diagnose and treat, thus causing eradication of TB a remote goal at present. The third is the feasibility of elimination. (3)
Another reason that is responsible for the non-eradication of TB from the world is the increased amount of Multidrug Resistance (MDR) cases. While India harbours the largest number of MDR cases in the world, it becomes increasingly difficult to treat such patients and they offer a therapeutic challenge to the health infrastructure. Other factors responsible are lack of awareness among the masses, lack of funds, effective infrastructure and lab facilities and lack of effective knowledge and information among the people. To achieve the goal of End TB we need to address all the above issues so that the world can be made TB free. No matter how intimidating it may sound, with proper political commitment, and ensuring effective case reporting and management this can be achieved. Other things that may help to eradicate TB are effective diagnostic methods, decentralized TB services, addressing the vulnerable and hard to reach communities, universal and free access to all TB services to all the sections of people, validating the special needs of migrants and people coming from high TB incidence countries etc. Thus we can conclude that, while many countries may achieve the goals of TB control, to eradicate the disease all the above things, new to be considered and effectively need to be worked on. Special attention should be given to the high-risk population and patients with MDR and latent TB as they pose a significant risk by increasing the rate of spread and incidence and thus pushing us even back in terms of achieving total eradication of TB. Even if it is scientifically possible to eradicate the disease, many administrative, operational and social issues are there which need to be addressed before the eradication of tuberculosis can be turned into reality.
REFERENCES - 1. https://doi.org/10.1136/bmj.k3918 2. https://err.ersjournals.com/content/27/148/180035 3. https://www.sciencedirect.com/science/article/pii/S1201971216312243