Tuberculosis is surging and it is no longer a malady of the poor or ladies. Urban
lifestyle is one of the reasons why the epidemic is now spreading among affluent and young Indians
(men and women both).
Aishwarya Rai shot into the news exactly at this time last year. Bollywood's leading lady was down with abdominal or genital tuberculosis (TB) and it was stopping her from becoming a mother, reported the media. Her star-studded family issued vehement denials served legal notice and demanded public apology. In that bitter war of words, what got lost was the issue: that TB, once considered a malady of the poor women, could invade the high and mighty women of this country.In 2011, with the World TB Day on March 24 each year -the buzz is: TB is going upscale. Mind boggling figure of tuberculosis are reported by gynaeologists and physicians. In Delhi hospitals, TB patients from higher income families have doubled in the last three years. Kolkata reports a new type of TB patient- professionals, business owners, affluent housewives. The talk among chest physicians in Bangalore is about the 25-35 year I.T. -old techies filling up their chambers. Mumbai medics are worried about the influx of educated, difficult-to-manage, TB patient population (India today 14th March 2011).
Infertility experts in India find it a silent disease. Only manifestation is infertility and relatively scanty periods. But patients from upper class yell at doctor's and crib that diagnosis must be wrong……Denial is routine among our patients, 50 percent of whom are from higher socioeconomic strata, Over 50 percent are working women or professionals. Most feel disgraced by the TB stigma. In last 3-4 years, TB number in Infertility cases has tripled in our practice. Other expert's statistics stand as a grim reminder of the ever-present danger posed by genital TB. What strikes we gynaecologist about genital TB in India, is not just infertility (25-40%) and scanty periods cases (30%), we find surprisingly genital koch's in 20% of chronic pain in abdomen cases and women with post menopausal bleeding.
It is a fact there's a resurgence of TB around the world, with India accounting for one-fifth of the global burden, says the World Health Organization. Till now, tuberculosis was number one cause of death in women; now two deaths occur every three minutes from TB One of the biggest causes of mortality in India. Not only does TB remain a killer disease but it is mutating in to deadly forms: multi-drug resistant (MDR) and extremely drug resistant (XDR) strains.
Although two millions Indians are diagnosed with TB every year, over 40 per cent are believed to have hidden, latent germs just waiting to get active. Globally, if one in 10 with dormant TB actually becomes sick, in India the ratio is one in three. The disease creates a three billions dollar drag on Indian growth, reports the world bank (India today 2011).
Conventional test (Mx test, x-ray chest, raised ESR, AFB C/S) are not giving the diagnosis in 80% cases. Most of test used in Indian doctors are PCR or antibody-based blood tests that are not approved by WHO,. The WHO has sounded out an alert against these. Yet Indian doctor's use them liberally to make the diagnosis, so the doctor can start the treatment. Magic is seen inform of relief i.e. quick pregnancy, clearance of lesion in chest or lymph node etc. Good news is around the corner. After a long wait, four new vaccines are in late-stage of trials. A dozen different drugs are in the pipeline. And a brand new molecular diagnostic, Xpert, is shaping up as the game-changer in the fight against TB by providing early diagnosis. By amplifying the DNA of the TB bacteria, it can diagnose 98 per cent of active cases in just 90 minutes. Soon it will be available in metros in India.
