Tuberculosis remains an important public health concern in India. According to a WHO study, each day, nearly 4000 people lose their lives to TB, and close to 28,000 people fall ill with this preventable and curable disease. The reasons for such high numbers include lack of proper awareness. Medicircle is conducting an awareness series featuring eminent clinical pulmonologists, immunologists and chest physicians treating tuberculosis through which we aim to create awareness and education among the public about the symptoms of the disease and also the impact of TB around the world.  

Dr. Jayalakshmi T K is a Pulmonologist with over two decades of experience in the medical field. She has authored and published many research papers on tuberculosis. Dr. Jayalakshmi has also received many prestigious awards like Dr. C.P. Mohanty Award and Gold medal for standing first in DETRD, Hermes European Diplomate Award. She has been awarded a fellowship at Bronchocon 2014 from the hands of Dr. A P J Abdul Kalam.

Great Experience of Receiving Award from Dr. APJ Abdul Kalam 

Dr. Jayalakshmi says, “It was wonderful. It was the time when he was actually quite senior and he had come over to our function at Bronchocon 2014 and my friend and I happened to receive the fellowship at that time. It was really a very great feeling.”

Viewpoints on Complete Eradication of TB By 2035

Dr. Jayalakshmi mentions, “It is a very ambitious target which has been set by our prime minister. It's a laudable target indeed but it's good that we are thinking in terms of eradicating tuberculosis. Till now we have not even thought that we will be able to eradicate this disease. It is good that the thinking process has at least been initiated. The thing is that the prevalence of tuberculosis in our population is really very high and there is still a lot of delay in the diagnosis of tuberculosis at a very basic level, not only in the poorer classes but also in the middle classes,” says Dr. Jayalakshmi.

People Don’t Talk About Tuberculosis

Dr. Jayalakshmi points out, “Awareness of tuberculosis is still low. People don't talk about tuberculosis. If we have diabetes, we talk about it, if we have hypertension, we will tell 10 friends, if we get heart disease, everybody in our social circle will know that he/she has got a stent. But if we get tuberculosis, nobody will know; only the immediate family will know and the family will try their best not to communicate it with friends or relatives. So, because of this behaviour, awareness among the middle class or even the upper-middle class about TB is very less. Patients come to me and say that they are very surprised to get tuberculosis. They ask, “Doctor is it not eradicated? Is it still there? How Did I get it when nobody in our family has had TB?” It becomes very difficult to explain that there are 4,000 deaths in a day due to TB and TB deaths are much higher than even COVID. When we hear 100 deaths from COVID in a day we get shocked but the high number of deaths from tuberculosis in a day is going on because of a lack of awareness," she says.

COVID Precautions might help us in our goal of TB eradication

Dr. Jayalakshmi says “Since, we wear masks due to fear of COVID and follow social distancing, actually, it might help us towards our goal of eradication of tuberculosis. But we still have a really long way to go.”

Difficult to treat every person having positive LTBI

Dr. Jayalakshmi informs, “We do screening for latent tuberculosis infection to check our immunity levels towards tuberculosis. This is checked in two methods. One is through a blood test and the other is through a skin test. However, the results do not tell you whether you have TB or not. It only tells you that you have been infected with tuberculosis sometimes in the past may be in the near past or maybe in the far past, it only suggests that you are not immune to TB. Having a positive LTBI in India does not necessarily mean that there would be treatment. We provide treatment if required like a single dose of a particular drug in cases where suppose a student is going abroad and needs that drug to prevent the emergence of the disease in the future.”

She further emphasizes, “Now, whether this should be done for all in India is a very moot question. Because in India, the incidence of LTBI is very high. Many of us have been exposed to tuberculosis through the period of growing up because the exposure levels in the community are very high. So, whether to do LTBI tests for everybody and to treat everybody is a question because the single drug which is given to prevent the emergence of the disease gets resistant. So, then there may be no point in treating everybody. However, in a close family of TB patients, suppose one person has got tested with LTBI then maybe it's possible that this person needs to be treated or a preventive treatment needs to be given. This way it may be possible to approach latent tuberculosis infection,” says she.

Regular Screening of Close Relatives of TB patients is Required

Dr. Jayalakshmi explains, “It is possible that close relatives of patients, especially those who are sputum-positive patients, may develop latent tuberculosis infection. Suppose one knows that he/she is negative in LTBI, and is following up every six months. At the end of six months, it might happen that the latent TB infection has come out to be positive, then, in that case, some people take the treatment for tuberculosis or take treatment for the latent tuberculosis infection that is a preventive treatment.”

The policy that might help in the complete eradication of TB

Dr. Jayalakshmi mentions, “There was a study done in a Kerala hospital. The nursing staff who were admitted to the hospital were checked every six months whether they were becoming positive for latent TB or not. Those who were becoming positive, were initially negative and then becoming positive. So, it indicated that they have been exposed in the last six months. So, staff were given prophylactic treatment. So, regular screening helps to prevent infection development. It is a very specific thing, but it will probably need to be done if we really want to eradicate tuberculosis. Otherwise, what we often find is we treat one patient in the family. After two, three years, another patient from the same family is coming up with the infection. So, if we have to completely eradicate TB, I think we will have to look seriously at this problem of latent TB infection which we haven't been doing so far in India because of the logistics involved,” Dr. Jayalakshmi says. 

Requirement of More Powerful Awareness Programs

Dr. Jayalakshmi points out, “There were advertisement campaigns with Amitabh Bachchan around five years ago with catchy slogans. That went a long way towards creating more awareness and towards creating acceptance because Amitabh Bachchan himself came forward to say that he had TB too. So that was a very great gesture. It really created a lot of acceptance in people to talk about it. So, in a similar way, we need more such campaigns. We got derailed because of the COVID over the last year. In fact, now I am seeing when patients are coming, they have much more advanced disease because over the last six months, a cough has been ignored or neglected. However, the general incidence of TB may go down over a period of maybe one or two years if we can have social distancing because ultimately, tuberculosis spreads by airborne content. So that might happen,” says Dr. Jayalakshmi.

Effect of Coronavirus on people already affected with TB

Dr. Jayalakshmi informs, “Generally, what we are finding is that people who are already affected by lung diseases are being really careful with Corona. Practically what I'm seeing is among my patients that they are really taking care, staying away mostly, in isolation. So, we are finding that the incidence of Corona is not higher in this population than in the rest of the population. The only thing is if the lung is already bad in condition and once you do get Corona there is a good possibility about worsening of lung infection because Corona can lead to more serious lung problems in the patient. Another thing that we are seeing is that we have had few patients and they are coming and getting admitted with Corona but at the same time, they have some shadow of TB. So often, it is getting picked up when the patients are getting admitted with Corona. But I would not say the incidence of getting it is more in this population, but there is a possibility of a more severe lung disease because they already have bad lungs,” says Dr. Jayalakshmi.

(Edited by Amrita Priya)