Early detection, treatment, prevents lung damage and reduces transmission risks | Sunday Observer
Cough for two or more weeks? It could be TB

Early detection, treatment, prevents lung damage and reduces transmission risks

29 May, 2022

The re - emergence of various infectious diseases amid the Covid-19 pandemic has caused concern among chest experts. T.B (Tuberculosis) is one such disease.

The Sunday Observer spoke to Consultant Respiratory Physician District General Hospital & District Chest Clinic, Trincomalee, Dr Upul Pathirana in an online interview to give us more insights into this disease which many people including patients themselves do not understand properly, while some are unaware of the early warning symptoms and fail to get themselves screened for the disease until it has advanced. This has led to health complications that leave lasting scars and damage to one’s lungs, he says.


Q. As many of our readers and even patients still don’t understand what Tuberculosis is ,how do you define it? Is it a virus or bacteria?

A. Tuberculosis is an infectious disease commonly caused by a bacteria called Mycobacterium tuberculosis. The organism has the capacity to affect almost all the systems and organs in the human body except a few such as hair and nails.

Q. How is it transmitted among humans? What are the common routes?

A. A person who has the disease in his lungs can release organisms to the environment through their respiratory secretions when he coughs, sneezes or laughs without a protective facemask. When this is followed by inhalation of organisms into the lungs of another person who does not have the disease., there is a cascade of reactions once the organism is deposited in lungs. The end result is that either he or she can develop the disease or the organism remains inactive within the body which is called Latent Tuberculosis Infection.

Q. What are the distinctive signs /symptoms of the disease that help to distinguish it from other respiratory infections ?

A. We should suspect Tuberculosis in any patient who has a persistent cough for more than 2 weeks. They also can cough out blood in their phlegm. Reduced appetite, loss of weight, night sweats, fever (might be evening fever), chest pain and breathlessness are other common symptoms. Patients can present with symptoms and signs related to the involvement of other sites called Extra-Pulmonary Tuberculosis as well. For example, localised neck swelling due to Tuberculosis affecting lymph nodes.

Q. Is it inherited? Can one get TB because someone in the family had it?

A. Tuberculosis is not an inherited (transmitted through generations) disease and anyone of us can catch the infection

Q. How do you screen a suspected patient for TB?

A. The medical officer will ask about symptoms of Tuberculosis and will examine you for physical signs. He will request three samples of sputum to detect the infecting organism by microscopy and you may undergo a chest X-ray as well. Once the initial tests are completed, he may diagnose or rule out Tuberculosis. When the demarcation is not very clear, you will receive an appointment with a Consultant Respiratory Physician.

Q. Can any doctor manning an OPD desk perform this task?

A. All the doctors are trained to detect Tuberculosis and therefore, you can ask your doctor whether you need testing and if the answer is yes, please discuss the types of tests. In addition, if anyone wants to get screened for Tuberculosis, he/she can directly walk to our District Chest Clinic (DCC) or outreach centers run by DCC. .

Q. What is the treatment currently available to patients? Is it the DOT system used in the past? If so, how effective is it according to your feedback?

A. Through the strategy of DOT, we ensure that that patient is receiving the correct drug, correct dosage, at the correct interval and required duration of treatment. The feedback we received of DOT is that we have a high success rate of treatment .

Q. Since both Covid 19 and T B are infections of the respiratory system which have a wide clinical presentation, is it possible for an examining physician to confuse the symptoms?

A. Both Tuberculosis and Covid-19 predominantly target the respiratory system even though it is not exclusively confined to it. The disease course is acute in the case of Covid-19 and it is generally subacute or chronic in Tuberculosis. The difficulty arises when both illnesses are co-existing together, where we have to have a high degree of clinical suspicion and offer testing for Tuberculosis in Covid-19 patients and vice versa. However I must reiterate, that even though the health care demand for the Covid-19 was high over the last 2 years, there was an uninterrupted flow of Tuberculosis services in our country.

Q. What about people who have HIV ?How vulnerable are they to getting TB? Are they screened for TB as well as a precaution?

A. HIV stands for Human Immunodeficiency Virus which hits on our immune system resulting in reduced protection against many infections like bacteria, viruses, fungi and parasites. Therefore, HIV infected patients are prone to develop pulmonary and extra-pulmonary tuberculosis. Millions of people are infected with both HIV and Tuberculosis worldwide. It is the leading cause of death among people who are HIV positive and accounts for more than one third of AIDS deaths worldwide. Hence we screen all patients with Tuberculosis for HIV infection and vice versa with the intention of catching both diseases early, thereby preventing further spread of both infections.

Q. According to new studies, Diabetes and other underlying pre-existing diseases have a close link to TB as risk factors. True or false?

A. Uncontrolled Diabetes mellitus (DM) is a strong risk factor associated with Tuberculosis and they can end up with complications too. Therefore, good blood sugar control is a Must both to prevent and successfully treat the disease.

Q. There have been reports that patients have become resistant to the drugs given them in certain cases. Why is this? Is it due to the patients not completing their treatment?

A. Yes. It is very important that patients must complete the full course of treatment to prevent recurrence, as irregular treatment is associated with emergence of drug resistance.

Q. As we move forward in this hi tech age tell us whether new and better techniques have been introduced to detect TB early and treat it. If so, are they also freely available to patients in state hospitals? Where ?

A. To answer your first question I will say, Absolutely Yes. The gene techniques can give you not only the diagnosis but also tell quickly whether you have drug resistant Tuberculosis or not. The available techniques are highly sensitive, specific and rapid. These techniques are distributed to cover the whole country and you don’t need to pay for the test. Endobronchial Ultrasound and Transbronchial Needle Aspiration (EBUS-TBNA) is a new development in Sri Lanka and it can sample lymph nodes inside your chest. EBUS-TBNA is available at National Hospital for Respiratory Diseases Welisara, National Hospital of Sri Lanka Colombo and National Hospital Kandy, and it is free of charge in these government hospitals.

Q. The current burden of TB in the country is relatively low compared to other Asian countries including neighboring India. Is this due to interventions being put in place by the Health Ministry and Epidemiology Unit? . To what extent are they on par with international standards?

A. We have a well-organised strong system to detect and treat tuberculosis in Sri Lanka. The National Programme for Tuberculosis Control and Chest Diseases (NPTCCD) is the central organisation of the Ministry of Health responsible for controlling and preventing tuberculosis throughout the country. The vision of NPTCCD is Tuberculosis free Sri Lanka. This is achieved by formulation of policies, planning, coordinating and monitoring of Tuberculosis and chest diseases control activities in the country. All these activities are in keeping with World Health Organization (WHO) standards as well. Each district in the country has a district chest clinic through which Tuberculosis control activities are implemented. The District Tuberculosis Control officer is responsible for the administrative work of the district chest clinic under the technical guidance by the Director, NTPCCD. The clinical activities of almost all the district chest clinics are supervised by Consultant Respiratory Physicians.

Q. What are Sri Lanka’s case rates in TB according to your latest data?

A. There were 7258 Tuberculosis cases in the year 2020 in Sri Lanka. This is a 14 percent reduction in Tuberculosis cases when compared to the year 2019. In the year 2021, the figure was 6771. The forecast is that a further reduction of Tuberculosis cases in the next 3 years. (Source: National Programme for Tuberculosis Control and Chest Diseases)

Q. A recent Epidemiology Unit report also stated that a decline in the number of TB cases was observed in 15 out of 25 districts. What caused this decline?

A. Yes I agree. There was a decline in detected Tuberculosis cases in some districts during 2020 and 2021.. Similar to Covid-19, Tuberculosis is also spread to humans through the respiratory route. As such there was loads of information regarding respiratory hygiene reaching people through all sorts of media. Furthermore, in contrast to previous years, due to travel restrictions and warnings, crowd gatherings were low which further reduced spread of the disease.

Q. It has been said that the present unrest and political situation and economic situation in the country could have a disruptive effect on TB services, and that the disruptive effects on routine health services would lead to further deterioration of TB care services in the country. Do you agree?

A. If there are disruptive effects on health services, irrespective of the reasons, there will be negative impact on Tuberculosis services as well. However we will continue to do our best to run the Tuberculosis care programme smoothly.

Q. Have you a word of advice for our readers ?

A. Tuberculosis is not an inherited (transmitted through generations) disease and anyone of us can catch the infection. If you have a cough for 2 or more weeks, feel free to come for our assistance.

Early detection and treatment not only prevents lung damage from the disease but also minimises transmitting infection to your family and close contacts. . Once the treatment is started the majority are non-infectious. Therefore, early treatment is the key. In addition you can help your country to achieve the goal of elimination of Tuberculosis.

Q. Is there a hotline or contact number which could be reached by a person with symptoms of TB to contact for more information?

A. Visit any government hospital if you have symptoms suggestive of Tuberculosis and the staff will direct you to the correct place for screening and treatment tailored to your specific