Tuberculosis Elimination Strategy

The challenge of Extra-Pulmonary TB


From UPSC perspective, the following things are important :

Prelims level: Diseases in the News;

Mains level: Health and Diseases in India;


Why in the News? 

A tuberculosis patient receives treatment from a nurse (instead of a specialist) at a TB hospital in Guwahati.

What is meant by Pulmonary Tuberculosis (TB)?  

  • Pulmonary tuberculosis (TB) is a serious infection caused by the bacterium Mycobacterium tuberculosis (MTB) that involves the lungs but may spread to other organs where it destroys body tissue. TB is a contagious disease that can infect anyone exposed to MTB.
  • It constitutes a significant portion of the TB burden in India, accounting for more than 20% of cases.

Present status of Extra-Pulmonary Tuberculosis (EPTB) in India:

According to the World Health Organization (WHO) reports, there are over 10 million new cases of TB every year and India alone accounts for 27% of the global TB burden. However, the burden of EPTB is hard to estimate. EPTB is often stain-negative, which means it is not detectable on regular TB stain tests.


The twin challenges of the Knowledge Gap: 

  • Lack of awareness:
    • Among Physicians: Many healthcare providers are unaware that TB can affect organs other than the lungs, such as the eyes and other immune-privileged sites.
    • Among Patients: Nearly 1/5th of TB patients have EPTB. Most of them go undiagnosed, and the few who are diagnosed cannot benefit from care unless they visit a few specialist health facilities.
  • Lack of Accurate Diagnostic and Treatment Criteria: There is a lack of accurate diagnostic criteria for EPTB, making it challenging to identify the disease correctly. Treatment protocols for EPTB are not well-established or widely known, complicating effective management.
    • Although guidelines like INDEX-TB (a set of guidelines by WHO for EPTB management in India) have been formulated, their implementation has remained dormant.
    • The current system for collecting EPTB data is fragmented, with specialist departments maintaining diverse data practices.
    • National Patient Management Portals, such as Ni-kshay in India, have incomplete and missing data on EPTB patients.

Need to Prioritize Research and Development (R&D) for EPTB:

  • Need to understand the infection mechanism deeply: A troubling aspect of EPTB infection is the prolonged presence of disease markers even after the infection is resolved with treatment.
    • This phenomenon causes a lot of misery to persons with EPTB and is an active area of research.
  • Prioritize Advanced Immunological Tools: Advanced Immunological Tools such as single-cell RNA sequencing, will be able to uncover the immune mechanisms for the disease.
    • This will also help physicians to understand the treatment better, instead of going for long-duration anti-TB therapy (sometimes for even two years or more).

Mains PYQ: 

Q Can overuse and free availability of antibiotics without a Doctor’s prescription, be contributors to the emergence of drug-resistant diseases in India? What are the available mechanisms for monitoring and control? Critically discuss the various issues involved.

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