Times of India
04 July 2011
By Atul Sethi

Aloke Prajapati works in a software company in Gurgaon. He’s the typical guy next door who likes to work hard and party harder. A few months back, he went for a medical check-up, since he was getting tired quickly and had a recurring fever. A bronchoscopy revealed that he had tuberculosis (TB) of the lymph nodes. His first reaction was one of disgust, followed by disbelief.

“I could not believe that I have a disease like TB, which is associated with poverty and malnutrition,” he says. Prajapati is not alone. Across India, doctors report an increasing number of TB patients from the middle class and the upper middle class – belying the stereotypical image of TB being a poor man’s disease. “TB affects people across all socioeconomic strata in India. No group is exempt,” points out Dr Madhukar Pai of the Montrealbased Mc Gill University, who also co-chairs the Stop TB Partnership Group of the WHO.

In India, two million new TB cases are reported every year. Two deaths occur every three minutes from the disease – making it one of the deadliest in the country. Pulmonary TB – that affects the lungs remains the No.1 killer essentially amongst the poor, but increasingly, extrapulmonary TB – affecting areas outside the lungs such as stomach, skin, eyes etc – is being diagnosed. “In our practice, we see on an average 20 new cases of pulmonary and 10 new cases of extrapulmonary TB in a month,” says Dr Praveen Pandey, pulmonologist at Noida’s Fortis Hospital.

Quite a few of the extrapulmonary cases are patients from affluent backgrounds. Chitrita, a boutique owner, was diagnosed with stomach TB after she complained of fever and loose motions. She says she still doesn’t know what caused the disease. “Probably, it was my irregular working hours and improper diet,” she says.

Doctors say that since the TB germ carries through air, almost everyone in the country would have been exposed to it. The body’s natural immunity keeps the germ at bay but often, factors like stress, obesity, hypertension or an erratic lifestyle can lower the immunity and trigger the disease.

How grim is the problem? Dr Rupak Singla of the Delhi-based LRS Institute of TB & Respiratory diseases says it is not easy to say. “There is no specific data on this issue. However, logically TB is the commonest infection among HIV / AIDS patients and HIV is common among affluent sections of society also. So we can imagine that there could be a minor resurgence of TB among the affluent sections of society.”

The actual numbers may not be available but the prevalence of TB amongst the wellheeled – Aishwarya Rai was rumoured to have been affected with stomach TB – has ensured that awareness about the disease has increased.

“It is a bit like the HIV epidemic in the 80s,” says Pai. “When Hollywood actors and sports celebrities were diagnosed with HIV, then public awareness of the problem went up. With rumours about Bollywood celebrities being affected, people are realizing that TB is affecting everyone, not just the really poor.”

Cause And Effect
Accurate diagnosis remains a major weak link in TB control in India. Either the tests are not sensitive enough, or are outdated. The good news, however, is that India has been gearing up to fight the disease on a war footing. The government-sponsored Revised National TB Control Programme – that has been successful in covering a large part of the population through its DOTS programme (Directly Observed Treatment Shortcourse) – is now entering a new phase with the objective of treating 90% of all TB cases in India by 2015.Considering the large number of new cases every year and the problems posed by difficult-totreat multi-drug resistant strains of the disease, it will be a big enough challenge. Will the killer disease succumb?