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1. DIAGNOSIS AND MANAGEMENT OF
TUBERCULOSIS IN INDIA - CURRENT
SCENARIO
Introduction
Tuberculosis (TB) is a common infectious disease
(https:/
/www.manipalhospitals.com/delhi/specialities/infectious-disease/) in India. There are approximately
world-wide 9 million new cases occurring and 3 million people die from TB annually. Of this, India accounts for
one-third of the global TB burden. In India, there are about 14 million suspected and about 35 million
bacteriologically proven cases of pulmonary tuberculosis
(https:/
/www.manipalhospitals.com/specialities/pulmonology-respiratory-sleep-medicine/) (PTB) with a
prevalence rate of 4.84/1000 population. TB kills more people in India than HIV, STD, malaria, leprosy, and tropical
diseases.
Clinical presentation
Main tuberculosis symptoms are:
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2. 1. Cough and expectoration lasting for more than two weeks.
2. Intermittent fever with evening rise in temperature/sweating for over two weeks.
3. Loss of weight and appetite
4. Haemoptysis
Supportive clinical features include Pleuritic - Chest pain, chronic fatigue, cognitive impairment, anorexia, or
unexplained low-grade fever
Diagnosis
Approximately 80% of TB patients manifest primarily lung involvement, though TB can involve almost any organ
in the body. Tuberculin skin test (Mantoux test) remains the diagnostic intervention of choice in children.
However, due to prior BCG usage and waning of immunity, it is of limited utility in the diagnosis of active
infection in the elderly and should not be used as proof of disease for treatment
(https:/
/www.manipalhospitals.com/delhi/). Similarly, Interferon Gamma Release Assay (IGRA) tests like
‘Quantiferon Gold’ should not be used exclusively for diagnosis as it cannot differentiate between old and active
TB.
Sputum smear examination and AFB culture for M. tuberculosis remains the cornerstone of diagnosis and should
be done in all patients. All serological tests for tuberculosis are banned in India and should not be used to
diagnose or treat tuberculosis. Rapid molecular tests such as CBNAAT (GeneXpert TB) and Line Probe Assay are
especially important in high-risk populations such as HIV-infected and MDR-TB.
A more aggressive diagnostic intervention like flexible fiberoptic bronchoscopy should be reserved only for
patients who are unable to expectorate sputum; in some cases, endobronchial ultrasound may be required to
sample mediastinal lymph nodes. Histologic examination of tissue from various other sites, such as the liver,
lymph nodes, bone marrow, pleura, and synovium, reveals characteristic tissue reaction.
Notification: As GOI has declared TB to be a notifiable disease, every healthcare provider including clinical
establishments run or managed by Government, private or NGO sectors and/or individual practitioners should
report about all TB patients at least on a monthly basis (on diagnosis or initiation of anti-TB treatment). The
prescribed format / online notification procedure is available through the website (http:/
/tbcindia.nic.in/), by
email (tbnotification@tbcindia.nic.in) or NIKSHAY mobile app
Treatment
As per RNTCP guidelines, all new TB patients in India should receive the WHO-approved first-line treatment
regimen. It includes an initial intensive phase of 2 months of Isoniazid (H), Rifampicin (R), Pyrazinamide (Z) and
Ethambutol (E). The continuation phase should consist of 3 drugs [H, R and E], given for another 4 months. This is
alternatively written as 2HREZ/4HRE. There is usually no need for an extension of the continuation phase. The
amount of drug should be given according to the bodyweight of the patient. All patients should receive their daily
TB medicine under direct observation (DOTS) (https:/
/www.tbfacts.org/dots/).
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3. Under DOTS (Directly Observed Therapy Short Term) the patient has to take the TB medication in front of a DOTS
agent who is usually a volunteer from the patient’s community and maybe a family member. Wherever possible,
fixed-dose combinations (FDC) of 4 drugs (RHZE), 3 drugs (RHE) and 2 drugs (HR) should be available. FDC are
helpful as they simplify getting TB drugs and the delivery of DOTS and this may increase adherence. The response
to therapy in patients with pulmonary TB, both new and retreatment patients, should be monitored. This should
be done by follow-up sputum microscopy/culture (one specimen) at the time of completion of the intensive
phase of treatment and at the end of treatment.
Manipal Hospital is one of the best hospitals for tuberculosis treatment in Delhi
(https:/
/www.manipalhospitals.com/delhi/)having TB specialists in Delhi who work together in areas of expertise
to provide the highest level of patient care. For tuberculosis treatment in Delhi consult the best TB hospital near
you.
Dr. Puneet Khanna (https:/
/www.manipalhospitals.com/delhi/doctors/dr-puneet-khanna-consultant-and-hod-
respiratory-medicine)
Head- Department of Respiratory Medicine (https:/
/www.manipalhospitals.com/delhi/specialities/pulmonology-
respiratory-sleep-medicine)
Manipal Hospitals, Dwarka, Delhi (https:/
/www.manipalhospitals.com/delhi/)
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4. (blog/impact-of-covid-19-on-pregnant-women-and-their-babies/)
(blog/self-proning-a-guilde-to-increase-oxygen-level-at-homes/)
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