TUBERCULOSIS – Myths & Realities

MYTH : TB is a curse bestowed upon one because of his wrong deeds/sins and carries a social stigma. 

REALITY : TB is an infectious disease spread by droplet infection (like common cold) from a sputum positive TB patient. There is no social stigma attached with TB as it affects rich and poor alike. Some famous personalities who were victims of TB include : Kamla Nehru, John Keats, Vivian Leigh and Percy B. Shelley. This fact can further be reinforced to the patient to help overcome any stigma he may perceive.

MYTH : TB is synonymous with an infectious disease and every TB patient is a source of infection to others. 

REALITY : Not all forms of TB are infectious. Lung TB (pulmonary) is the most infectious form of the disease. It is spread by infected (sputum-positive) patients when they cough, sneeze or talk; thereby discharging a large number of TB germs in the air. When a TB patient is put on anti-TB drugs he usually becomes non-infectious within 3 – 6 weeks (it can sometimes take up to 2- 3 months) of starting the therapy. Sputum negative and extra-pulmonary TB patients are usually not a source of infection.

MYTH : TB patients should be isolated from others, treated in hospital and put to complete bed rest.

REALITY : It has been proved by various studies that TB patients need not be isolated and put to minimum physical activity. In fact TB can be easily treated at home with the patient pursuing his normal activities. The infectious cases usually become non-infectious within 3 – 6 weeks of starting the medicine. Only those patients who are severely affected or have complications of TB, should be admitted and treated in a hospital / sanatorium.

MYTH : X-ray is the investigation of choice in TB Patients.

REALITY : It is a wrong notion that TB can only be diagnosed by X-ray. The gold standard test for diagnosing a case of lung TB is sputum examination. Sputum is stained by a special dye and examined under the microscope, where it shows the presence of TB germs – Acid Fast Bacilli (AFB) seen as red rods .

MYTH : TB is cured by injections only.  

REALITY : In the early part of the last century, (after it was shown that streptomycin is active against TB) injections of streptomycin were used to treat TB. Since then it has played an important role in the treatment of TB. But now with the availability of very potent oral drugs, such as Rifamipicin, Isoniazid, Ethambutol and Pyrazinamide; the injections of streptomycin are no longer used to treat all the cases of TB. Streptomycin injections are used in special conditions only.

MYTH : Each patient should have his own treatment regimen.

REALITY : This is also a wrong notion in the community, as widespread disparity in the dose / combination / duration of treatment, has led to failure to achieve cure. Some patients may have side-effects to one / more drugs and may need special treatment regimen. Same may be the case in drug-resistant cases who have tailor-made regimens prescribed to them. Your physician is the final authority in deciding the required regimen.

MYTH : A woman suffering from TB should not breast  feed her child.  

REALITY : Breast feeding should be continued by the mothers who are sputum positive. The child should receive a prophylactic (chemoprophylaxis) treatment (Isoniazid) for six months. The child can be immunized with BCG at birth to prevent serious forms of TB.

MYTH : A high ESR value is diagnostic of TB.

REALITY : ESR is a non specific test and only indicates some acute or chronic inflammation / infection in patient’s body but does not prove anything beyond that.

MYTH : A positive Mantoux / ELISA test is conclusive of TB.

REALITY : A positive test indicates that the person had been infected by TB germs and has formed antibodies to them. Thus it is not a conclusive evidence of disease but just an indicator of previous infection. Most people, living in India are Mantoux positive, irrespective of having suffered the disease or not. Only in a newborn child and children younger than five years (who have not  been exposed), is it suggestive of TB. Isoniazid chemoprophylaxis may be given in such a case.

MYTH : TB drugs are very expensive. 

REALITY : The total cost of treatment of TB in a fresh / relapse case for the full duration of 6 – 8 months is between Rs. 2000 to Rs. 5000. This cost is nothing compared to the cure rate (95 – 100%) which is usually for life. If the patient takes the treatment irregularly or stops it prematurely, then he can develop MDR -TB. The total cost of treatment for this type of TB is between Rs. 1 – 1.5 lakhs for a duration of about two years which is expensive. Hence the myth that TB is very expensive to treat (initially) is not true.