OVERVIEW

Pulmonary TB:

• Definition: Pulmonary TB is caused by Mycobacterium tuberculosis (M tuberculosis) and primarily affects the lungs.
• Infection Scope: It is a serious infection that can spread to other organs from the lungs.
• Specifics: When the infection is confined to the lungs, it is referred to as pulmonary TB.

Extra-Pulmonary TB (EPTB):

• Definition: EPTB refers to tuberculosis outside the lungs.
• Categories: It can be categorized as active or latent depending on the disease’s stage.
• Examples: EPTB includes conditions like tuberculosis meningitis, abdominal TB (often with ascites), skeletal TB, Pott’s disease (spine TB), scrofula (lymph node TB), and genitourinary TB (renal TB).
• Diagnostic Challenge: EPTB is often stain-negative and may mimic other non-TB conditions, making detection difficult.
• INDEX-TB: In 2014, experts collaborated to create guidelines for managing EPTB in India.

Mycobacterium:

• Identification: The mycobacterium responsible for TB was first isolated in the eye shortly after Robert Koch’s discovery.
• Genus: Mycobacterium is a genus containing over 190 species within the phylum Actinomycetota, with its own family, Mycobacteriaceae.
• Pathogenicity: Mycobacterium species are known pathogens causing serious diseases like tuberculosis and leprosy in humans.

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CHALLENGES

• Hidden Prevalence
  • Diverse Infection Locations: Extra-pulmonary TB (EPTB) affects organs beyond the lungs, such as lymph nodes, brain, gut, eyes, etc.
  • Immune Privileges: Some organs hosting EPTB have immune privileges, complicating detection and treatment.
• Diagnostic Challenges
  • Stain Negativity: EPTB is often stain-negative, making it hard to detect with regular TB tests.
  • Mimicking Other Conditions: Symptoms can mimic non-TB conditions, leading to misdiagnosis.
• Underestimation
  • Lack of Awareness: Even healthcare providers may be unaware of the association between TB and certain organs.
  • Incomplete Data: The true prevalence of EPTB is underestimated due to incomplete data and underreporting.

KNOWLEDGE GAP

• Awareness and Collaboration
  • Lack of Awareness: Many healthcare professionals lack awareness regarding EPTB diagnosis and treatment.
  • Silos of Knowledge: Lack of protocols for information exchange between specialists in different organ systems.
• Data Collection and Management
  • Incomplete Data: Current data sources fail to capture EPTB cases from specialist departments.
  • Data Sharing: Specialist departments need to share patient data with national TB control programs for better management.

RESEARCH PRIORITY

• Immune Mechanisms
  • Persistent Inflammation: Understanding why EPTB markers persist post-treatment, leading to prolonged effects.
  • Advanced Tools: Utilizing tools like single-cell RNA sequencing for in-depth immunological research.
• Clinical Protocols
  • Treatment Guidelines: Lack of standardized diagnosis and treatment protocols for EPTB across organ systems.
  • Update and Collaboration: Updating existing guidelines like INDEX-TB with multidisciplinary inputs and latest data.

VARIOUS TYPES OF TUBERCULOSIS

• MDR-TB (Multidrug-Resistant TB)
  • Drug Resistance: Develops resistance to standard anti-TB drugs like isoniazid and rifampicin.
  • Limited Treatment: Treatment options are limited and costly, posing challenges in management.
• XDR-TB (Extensively Drug-Resistant TB)
  • Additional Resistance: Resistant to multiple anti-TB drugs, including fluoroquinolones and injectable second-line drugs.
  • Severe Cases: Presents challenges in treatment due to extensive drug resistance.

EFFORTS TO CONTROL TB

• National TB Control Programme
  • Early Detection: Aims to detect TB cases early and provide timely treatment through district Tuberculosis Centres (DTCs).
• Directly Observed Therapy (DOT)
  • Treatment Monitoring: Involves observing patients taking TB medications to ensure adherence and effectiveness.
• NI-KSHAY System
  • Patient Management: Web-enabled system under the National Tuberculosis Elimination Programme (NTEP) for comprehensive TB patient management