Tuberculosis: Brief overview and its shifting paradigm for management in India

Tuberculosis, or TB, is one of the most ancient infectious bacterial disease caused by Mycobacterium tuberculosis. On the basis of site of tuberculosis it is mainly divided in to two categories: pulmonary and extra-pulmonary which is further divided into 5 and 7 different category, respectively. The TB is a highly contagious disease that is usually transmitted by coughing and sneezing. It is mainly diagnosed by detecting the presence of Mycobacterium tuberculosis bacteria, abnormal chest x-ray and surgical biopsy in the patient. In 199, World Health Organization has declared this disease a global emergency and established a new strategy for treating patients, called Directly Observed Treatment, Short-course (DOTS). India is the highest TB burden country accounting for one fifth of the global incidence. There has been significant change in management of tuberculosis never since pre-chemofherapeutic era to the present day RNTCP protocol based on specific disease categories. Its initial management in an organized way was started in late 1930 when the main line of treatment was good food, open air and dry climate. Effective drugs against TB began available around the time India gained Independence and District Tuberculosis Programme (DTP) was started to reduce the TB problem across me country. But major problem raised was mat of keeping the patients on continuous treatment as only 66% of the patients were taking drugs regularly. In seventies, availability of two highly effective drugs-rifampicin and pyrazimamide enabled to cut down the duration of treatment and Short Course Chemotherapy (SCC) policy was implemented. Inspite of the introduction of SCC, a high rate of defaulters and the disturbing trends of low compliance in SCC districts were reported. In 1992, the Government of India designed the Revised National Tuberculosis Control Programme based on DOTS strategy. Phase II of the RNTCP started from October 2005, which is a step towards achieving the TB-related targets of the Millennium Development Goals. By March 2006, the programme was implemented nationwide in 633 districts, covering 1114 million (100%) population. In 2008, 1.51 million patients have already been placed on treatment and NSP treatment success rate was 86%.