Dr K K Pandey
The enormity of this MDR tuberculosis is so much that on one hand it almost cripples the victim and on the other it engulfs a whole set of people who come in close contact with the victim of this disease. A patient suffering from MDR tuberculosis on one hand becomes totally unfit for earning livelihood, thus pushing his family members and dependents into an abject state of poverty and on the other hand he himself becomes a source of infection to his family members who unwittingly fall victim to tubercular infection, due to proximity. The office colleagues, close friends, relatives and neighbours of a MDR tubercular patient also become vulnerable to catching a tubercular infection from him. What a scenario worse than this can happen in our society, when a single MDR tubercular patient becomes a source of infection to at least a thousand people!
What is MDR tuberculosis ?
The simple meaning of MDR tuberculosis is a form of tuberculosis, which is resistant to all antitubercular drugs and thus the affected lung reaches a stage of near-destruction. In this almost completely destroyed lung, pus and germs-infested tissue accumulate. When a patient suffering from MDR tuberculosis normally coughs, about 3000 tubercular germs are thrown out into the atmosphere from the wind pipe in a single bout of cough. Therefore, it is said that the lung of a MDR tubercular patient becomes the storehouse of tubercular germs. In such patients, the first line of antitubercular medication had already proved ineffective, even the second line of antitubercular medication does not help at all. Therefore, on one hand occurs a waste of money and on the other hand there is always a danger of impending death. If timely treatment by a thoracic surgeon on a chest surgeon is not done, death, sooner or later is inevitable.
Why does this MDR tuberculosis occur ?
If a tubercular infected lung during the course of antitubercular treatment gets converted into MDR tuberculosis, the main reason for this conversion especially in India happens to be irregular and erratic treatment taken by him for tuberculosis. In the initial stage of antitubercular treatment, 4 to 5 medicines are given simultaneously and these antitubercular medicines must be taken regularly and daily for at least 6 months. Generally what happens in India, a tubercular patient instead of taking 4 medicines, in fact takes one or two antitubercular medicines. There are two reasons for this irregularity, firstly due to poverty and economic constraint a tubercular patient is unable to afford the cost of medicines, and secondly patient does not take antitubercular treatment seriously and become lazy in following the regular regime of treatment.
Majority of tubercular patients, when they notice some improvement in their general condition after some months of treatment, they leave the treatment midway and never complete the treatment. This incomplete treatment lays the foundation of beginning of MDR tuberculosis. When the same patient restarts the antitubercular treatment after a gap of certain period, the same medicines which were previously effective become totally defunct and there after destruction of lung begins.
What to do if you are suffering from MDR Tuberculosis ?
If the first line of antitubercular drugs like Isoniazide, Rifampicin, Ethambtol and Pyrazinamide become ineffective, immediately consult a chest specialist or Tuberclosis specialist instead of a general physician. Under the guidance of a chest specialist only, the second line of antitubercular drugs Kanamycin, Amikacin, Capriomcin, Ethionamide and Cycloserine should be started. Remember, the second line antitubercular drugs cost you heavily on one hand, and secondly carry a risk of adverse side effects on the body. The patient has to take second line drugs for at least one to two years. Never change the dose of these drugs on your own and always seek the advice of your doctor for change of drug-regime. Always get your phlegm/sputum examination every month without fail.
Where to go if you have MDR Tuberculosis ?
Remember, always go to a hospital where 24-hour availability of a full-time thoracic surgeon is there. It has been observed that a person, who is involved more with heart surgery, does not have enough experience of lung surgery. Therefore one should make sure whether the thoracic surgeon in a hospital has good experience of lung surgery or not. For lung surgery, always select a hospital where a full-fledged department of critical care, and facility of a ultra modern intensive care unit (ICU) and a good blood bank are there. For lung surgery, the experience of a good and trained anaesthesiologist counts, otherwise during or after lung surgery complications may arise.
(The author is a Senior Consultant in the Department of Cardiothoracic & Vascular Surgery at Indraprastha Apollo Hospital, New Delhi)
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