Even today after the development of advanced diagnostic and treatment methods, a third of the world’s population is infected with the organism. In the developing world the numbers are over 90%. With the advent of HIV infection there is a dramatic resurgence of tuberculosis with more than 8 million new cases each year worldwide and more than 2 million persons dying from it.
In the nineteenth century, tuberculosis was known as “the captain of all men of death”. It may be true to some extent even today. TB is caused by the “tubercle bacillus” and was first demonstrated by Robert Koch in 1882. The savant also unraveled its highly contagious potential. In 1884, the first “sanatorium” was established in the United States where infectious persons were isolated from society and treated with rest and improved nutrition for lack of drug therapy. The development in 1895 of “X rays” made it possible to diagnose early tuberculosis and isolate infected individuals.
In those days, “surgery”, for lack of effective drug-therapy, was often a life saving option. I fondly remember our late colleague Dr. Bento Egipsy, who had specialized in Thoracic Surgery in Europe. After returning to Goa, he worked day and night performing veritable miracles at the Margāo TB Sanatorium. An expert in thoracotomies, he gave dying TB patients a new lease of life. To me, Dr. Egipsy was our own Albert Schweitzer. He lived as he preached. He was compassionate and kind to patients, endowed with a magic healing touch. He was a lover of animals, an erudite Aesculapian, musician, musical scholar, philosopher, loving husband, father and friend. He was a rare gem. His death, some years ago, left a vacuum difficult to fill in. Another physician who worked in the Margāo TB Sanatorium and deserves mention is late Dr. Ramesh Borkar who, after a stint in Lisbon, did a lot of philanthropic and compassionate work among TB sufferers in Goa.
“Chemotherapeutic agents” against tuberculosis were used for the first time in 1944 after the discovery of injectable streptomycin. Use of this agent “alone” led to resistance that is still a major problem. Better results followed the development of oral agents like isoniazid and rifampicin. Currently, there are at least 20 agents with activity against the tubercle bacillus.
Sometime ago doctors became aware that tuberculosis is completely curable through short-course chemotherapy. Treating TB cases who are sputum-smear positive (and who can therefore spread the disease to others) at the source is the most effective means of eliminating TB from a population.
DOTS (Directly Observed Treatment Short Course) is at present the internationally recommended strategy for TB control recognized as a highly efficient and cost-effective strategy. But DOTS has a few provisos which must be strictly followed. The era of sanatoriums was bound to disappear with the advent of DOTS.
When all seemed well on the “TB treatment front” doctors were jolted as they stumbled upon strains of tubercle bacillus resistant to several drugs – multi-drug-resistant TB (MDR-TB). MDR-TB is an increasingly serious problem especially in India. Even more serious is the “extensively drug resistant TB” where the bacillus becomes resistant even to some of the newer drugs like “fluoroquinolones” and others.
But there’s good news at last: The government has recently launched “Bedaquiline”, an exclusive drug to tackle drug resistant TB cases in the country. According to the union health ministry, “Bedaquiline” is being introduced at six identified tertiary care centres across India, having advanced facilities for laboratory testing and intensive care of patients.
“Bedaquiline” will be given to multi-drug resistant TB patients with resistance to either all “fluoroquinolones” or all “second line injectables”. It may be considered as a miracle drug but it’s important to follow strict guidelines when administering the same to prevent resistance to it.
Famous men and women over ages who suffered from TB include poets John Keats and Percy Shelley, the authors Robert Louis Stevenson, Emily Bronte, and Edgar Allen Poe. Musicians Nicolo Paganini and Frederic Chopin also died of tuberculosis.
We are now luckily able to save many lives but, once upon a time, TB led to much suffering and misery. Patients were stigmatised like AIDS patients nowadays. Here is the testimony of a patient who was diagnosed of tuberculosis in 1944: – “I suddenly coughed up mouthfuls of blood. I phoned the doctor who arranged for an X-ray. I was convinced it was nothing. Soon came the verdict: tuberculosis in right lung. Treatment? Sanatorium for 12 months which meant a forlorn and secluded life. Days were dreary, nights unending. To let off steam I began to write letters to family and friends. Few bothered to reply. I was a pariah! A year later as treatment failed I find death staring at me”.
“All these months I have learnt one thing: after the first genuine rush of emotion, no one is interested in other people’s troubles. If I managed to carry on thus far it is thanks to my “diary”, my trusted friend, and the hope that beyond the grave, “Someone” awaits in the resurrection to wipe every tear from my eyes. Goodbye!”
(Dr. Francisco Colaço is a seniormost consulting physician, pioneer of Echocardiography in Goa.)
