(1) Thanks all for the massive response on my thread on the menace of TB. This time around, let’s discuss the basics of (1) how do I know if I have symptoms of TB (2) what do I do if I have these symptoms and (3) what all facilities has the Govt made available for this?
https://twitter.com/parija_d/status/1365175557579829251
(2) As discussed in my prev. thread, TB mostly (>70%) affects the lungs. Hence, the commonest symptom obviously is cough. Not just any cough though - cough that persists for at least 2 weeks. Sometimes tinged with blood (NOT the copious amounts of blood that we saw in old movies)
(3) In addition, it may be accompanied by fever (low grade, evening rise of temp), night sweats, weight loss, loss of appetite and so on. For TB affecting organs other than lungs, the symptoms would be organ specific.
(4) Commonest are swelling of glands in the neck, no healing and pus forming lesions in the bone and so on. The deadliest is the one that affects the covering of the brain and spinal cord – TB meningitis.
(5) Now regarding the “what to do”. As explained earlier, there is ONE and ONLY ONE way to definitively diagnose TB. That is, to prove the presence of Myc. TB bacillus in the body. For that, one will need to provide the relevant sample for testing.
(6) For TB of the lungs, it is sputum. Not saliva, not spit but sputum. The one with pus that you cough out. For other sites, it will be site specific. Tissue or fluid samples drawn out by aspiration etc.
(7) These samples are subjected to testing. Commonest is Microscopy. Readily available all over the country. You can actually see the bacteria. This is how the little 'bug'ger looks using the ZN Stain. 
(8) Then we have more sensitive & modern tests that look for the DNA of the bacillus. The GeneXpert and the Truenaat. Again, available in all districts. In addition, these tests can also tell you whether the TB is sensitive or resistant to Rifampicin – the best available TB drug.
(9) If your Physician suspects additional drug resistance, then there are advanced tests like Culture and DST, LPA etc which tells us about the sensitivity of the bacillus to different anti-TB drugs.
(10) The Govt has set up ~21,000 Microscopy Centres, ~3000 NAAT Labs and ~ 85 Labs offering advanced tests. To diagnose TB and DR TB. All free of cost. If required, there are provisions to collect and transport samples for testing to these Labs. Again free of cost.
(11) If your sample tests negative for presence of TB bacillus, and the physician still suspects TB, s/he may go in for additional tests like X-Ray, skin tests to come to a conclusion. However, as explained these are supportive tests and not conclusive by themselves.
(12) So if, God forbid, one gets diagnosed there is actually no reason to panic. The disease is COMPLETELY curable with the correct medicines, in the correct doses for the correct duration. All 3 are crucial. Again, the entire course of medication is provided, completely free.
(13) Not only that, the Program will identify and allocate a treatment supporter for each patient who will motivate the patient to complete treatment. This person is trained in counselling and identifying / managing minor side effects of any
(14) It doesn’t stop at that. Every patient, notified to the program, is entitled to an allowance of Rs 500 per month for the entire course of treatment. Though direct beneficiary transfer. No middlemen. So far, (from Apr18), ~1,000 crores have been disbursed to ~40 Lakh patients
(15) The travel requirements of seriously ill patients (along with one attendant) to hospitals are supported. This is actually huge. How, I explain the next tweet.
(16) For context, the same treatment for sensitive TB in the private would cost anything between 10 to 20 thousand while the cost of resistant TB runs in to LAKHS of RUPEES (I kid you not). All of this is provided free under the program.
(17) TB is a notifiable disease – meaning – anyone diagnosing or treating TB is law bound to inform the Govt. and there are even financial incentives for doctors notifying TB cases.
(18) The drugs provided are so efficient that the TB patient is rendered non infectious in less than a month. So, there is no need to discriminate against or avoid a patient. Just ensure that the patient wears a mask, disposes of his cough and spit properly and you are good to go
(19) We need to remember that the magnitude of this menace is so huge that the Govt alone can't do squat. WE all need to come together, spread awareness, get diagnosed promptly and complete the entire course to get a handle on this. We did it for Polio, we CAN do it for TB.
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