Bacteriological Studies of Tuberculosis

Abstract

Tuberculosis is one of the biggest National Health problem but information concerning its incidence, etiology and drug sensitivity is not available which makes the whole tuberculosis control programme a shot in the dark. This study was initiated to investigate on bacteriological aspects of tuberculosis emphasizing on the tuberole bacilli which are prevalent in this area and are causing tuberculosis infection of lungs and other sites of body. It was observed during this study that besides lung tuberculosis, tuberculosis of other parts of the body, like bones, intestine, Genito-urinary system, lymphatics, etc., is also common but not as much as lung infection. There are different types of tuberculosis germs called a-typical mycobacteria besides typical M. Tuberculosis. These investigations revealed that in lungs, infection due to atypical mycobacteria is rare but in extra-pulmonary cases atypical mycobacteria are encountered more often. The most significant findings of this study are the incidence of drug resistance in parents and its comparison with the patient’s history of anti-tuberculosis therapy. The tuberole bacilli develop resistance to a drug when they repeatedly and irregularly exposed to that drug in small doses. The results of this study are startling since more than half of the pulmonary tuberculosis cases were found to be resistant to at least one of the three primary drugs. These primary drugs are INH, Streptomycin and PAS are the routine drugs given to patients to all TB centers, hospitals and even by the private practitioners. This means that more than half of the INH and streptomycin consumed in this area is wasted because it is ineffective against the disease due to development of drug resistance. This is a colossal economic loss at one side and causes great harm to the patients since they get drugs, which are no good to control their disease. In those cases, who are chronic and long treated, the problem is worse and more than two-third cases fail o respond to INH and Streptomycin, generally to both. Even among fresh untreated cases the drug resistance was found to be high. This is something which ought to be given importance and measure should be taken to control emergence of the drug resistance. Some of the patients are at such a stage that they have developed resistance to secondary drugs including some of the recently introduced and highly potent drug like Rifampicin. Actually, what happens is that patients first report to a private doctor or a TB clinic, takes the first medicine and after a short treatment feel better and leave the medication. This disease gets temporarily suppressed since in tuberculosis at least 1-1/2 to 2 years treatment is essentials to cure the disease. After sometime the patients get symptoms again, comes back to the doctor or clinic takes medication for few days and leave it again. This process continues for years and causes emergence of drug resistance. Unfortunate part is that this is a common practice in almost every case and thus tuberculosis is considered to be uncurable disease in Pakistan, because a very small fraction of the tuberculosis patient evr get rid of this disease. The responsibility lies not only on the patient but on the health planning and tuberculosis control programme. There is complete lack of health education and follow-up of the patient which make the patient not only drug resistant but also keep patient sputum positive, i.e., he keeps spitting tubercule germ, and a resistant strain, given this disease to his close contact. After seeing the data, it is felt that this kind of study should be carried out in other parts of the country and after analyzing the data immediate measure should be adopted to, at least, control the drug resistance which is spreading unchecked. This was a small study with limited funds and resources. It is hoped that this is study on larger scale may be carried out with the provision of sufficient funds and better resources.