Ministry of Health: Know TB symptoms, get tested without delay
A chronic cough that doesn't improve over two weeks is a classic sign of TB. It may start dry and later produce phlegm. In some cases, it can lead to severe chest irritation.Sudden and unexplained weight lossOne of the hallmark symptoms of TB is sudden weight loss without any lifestyle or dietary changes. The body's metabolism speeds up as it fights the infection, leading to noticeable weight loss.Blood in sputum (Hemoptysis)Coughing up blood or blood-tinged sputum is a serious symptom and should not be ignored. It suggests the infection is affecting the lungs more severely.Chest pain or discomfortPain in the chest while breathing or coughing may occur, often due to inflammation in the lung linings. This symptom requires immediate evaluation, especially when paired with coughing and breathlessness.
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Recent physical changesTB can sometimes bring about visible and internal physical changes, such as fatigue, skin pallor, or altered breathing patterns. These signs may seem subtle, but are important to note.Evening feversA fever that spikes in the evening is a telltale symptom of TB. Unlike typical viral fevers, TB-related fevers are often low-grade but persistent.Night sweatsExcessive sweating during the night, even in cooler weather or air-conditioned environments, can be a symptom of TB. These episodes may soak clothing or bed linens.Fatigue and weaknessGeneral tiredness, even without exertion, is another red flag. Many TB patients report feeling weak or unable to carry out everyday activities.Swelling or lumps in the bodyTB can also affect lymph nodes or other organs, causing painless swellings or lumps. These can appear in the neck, underarms, or groin and should be checked by a doctor.Pre-existing or chronic illnessThose already dealing with other health issues or a compromised immune system are at a higher risk of TB. People living with HIV/AIDS, diabetes, or malnutrition are particularly vulnerable.Tuberculosis is curable with timely and complete treatment, usually involving a 6-month course of antibiotics. Early detection is crucial to breaking the chain of transmission. If you or someone you know is experiencing any of these symptoms, visit a health facility and get tested.Must Watch
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The Print
an hour ago
- The Print
Bringing dramatic drop in TB deaths, how TN set an example for rest of India with one-of-a-kind model
While TB-related death simply refers to a death among a person with TB within 12 months of notification (diagnosis), early TB death refers to deaths that happen within two months, often within the first few weeks of the notification. It is estimated that around 70 percent of TB deaths in the state are early TB deaths. An analysis by the agencies implementing the Tamil Nadu Kasanoi Erappila Thittam (TN-KET, which means TB death-free project) has shown that within six months of the launch of the initiative in April 2022, overall TB-related deaths have come down by nearly 10 percent while early TB fatalities reduced by nearly 20 percent. Chennai: A first-of-its-kind statewide differentiated tuberculosis (TB) care initiative in Tamil Nadu has significantly brought down TB deaths in the state, prompting researchers to pitch it as a model that can be replicated across the country. These results from TN-KET hold significance for India which continues to report the highest burden of TB and TB-related mortalities globally despite making significant strides in curbing the burden of the bacterial disease over the last several years. India is considered a TB endemic country, a highly infectious disease caused by a bacteria called Bacillus Mycobacterium Tuberculosis, which is spread when people who are sick with TB expel the pathogen into the air, mostly by coughing. Spearheaded by the Tamil Nadu State TB Cell and Indian Council of Medical Research-National Institute of Epidemiology (ICMR-NIE), the TN-KET initiative involves triaging (preliminary assessment) adults with TB at diagnosis, and those identified as severely ill based on specified indicators are prioritised immediately for referral, comprehensive assessment, and inpatient care. 'The key aim is to gauge or predict the patients who are likely to die due to the infectious disease while first identifying the disease in them and immediately offer them hospitalised care to treat the severe symptoms they have,' said ICMR-NIE director Dr Manoj Murhekar. The initiative, also supported by the World Health Organisation (WHO) India and the ICMR National Institute for Research in TB (ICMR-NIRT), has been implemented in all 38 districts of Tamil Nadu, except for Chennai. 'This initiative has shown that it is possible to bring down TB-related deaths remarkably by following some scientifically designed tools and methods. Severe illness can be quickly identified through triaging and they can be promptly admitted after diagnosis,' Dr Hemant Deepak Shewade, a senior medical scientist with ICMR-NIE who is associated with the initiative, told ThePrint. While the impact of the project in the first year has been analysed, the analysis of the second year (2023-24) is still underway but the early indications from routine monitoring of TN-KET suggest that it is even better than the previous results, Shewade said. 'We feel that scaling the model across India will be beneficial in bringing down the number of people dying every year due to the disease,' he added. The senior scientist, however, cautioned that such an initiative could only bring down TB-related deaths by up to 30 percent, and measures like detecting all TB incidents, early detection, comorbidity management, universal health coverage, among others, were crucial to further reduce TB deaths in the country. Dr Asha Frederick, Tamil Nadu's State TB Officer, said that district TB officers and Nodal physicians have played a key role in the implementation of the initiative. 'We recommend that these triage variables are captured elsewhere including other Indian states and high TB burden countries to guide patient management,' Dr Frederick said. On the future plans for the TN-KET, the state has started identifying other severe comorbidities like uncontrolled Diabetes (requiring insulin) among people with TB. 'If this goes well, we plan to cover other severe comorbidities like severe addiction to alcohol and tobacco,' Frederick added. According to the World TB report 2024 by the WHO, there were an estimated 28 lakh incident people with TB in 2023, 26 percent of global TB burden. Also, the country had an estimated 3.1 lakh TB deaths that year which was 29 percent of all TB mortalities globally. Tamil Nadu is among the states with high TB burden in the country. Also Read: Lancet report highlights gaps in immunisation—no routine vaccine for 14.4 lakh Indian kids in 2023 How the strategy works As part of the project, health workers triage every new TB-diagnosed adult (all above 15 years) for very severe undernutrition, respiratory distress or poor physical condition on five variables—body mass index (BMI), pedal oedema (swelling of feet and ankles), respiratory rate, oxygen saturation, and ability to stand without support. This is carried out as a health system initiative in routine operational settings by existing health workforce. Whether or not a patient is severely ill is confirmed by entering the details into a software application TB SeWA (Severe TB Web Application). All those identified as severely ill are then prioritised for in-patient care by nodal physicians in nodal inpatient care facilities of the districts, using TN-KET case record form and in-patient care guides specifically developed for such patients. A study published on the early implementation of the project and its feasibility underlined that 80-90 percent of severely ill patients (as per triage tool) are getting detected and admitted within one day of diagnosis. The admission of severely ill patients (triage-positive) has improved over the years: 67 percent in 2022, 86 percent in 2023 and 91 percent in 2024. The median admission duration was five days in 2022 and this has improved to seven days in 2023 and 2024. Over the years, the focus has been to ensure quality comprehensive assessment and inpatient care during the admission of the severely ill patients with focus on therapeutic nutrition for very severely undernourished patients as half of those eligible for admission have very severe undernutrition. Between April 2022 and June 2023, as per details shared by ICMR-NIE scientists, 66,765 of 72,404 notified adults were triaged, and 7,950 were triage-positive (identified as severely sick due to TB). Among these, 5,870 (or 74 percent) patents were referred and admitted. The analysis later showed 21 percent decline in early TB death rate and 11 percent reduction in overall TB death rate during treatment. By improving the admission among triage-positive patients, there is scope to further reduce TB death rate, the researchers noted, adding that once the goal of 30 percent mortality rate reduction among notified TB patients using this strategy is achieved, they will consider adding follow up triaging for all patients at two months for further reduction in mortality rate. As per the Sustainable Development Goals (SDG), India has to eliminate TB by 2030. (Edited by Ajeet Tiwari) Also Read: COVID-19 vaccines linked to cardiac-related deaths? Siddaramaiah, Biocon founder Shaw spar on X
Hindustan Times
an hour ago
- Hindustan Times
New drug candidate targeting bacterial metabolism could cut TB treatment time
MUMBAI: A newly identified drug candidate, JNJ-6640, has demonstrated a novel mechanism of action against mycobacterium tuberculosis (the bacterium that causes TB), including dormant and drug-resistant forms, marking a significant step forward in TB drug research. By targeting a previously unexploited metabolic pathway essential for bacterial survival, the drug candidate may offer the potential to develop safer, shorter and more effective treatment regimens. Further optimisation and clinical evaluation are needed to assess its suitability for human use. Anil Koul, professor of translational discovery at London School of Hygiene & Tropical Medicine (LSHTM). The findings, published in Nature magazine recently, are the result of a collaborative effort between researchers at Johnson & Johnson and the London School of Hygiene & Tropical Medicine (LSHTM). JNJ-6640 works by inhibiting the enzyme PurF, which deprives the TB bacterium of essential metabolites, ultimately leading to bacterial death. Anil Koul, professor of translational discovery at LSHTM and lead corresponding author of the study, pointed out that the over-70,000-year-old human pathogen had evolved into a highly persistent organism. 'Its ability to survive inside macrophages, resist antibiotics and adapt to hostile environments makes TB extremely difficult to eliminate,' he said, noting that TB remains the leading infectious cause of death globally and infects nearly a quarter of the world's population. Unlike most current TB drugs which target actively replicating bacteria, JNJ-6640 showed bactericidal activity against both replicating and dormant TB populations. It remained effective under multiple stress-induced dormancy models, including nutrient deprivation, hypoxia (low-oxygen conditions) and intracellular infection. This is particularly relevant, as TB bacilli often persist in non-replicating states within granulomas (clusters of immune cells that wall off the infection), where they are shielded from antibiotics. 'Many frontline TB drugs, such as isoniazid, lose efficacy in these dormant or low-oxygen conditions,' said Koul. 'JNJ-6640 retained activity in all these conditions. This broad-spectrum activity suggests that the drug candidate could contribute to treatment shortening, an essential goal in TB therapy.' Preclinical studies also indicate that JNJ-6640 may have potential in treating drug-resistant TB. It demonstrated no cross-resistance with existing drugs and was effective in combination with bedaquiline and pretomanid—two key components of newer regimens for multidrug-resistant TB. 'Replacing current drugs like linezolid, which carries significant toxicity risks, or moxifloxacin, which is increasingly compromised by resistance, is crucial. JNJ-6640's new mechanism and safety potential make it a strong candidate for future combination regimens,' said Koul. In addition to its bactericidal activity, JNJ-6640 exhibited a post-antibiotic effect (continued killing of bacteria even after the drug is removed) in vitro. While this property could help reduce relapse rates and improve patient recovery, researchers are cautious in interpreting its long-term clinical relevance. 'We need more data to determine whether this effect will translate into reduced relapse or allow intermittent dosing in patients,' he said. One limitation of JNJ-6640 is its poor metabolic stability (it is broken down too quickly to be effective when given orally) in mice. To overcome this, the team developed a long-acting injectable (LAI) formulation. 'The goal remains to develop an orally bioavailable molecule, but the LAI formulation allowed us to maintain therapeutic concentrations in vivo and validate the drug candidate's potential. LAIs could also be useful for prophylactic therapy in high-risk individuals or those with poor adherence,' said Koul. At present, JNJ-6640 is considered a validated lead drug candidate but not yet suitable for clinical trials. Koul emphasised that the discovery of JNJ-6640 exemplifies the importance of academic-industry collaboration in addressing unmet medical needs. 'This project brought together experts in microbiology, structural biology, chemistry and pharmacology,' he said. 'Targeting novel bacterial pathways is not only feasible—it's essential. We urgently need global funders and policymakers to prioritise TB drug development if we are to control, and eventually eliminate, this disease.'
Indian Express
3 hours ago
- Indian Express
How this TB triage tool experiment in Tamil Nadu reduced death by 20 per cent: Can it be used in national programmes?
A simple five-question triage tool — without the need for any laboratory tests — may be the key to saving lives of people diagnosed with tuberculosis (TB). Within two quarters of implementation in Tamil Nadu, the tool resulted in a state-wide reduction of early TB deaths — deaths recorded within the first two months of initiating TB treatment — by 20 per cent. In fact, two-thirds of the total districts in the state documented a 20 per cent to 30 per cent reduction in total deaths in 2024. Discussions are ongoing to implement a similar tool under the national programme. There were an estimated 28 lakh TB cases and 3.15 lakh deaths in India in 2023, according to the latest available data from the Global TB Report. Health workers in the state record five key parameters for all TB patients in the state — height and weight for calculating the body mass index (BMI) which can flag undernutrition in TB patients, swelling of the leg by pressing it for 15 seconds, respiratory rate per minute in a sitting position, oxygen saturation on a pulse oximeter and ability to stand without support. A patient is tagged severely ill if they have any one condition — severe undernutrition indicated by BMI of less than 14kg/m2, respiratory insufficiency as indicated by the respiratory rate and oxygen saturation, or poor performance status as indicated by their inability to stand. The 'severely ill' patients are immediately referred for comprehensive assessment and inpatient treatment. 'Immediate in-patient care can reduce the probability of early death in the severely ill patients between one per cent and four per cent. Otherwise, the probability of death in these patients is between 10 per cent and 50 per cent,' said Dr Hemant Shewade, senior scientist from the National Institute of Epidemiology, who has studied the implementation of the initiative called Tamil Nadu-Kasanoi Erappila Thittam (TN-KET). The initiative, rolled out in 2022, is the first state-wide implementation of the country's differentiated treatment guidelines, which aims to provide more support to severely ill patients. The implementation over the last couple of years demonstrates the feasibility and effectiveness of differentiated care models. And, it goes a step beyond, to show that the triaging process can be shorter and quicker. The tool used in Tamil Nadu depends on just five parameters, instead of the nationally recommended 16 parameters. The triaging is performed by the health workers in the state within a day of diagnosis, with 98 per cent of those confirmed to have severe illness admitted to a hospital within seven days of diagnosis. While the tool can be used with just pen and paper, the TN government has a portal called Severe TB Web Application. 'Now, this portal will have a prediction of the probability of a patient dying when the parameters are entered. This will help guide the health workers to take immediate action and prevent TB deaths,' said Dr Manoj Murhekar, head of the National Institute of Epidemiology. The research from the institute has not only led to successful reduction of deaths due to TB but also in several interventions that have now been included in the national programme. One such intervention was increasing the monetary nutritional support provided by the government from Rs 500 to Rs 1,000. Importantly, the first three instalments of this monetary support are provided at the time of diagnosis. Dr Shewade said, 'Our research found that in many cases there were delays in providing the monetary support, with many experiencing adverse outcomes before they got the support. We know that half of all the TB deaths that have to happen, happen within the first two months. And, without proper nutrition, the treatments are not likely to be as effective. This was the evidence behind the change in policy.' An evaluation of the national programme by the NIE showed that patients, on average, received the first instalment of their monetary nutritional support 91 days after the diagnosis. In fact, two thirds of the patients with an unfavourable outcome received the support after their outcome was declared, according to the evaluation. The evaluation also suggested doubling the monthly rations for those with severe and very severe under-nutrition — a suggestion that has not yet been implemented as part of the national programme. Anonna Dutt is a Principal Correspondent who writes primarily on health at the Indian Express. She reports on myriad topics ranging from the growing burden of non-communicable diseases such as diabetes and hypertension to the problems with pervasive infectious conditions. She reported on the government's management of the Covid-19 pandemic and closely followed the vaccination programme. Her stories have resulted in the city government investing in high-end tests for the poor and acknowledging errors in their official reports. Dutt also takes a keen interest in the country's space programme and has written on key missions like Chandrayaan 2 and 3, Aditya L1, and Gaganyaan. She was among the first batch of eleven media fellows with RBM Partnership to End Malaria. She was also selected to participate in the short-term programme on early childhood reporting at Columbia University's Dart Centre. Dutt has a Bachelor's Degree from the Symbiosis Institute of Media and Communication, Pune and a PG Diploma from the Asian College of Journalism, Chennai. She started her reporting career with the Hindustan Times. When not at work, she tries to appease the Duolingo owl with her French skills and sometimes takes to the dance floor. ... Read More
