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The challenge of extra-pulmonary TB
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Context
While pulmonary tuberculosis (TB) remains the most common form, extra-pulmonary TB (EPTB) presents unique challenges due to its varied manifestations and diagnostic complexities. Addressing EPTB is crucial for comprehensive TB control and effective treatment.
EPTB Overview:
- Hidden Burden: Approximately 20% of TB infections are extra-pulmonary, affecting organs like lymph nodes, brain, gut, eyes, etc., with potential long-term complications due to organ damage.
- Underestimation: EPTB is often undetected or misdiagnosed due to its atypical presentation, leading to a significant underestimation of its prevalence, especially in countries like India with a high TB burden.
- Diagnostic Challenges: Lack of accurate diagnostic tools and awareness among physicians contribute to delayed diagnosis and inappropriate treatment of EPTB cases.
Challenges in Tackling EPTB:
- Lack of Awareness: There is a lack of awareness about EPTB, even among physicians, and a lack of accurate diagnostic and treatment criteria.
- Data Practices: Specialist departments for each organ, which are the primary centres for EPTB management, have diverse data practices that do not contribute to aggregate numbers for EPTB prevalence.
- Need for Guidelines: The guidelines and practice points for EPTB management, formulated by a group of experts in 2014, have remained dormant and need to be updated with the latest data and experience.
The Need for Research and Action:
- Research Priority: Key aspects of EPTB, including the mechanisms of infection spread and the TB bacterium’s interactions with our organs, remain under-explored and require active research.
- Updating Guidelines: The INDEX-TB guidelines, formulated over a decade ago, need to be updated with the latest data and experience, and should benefit from inputs from a variety of specialized areas of healthcare.
- Bringing EPTB Out of the Shadows: With nearly one in five TB patients having EPTB, it is time to bring EPTB out of the shadows and ensure that those diagnosed can benefit from care.
Recommendations:
- Improved Diagnosis: Developing diagnostic protocols specific to each organ affected by EPTB and updating existing guidelines like INDEX-TB to incorporate multidisciplinary inputs can enhance diagnosis and treatment.
- Data Sharing and Collaboration: Enhancing collaboration between TB departments and specialist organ-specific departments can improve data sharing and patient management, leading to better outcomes.
- Research and Development: Investing in research to understand the immune mechanisms underlying EPTB infection and its persistence can guide the development of targeted therapies and improve patient care.
UPSC Mains Questions:
Discuss the public health challenge of extra-pulmonary tuberculosis (EPTB) in India. What are the factors contributing to its underestimation and what measures can be taken to address this?
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