POPULAR MYTHS/MISCONCEPTIONS

1. Myth: TB runs in the family; it is a genetic / hereditary ailment.

For centuries, man believed that consumption (TB) was a hereditary (or genetic) condition, since several members within the same family were often seen afflicted one after the other. It was only recently, in 1882, that Sir Robert Kock shattered that family myth; he uncovered the real culprit – a germ, which can attack simply anyone. Heredity or genes have simply no role.

Source of these germs is a TB patient. When a full-blown patient of lung TB coughs, these germs spread out in to the air around him; they keep hanging and floating in air. A healthy person nearby e.g. a family member may inhale them during normal breathing and may get infected.

Since the rich and the poor have at least one thing in common – the air they breathe in, no one is immune from the risk of being infected.


2. Myth: TB is highly infectious.

Measles, mumps or chicken pox may be much more infectious, wherein a brief exposure to the patient could cause infection and illness. Not so in TB.

Only a prolonged, indoor and close contact with a sputum positive TB patient may lead to infection. Chances of infection are low if we meet the patient (source of germs) outdoors, as the germs coughed up by him get infinitely diluted in the atmospheric air; germs are swept away with the wind; direct sunlight rapidly kills these germs. That is why, a sputum positive patient is advised to spend most of his time out in the open – in a courtyard, a park or on the roof rather than in a closed, unventilated, crowded room.


3. Myth: Each and every TB patient spreads disease.

a) Not all, but about a third of TB patients are infective – mainly those lung cases who, while coughing, emit germs in to air, and which can be demonstrated by testing their sputum. They are called sputum positive cases.

Please don’t have undue fear; most sputum positive patients too tend to turn germ free (non-infective) within a month of effective treatment. Meanwhile, they can minimize transmission by observing simple precautions (see do’s and don’ts).

A useful thumb rule to work with TB patients is – if the patient doesn’t have cough, there is no risk of infection.

b) TB in organs other than lungs:

Apart from lungs, TB can occur anywhere in the human body from head to toe. When sickness occurs in organs other than lungs (e.g. lymph glands, bones and joints, abdomen, spine, brain or genitals etc.), it is, as a rule, non-infective

Exception: A rare source of infection may be pus discharge from an open wound over a TB lesion in the skin, glands or bone, which may contain some active germs; so, keep the wound neatly covered / bandaged, don’t touch such a wound with bare hands, wash hands frequently and wash patient’s clothes separately and in boiling hot water.

c) Childhood TB is mostly non-infective.

d) Even a lung TB patient whose sputum repeatedly tests negative for germs poses little risk to others.

TB also occurs in the animals. Some scientists in fact blame the animal world as being the very source of its origin in humans – following domestication. Cat, dog, buffalo, and cow etc. can all suffer from TB. So, always pasteurize or boil the milk before drinking it and avoid sleeping amidst a herd of cattle.


4. Myth: A TB patient must at once be sent away – to TB hospital / sanatorium.

Several forms of disease are as such non-infective. Besides, once effective treatment begins, even a sputum positive (infective) patient quickly turns germ free (non-infective). So if the patient religiously takes proper treatment and observes precautions while staying at home, he poses no additional risk of infection to his family members. That is why now-a-days home-treatment (domiciliary treatment) is the norm and hospitalization an exception. The concept of TB sanatorium is a thing of the past.

Remember, a known devil is better than an unknown devil. An undiagnosed (but sputum positive) patient may transmit more effectively than a known infective case already on proper treatment and precautions. Hence, need for an early diagnosis. And which will only happen through public awareness of symptoms and timely suspicion; hence websites like this.


5. Myth: There is no cure for TB; it means sure death.

TB is curable. Effective anti-TB medicines have been available since 1950’s.

However, there is one problem – Treatment of TB is pretty long. Medicines must be taken for a minimum of 6 to 8 months for complete cure.

Most patients discontinue medication prematurely, once their symptoms abate within a couple of months. In India, about 60% TB patients never completed the full course and risked relapse and complications.

This large-scale non-adherence to treatment is the single largest challenge to TB control worldwide and which has necessitated DOT – an instrument to keep a close watch over patient all along till he is fully cured. He simply can’t default.

Death is not because TB is incurable; it is often due to premature discontinuation of treatment!

Patient education therefore is absolutely crucial; hence this website.

Please read: ADEM (14-16) I am OK now (Ashok).


6. Myth: TB treatment is very expensive.

Treatment of TB is not expensive.

In India, a full 6-month course of daily regime for a category 1 patient (2EHRZ + 4HR) costs merely about Rs. 1680 only (sputum tests and X-ray costs being extra).

Under Revised National TB Control Program, Govt. of India provides drugs and tests absolutely free of cost to an Indian.


7. Myth: TB is a disease of the past era; almost eradicated now. So why bother.

TB continues to be a major killer even today. It continues to play havoc with the poor societies within the third world, which has seen no let up in suffering and death. TB continues to be the topmost public health concern in several developing nations. As per govt. data, nearly 2 Indians die of TB every 3 minutes.

No doubt, developed affluent nations of the West were able to rein in TB long ago – in the 1970’s. It is a testimony to the heavy tilt of the global media and overall attention towards the elite West that a false impression was allowed to gain ground worldwide that TB has largely been eradicated.

Whenever an educated person states this myth, the author is overwhelmed with an excruciating pain in his heart. It is like rubbing salt into the simmering wounds of citizens the of a high burden country like India. What about human rights? That much about lofty claims that every human life is equal and precious!


8. Myth: TB occurs only in the lungs.

TB mostly (80%) occurs in the lungs.

Extra-pulmonary TB:

TB can occur anywhere in the human body – from head to toe. When it occurs in organs other than the lungs, it is called extra-pulmonary TB. Depending upon the organ involved, it can present with any sort of tricky symptoms:

·        Swollen glands and discharging sinuses around neck: cervical lymph nodes TB.

·        Pain, swelling, abscess over backbone / along ribs with crooked posture / gait: backbone / rib TB.

·        Pain, swelling, abscess over usually a single joint.

·        Fluid collection in the abdomen (ascitis):  TB of intestines, peritoneum or lymph glands etc.

·        Constipation, vomiting, distension and pain abdomen: sub-acute intestinal obstruction.

·        Painless bleeding, pus discharge in the urine: kidney TB.

·        Failure to become pregnant (Primary sterility): TB of female reproductive organs.

·        Non-healing skin wounds.

However, behind a confusing picture, you can commonly discern that familiar streak of “long duration of illness, low-grade fever and weight loss” provided you have learnt to maintain a high index of suspicion of this ailment at the back of your mind.

A temperature chart, weight records and listening carefully to the patient’s story often prove crucial towards arriving at a diagnosis.

Since presence of germ can’t usually be demonstrated, diagnosis of ‘TB in organs other than lungs’ is often not straight forward as is in lung TB. The clincher here is Biopsy of the affected organ and its histopathology and which is not always feasible. At times, there is no option but to treat on the basis of suspicion alone.


9. Myth: Exposure to a TB patient leads to infection and infection means sure disease.

Being infected is not synonymous with falling sick with TB. These are two different things.

Inhaling TB germs doesn’t necessarily lead to clinical disease. Robust body immunity is able to keep illness at bay. Fortunately, only 10% of those fully exposed to the germ will fall sick with TB. The rest (90%), though infected, remain forever healthy. That’s why after years of clinical work, most doctors and nurses remain fit.

Once they gain entry into the healthy lungs, TB germs may quietly settle down – as seeds of potential disease in future. As the time passes, the risk keeps receding. However, TB germs are known to remain dormant for several years without bothering the host and then suddenly may reactivate and cause sickness.

Can I lead a normal healthy life once I am infected with TB?

Yes.     Of course, if you are an Indian adult, chances are that you already are doing so.

In India, since there is no dearth of sputum positive TB patients, 40% of the citizens, by the time they attain adulthood, tend to get exposed and infected unknowingly. Of them, very few actually fall sick; most continue to lead a normal life.

Doctors and nurses are highly likely to get infected. But, thanks to good body immunity, most of them remain fit and lead a normal healthy life.

It is estimated that one third of the globe’s population is infected with TB germ.


10. Myth: After a couple of months of proper TB treatment, symptoms subside and the patient feels much better. Thereafter, the patient can safely stop anti-TB medicines.

The root cause of man’s failure in TB control is nothing but this very misconception.We know that TB is curable. Effective anti-TB medicines have been available since 1950’s. However, there is one problem – Treatment of TB is pretty long. Medicines must be taken for a minimum of 6 to 8 months for complete cure.

Most patients discontinue medication prematurely, once their symptoms abate within a couple of months. In India, about 60% TB patients never completed the full course and risked relapse and complications.

This large-scale non-adherence to treatment is the single largest challenge to TB control worldwide and which has necessitated DOT – an instrument to keep a close watch over patient all along till he is fully cured. Death is not because TB is incurable; it is often due to premature discontinuation of treatment!

Please read: ADEM (14-16) I am OK now (Ashok).


11. Myth: To cough out blood with sputum (phlegm) means sure shot TB.

No doubt, some TB cases do cough out blood stained sputum or frank blood. Others may even vomit out blood. They may do so before being diagnosed, during the long course of TB treatment or even long after they have been fully cured. However, this is not a sure sign of active TB.

Please remember, presence of germs in the sputum (and not blood) is diagnostic criteria of TB.

Blood in spit may also occur due to several non-TB causes like – bleeding gums or teeth, sore throat, ulcers in mouth, nose bleed, pneumonia, peptic ulcer, bleeding disorders, cancer or idiopathic (of unknown origin). Blood with cough is NOT synonymous with TB. Look for germs in sputum.


12. Myth: I am educated and well off. I live in a posh colony. I can never catch TB – a disease of poverty. I don’t need to know a word about TB.

Nothing can be farther from truth. Educated, rich person like you who has access to the internet has greater social responsibility to the ignorant and poor around you.Besides, storms don’t send a post card of warning. And one can’t learn navigation in the midst of a storm. Now is the time to learn a little bit. Every two-wheeler rider is required to wear a helmet; not every one meets with accident. It is for prevention – just in case.

Similarly, if you live in a high burden country like India, smart thing is to gather sufficient knowledge about this common ailment, and right now, which would protect like a helmet. It would mean – a high index of suspicion, an early diagnosis, diminished transmission, correct treatment and full cure for someone, a kin or a neighbor – in other words prevention.

No doubt, a pre-requisite for TB ailment is to get infected with its germ, chances of which are higher in high TB burden communities of the third world. Obviously, the disease can’t occur without exposure to / entry of the causative germ. Since transmission is through air and each one breathes the same air, no one is immune to getting infected. However rich, you can possibly catch infection from your sick driver, servant, barber, tailor, domestic help or an office colleague. And once you are aware, you can help them immensely. And yourself.

Lack of awareness, unhygienic and congested living (e.g. in a slum) no doubt promotes chances of infection from an infective patient nearby or within the family