Urban India fighting new health hazards

New Delhi: Ajay Tyagi, a 51-year-old lawyer in Jaipur, is diabetic. Five years ago, doctors diagnosed him with TB and warned him of consequences of constant travelling and unregulated eating habits.

He couldn’t avoid either. His sugar level shot up to 700 milli gramme/ decilitre; the normal range is 80-120 mg/dl. Biopsy of his lymph node at All India Institute of Medical Sciences (AIIMS) in New Delhi confirmed multi-drug resistant TB.

The doctors in Jaipur didn’t have the expertise to deal with it and he had to travel often to Delhi for treatment.

His condition worsened: nerve damage that hindered walking, nausea and vertigo. He was unable to work. Travel and treatment took about 18 months and he spent more than Rs 3 lakh on the two.

Tyagi was surprised he had TB. He was under the impression TB was restricted to poor people. That is common perception, say doctors.

But with migration, everyone is more or less equally exposed to the bacteria. Although doctors observe an increasing association between TB and lifestyle diseases, its new risk factors, they say there are very few studies to establish this.

“High blood sugar levels especially affect cells responsible for immunity,” said Anoop Misra, Tyagi’s doctor who is now with Fortis Hospital, Delhi.

A review of studies on the link between diabetes and TB by Harvard School of Public Health, US, in 2008 showed diabetes increases the risk of TB irrespective of the area of the study.

The researchers found those with diabetes were three times at greater risk of getting TB than non-diabetics.

It also increased the chances of TB becoming multi-drug resistant. The chances of diabetics not responding to common TB medicines are high, said Misra.

“Forty per cent of Indians carry latent TB infection,” said Dushyant Behra, director of LRS Institute of TB and Allied Diseases, Delhi.

“The latent infection manifests itself as full-blown TB in people leading stressful lifestyles, undergoing treatment for cancer, smoking, exposed to pollution or recovering from an illness.”

India is home to 20% diabetics in the world. Deepak Nama, respiratory diseases specialist, explained a stressful lifestyle releases adrenaline in the body. “It disrupts sleep, causes fatigue and immunity is lowered.”

Malnutrition is another factor, added Nama, also with the Fortis hospital. “While this immediately brings to mind underfed, skinny children, malnutrition can also imply the other extreme – obesity.

Obesity is increasing in children and adults. The reasons are improper nutrition and irregular eating habits,” said Nama.

Two million TB patients

The World Health Organisation (WHO) declared India has the highest number of TB patients in the world – two million, according to its 2009 report.

And it affects the income-generating age group the most – 15 to 49-year-olds. Worldwide, the bacterial infection kills over 10 million people every year.

In 1993, WHO declared it a global emergency. Twelve years later, a survey conducted by a health ministry body reported TB in India claimed 100 million productive days each year.

This cost the economy over Rs 12,000 crore. The next year, in 2006, the National Family Health Survey found TB had declined 18% between 1999 and 2006.

The survey collected data on the prevalence of TB among people of different income groups. A comparison of the 1999 and 2006 data showed that TB had declined 16% among the poor and 18% in the middle class and the rich. But this figure does not tally with WHO’s data.

The reason is while the government data is based on patients admitted to government hospitals only, who collects data from other sources as well, including NGOs.

The rich are not included in government surveys because most of them get treated in private hospitals, said Zarir F. Udwadia of PD Hinduja Hospital in Mumbai. “About 70% of TB patients go to private practitioners. These cases go unreported. So the government data on TB prevalence is a gross understatement of facts,” said Udwadia.

The profile of TB patients would change if more studies are conducted to ascertain the relationship between income, lifestyle diseases and TB.

Rheumatoid arthritis also increases the risk of TB. A 2009 study by University Hospital of ULM in Germany compared immune cells of patients before and after arthritis therapy. They found some immune cells are lost during treatment and this reactivates latent TB infection.

Depending on where the infection is present, the success rate of treatment can vary – it is easiest to treat lymph node TB; the highest mortality is usually associated with brain TB, or tuberculosis meningitis.

Ajay Tyagi has recovered, and learnt his lesson. He leads a healthier life style and is careful when he travels. But it’s going to be no cakewalk to check the growth of the bacteria fast getting used to an affluent lifestyle.