By Dr Bandi K Sangma
For centuries, tuberculosis (TB) has silently claimed millions of lives, lurking in the shadows of history as one of humanity’s deadliest infectious diseases. Despite remarkable advancements in medical science, TB remains a persistent global threat, disproportionately affecting vulnerable populations. In 2023 alone, the World Health Organization (WHO) estimated that 10.8 million people fell ill with TB, and 1.25 million succumbed to it. But what if the real battle isn’t just against the bacteria itself, but against the misinformation, stigma, and systemic neglect that allow it to thrive?
As we mark World Tuberculosis Day on March 24, 2025, it is time to confront the harsh realities of this ancient disease and commit to a future where TB is no longer a leading cause of death. From its traces in Egyptian mummies dating back 9,000 years to its modern-day devastation, TB’s story is one of missed opportunities and urgent calls for action. By understanding its history, challenges, and the steps needed for eradication, we can turn the tide against this enduring epidemic.
TB is one of the oldest recorded diseases, with references in ancient Greek and Roman texts. Hippocrates described it as “phthisis,” and it was long considered a death sentence due to the lack of effective treatments. It was only in 1882 that German scientist Robert Koch identified Mycobacterium tuberculosis as the causative agent, revolutionizing TB diagnosis and treatment. The term “tuberculosis” was later coined by Johann Lukas Schönlein, marking a turning point in the disease’s scientific understanding.
India bears the highest burden of tuberculosis worldwide, with approximately 2.64 million new cases annually, accounting for nearly 26% of the global TB burden. On average, one TB patient dies every two minutes in India. Despite government efforts such as the National Tuberculosis Elimination Program (NTEP), significant gaps remain.
The profound tragedy of TB extends beyond its biological consequences, encompassing the pervasive social stigma associated with it. Misconceptions and myths, particularly prevalent in India, perpetuate this stigma. Common beliefs include the notion that TB is a hereditary curse, a sign of weakness, or even divine punishment. These misconceptions lead to delayed diagnosis, reluctance to seek treatment, and social ostrazisation—especially among women, who often conceal their symptoms for fear of abandonment by their families.
A key factor exacerbating TB’s impact is the presence of co-morbidities. The high prevalence of malnutrition, alcohol and tobacco use, diabetes and HIV infection in India significantly increases susceptibility to TB. Studies show that individuals with HIV are 16-27 times more likely to develop active TB than those without the virus. Additionally, air pollution, particularly exposure to fine particulate matter (PM2.5), weakens lung function and raises TB susceptibility. The deteriorating air quality in Indian cities underscores the urgent need for robust environmental regulations and public health interventions.
Tuberculosis exists on a spectrum. Latent TB occurs when an individual is infected with Mycobacterium tuberculosis but does not manifest symptoms or transmit the disease. In contrast, active TB presents with symptoms such as chronic cough, fever, and weight loss and is highly contagious. The WHO is considering a third category, asymptomatic TB (aTB), current thinking positions aTB as a state on a continuum of M tuberculosis infection to clinically apparent symptomatic disease, with considerable variation in disease trajectories among individuals. Another critical question is the extent to which aTB contributes to transmission and its duration of infectiousness. Although transmission has been shown there is little and conflicting evidence about the relative infectiousness of people with aTB compared with those who cough. Some experts argue that many asymptomatic people releasing fewer infectious respiratory particles each time they exhale can be of greater importance than a smaller number of individuals who cough. Although molecular methods like Nucleic Acid Amplification Tests (NAAT) and artificial intelligence have enhanced the confirmation of TB diagnosis to a certain extent, there exists a significant population of patients who exhibit symptoms and X-ray findings indicative of active TB but are sputum negative. These patients necessitate specialized investigations such as computed tomography (CT) scans and bronchoscopy, which are typically performed by pulmonologists or respiratory specialists to definitively confirm the diagnosis.
Treating TB is a protracted and arduous process, significantly more intricate than managing other diseases like malaria or typhoid, which can be effectively treated with brief courses of one or two medications. In contrast, TB necessitates a minimum of six months of intensive, three to four drug therapy with some cases requiring more than a year of treatment. This prolonged treatment often leads to adverse drug reactions , non-adherence, contributing to the rise of drug-resistant TB. According to WHO data, approximately 410,000 cases of multidrug-resistant TB (MDR-TB) were reported globally in 2023. India alone accounted for nearly 27% of these cases, underscoring the urgent need for better adherence strategies and stronger healthcare infrastructure. MDR-TB is primarily a man-made crisis, stemming from improper use of antibiotics, incomplete treatment courses, and poor healthcare practices. MDR-TB is significantly harder to treat, requiring longer durations of therapy with more toxic drugs. Newer treatment regimens such as bedaquiline-containing regimens have shown promise, but their accessibility remains limited due to high costs and regulatory barriers.
Despite India’s ambitious goal of eliminating TB by 2025, the department of respiratory medicine, commonly referred to as pulmonary medicine or TB and Chest, has been designated as a non-essential department by the National Medical Commission (NMC). Consequently, it has been removed from the MBBS curriculum and not included in the newly established medical colleges. As a result aspiring doctors would receive minimal exposure to TB management, leading to gaps in care and expertise. This oversight must be rectified to equip future physicians with the necessary skills to combat TB effectively. Medications alone won’t suffice; we also need specialists.
Pulmonologists or respiratory medicine specialists, play an instrumental role in diagnosing, treating and managing TB, as well as difficult to treat TB and MDR/XDR TB. Their expertise extends beyond TB, encompassing a wide range of pulmonary diseases such as lung cancer, asthma, chronic obstructive pulmonary disease (COPD), critical care, interstitial lung diseases, interventional procedures and sleep medicine, among others. To effectively address these challenges, it is imperative to strengthen the pulmonology specialty and mandate the inclusion of pulmonary/respiratory medicine departments in upcoming medical colleges. This initiative will significantly enhance TB care and improve overall respiratory health outcomes in India.
TB and lung cancer often present with overlapping symptoms, leading to delayed diagnosis and mismanagement. Chronic TB infections have also been linked to an increased risk of lung cancer due to prolonged lung inflammation and scarring. Unfortunately, India lacks a nationwide lung cancer screening program, making early detection difficult. Given the high burden of respiratory diseases and tobacco use, implementing systematic lung cancer screening could significantly improve survival rates. To effectively combat TB, a comprehensive strategy is necessary—one that encompasses government policies, medical advancements, and public awareness initiatives. Key components of this strategy include expanding diagnostic facilities, ensuring adherence to treatment regimens, reducing stigma, integrating TB education into medical curricula, addressing air pollution, and implementing lung cancer screening programs. Additionally, India must prioritize investment in newer TB vaccines and innovative treatment regimens to accelerate progress toward eradication.
Lets reaffirm our commitment to raising awareness, dispelling misconceptions, and collaborating to eliminate TB and other respiratory diseases on World Tuberculosis Day. The fight against TB is a social, economic and ethical imperative. Together, we can defeat this age-old adversary and build a tuberculosis-free future.
(The author is MBBS,MD Respiratory Medicine, Assistant Professor, PA Sangma Medical College, USTM, Meghalaya).