The warning signal that if a person has a cough for more than 14 days, with fever, loss of appetite and weight, he must report to his physician for check-up and tests, for the inclusion/ exclusion of tuberculosis, is hardly followed, and, even the symptoms are not known to all. The longer the disease remains undiagnosed, the more difficult it becomes to eradicate the infection. Even when it remains asymptomatic for sometime in many of the cases, when it presents itself, there may occur only vague symptoms of the disease. In such cases, either the above mentioned symptoms are missing or are not clearly recognized by the patient. All this further delays the treatment, and, therefore, the public is required to be highly vigilant and should have up-to-date and elaborate knowledge of early symptoms.



When the patient is late, and on top of it, he has taken some haphazard antituberculosis treatment, it will create a good deal of problem for the physician, to prescribe drugs, as the tubercle bacilli may have already developed resistance to some of the routine' drugs for tuberculosis. Much difficulty arises, as is seen often, in most of the cases, because the patients do not know even the names of the drugs they have taken, and their prescription is often missing.

It must be known by all that drug resistance to tubercle bacilli is the major cause of failure to control the disease in any country. Once some routine antituberculosis drugs are not effective in killing tubercle bacilli, a great hope, for eradicating the disease, in a particular patient, is lost, because the second line of antituberculosis drugs is fairly costly, and one is never sure of their sensitivity to the tubercle bacilli in the concerned patient, and above all, they may not be easily available. Further, all patients are unlikely to benefit from them, and as such, the situation almost reaches a stalemate under these circumstances.

Tubercle bacilli rapidly" undergo mutation or change their strains, which become resistant to the drugs administered. Since laboratory facilities for testing the sensitivity of various drugs are available only at a very few selected places, great caution is required in the treatment of tuberculosis to avoid drug resistance.

It, indeed, becomes a major issue in the control of tuberculosis, when the tubercle bacilli become resistant to various antituberculosis drugs, in a good number of cases, because such patients go on transmitting these multi-drug resistant tubercle bacilli to a large number of the population, making them all patients of multi-drug resistant tuberculosis, and these patients, even if they report themselves, are difficult to treat with routine drugs. These so-called multi-drug resistant tuberculosis (MDRT) patients go on spreading the disease like wildfire, which may be responsible for heavy casualties.

Such cases of MORT become potential dangers to society / country, as their treatment, even if it is carried out, is not an easy one. It is one of the important tasks of NTP to pinpoint such cases, and all efforts should be made to treat them in hospitals. On discharge they must be educated to live in isolation at home and take preventive steps like wearing masks and avoiding crowded places, so that they do not transmit the resistant tubercle bacilli to other persons till they have been declared completely fit.

Close contact with family members, especially children, who may have a low resistance, must be avoided in the case of such patients. As more members of a family may contract this resistant form of the disease, it will not only add to the financial burden, but may also cause death/s in the family, if immediate steps for treatment are not taken. Undoubtedly, the threat of this type of resistant tuberculosis still needs a concrete solution, since fast-spreading cases of MDRT are a major obstacle for the control of tuberculosis, since these cases are neither easy to detect nor treat. When detected, they become a hard task for the specialist. It should be pointed out that unless this group of cases is dealt with satisfactorily, the entire programme of control of tuberculosis can never be successful.

Needless to say that the whole situation mentioned above is entirely due to human error on the part of patients of tuberculosis. If they report in time and take a full course of routine antituberculosis drugs, the problem will be largely solved.

But patients, even if they reach in time, may take the treatment during the first two months of therapy, when more than 2-3 drugs are given, but as during this initial period of treatment, they become free of symptoms, they hardly bother to follow the further course of four to six months, and thus a relapse occurs, and the patient goes on transmitting the disease to others. The patient, most likely, stops further treatment due to sheer ignorance, neglect or apathy. In any case such cases.