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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 7  |  Issue : 1  |  Page : 39-41

Active tuberculosis cases in the community, lessons learned: Case series


Department of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India

Date of Submission20-Jul-2020
Date of Decision17-Feb-2021
Date of Acceptance27-Apr-2021
Date of Web Publication02-Jul-2021

Correspondence Address:
Ariarathinam Newtonraj
Department of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry - 605 014
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrsm.jcrsm_54_20

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  Abstract 


India is working hard to eliminate tuberculosis (TB) by 2025 and one of the key strategy is active case finding (ACF) of TB by house to house visit in the community. Through this ACF, which was carried out in a rural area of Pondicherry, three active cases of TB were identified. Active cases found through ACF differs from passive cases finding mainly in health care-seeking behavior and act as a source for spreading of the disease in the community and it is imperative to discuss about them. All the three cases that were detected were having diabetes and two of them were from a scheduled community area. One among them is a “newly diagnosed” case, while the other two cases belonged to “loss to follow up” and “failure of treatment” criteria. There was a lack of motivation among these patients to seek health care and adherence to treatment; and the health system also needs to gear up to tackle these active cases in the community, so that elimination of TB can be achieved by 2025. All the cases were notified with the health system and appropriate intervention was started.

Keywords: Active case finding, Cartridge-Based Nucleic Acid Amplification Test, National Tuberculosis Elimination Program, Revised National Tuberculosis Control Program, screening


How to cite this article:
Mohankumar R, Rajakarthika G R, Nandhinikumari N R, Sri R N, Mruganayani G, Julieanne J M, Shereen A S, Newtonraj A, Konduru RK. Active tuberculosis cases in the community, lessons learned: Case series. J Curr Res Sci Med 2021;7:39-41

How to cite this URL:
Mohankumar R, Rajakarthika G R, Nandhinikumari N R, Sri R N, Mruganayani G, Julieanne J M, Shereen A S, Newtonraj A, Konduru RK. Active tuberculosis cases in the community, lessons learned: Case series. J Curr Res Sci Med [serial online] 2021 [cited 2021 Dec 4];7:39-41. Available from: https://www.jcrsmed.org/text.asp?2021/7/1/39/320502




  Introduction Top


Worldwide around 10 million individuals develop tuberculosis (TB) every year, but only 60% are notified to the health system and the rest go undetected. India has the highest total TB cases among all the countries.[1],[2],[3] In India, the estimated incidence is 2.7 million new cases every year but among them, only 2.1 million cases were notified in 2018. Even though it is a great achievement, the problem of missing cases poses a great challenge in TB elimination. India is working hard towards the elimination of TB by 2025 and the government of India is stressing each and every state to develop their own strategy to eliminate TB and achieve the targets by 2025.[4] One of the key strategies to achieve this target is by active case finding (ACF) of tuberculosis (TB) through house to house visit.[5]

With the approval and support of the Government of Puducherry and the Nation Tuberculosis Elimination Programme Office, ACF on TB was conducted in January 2020 in one of the rural areas of Pondicherry with the help of Undergraduate Medical Students and 3 cases were detected. This ACF was conducted in January 2020 covering an approximate population of 5000.

Active TB cases found through ACF in the community differs from passive cases in few ways like health-seeking behavior (belief, barriers, etc.), socio-economic conditions, clustering of cases and will also give us a clear picture to initiate community interventions and preventive strategies. Hence, it is imperative to discuss about the active cases found through ACF to understand programme challenges and possible strategy to achieve TB elimination at that local level. In this paper, those cases are discussed to help the program managers and policymakers to design appropriate strategy to eliminate TB. Informed written consent was obtained from all the patients. The anonymity of data is maintained. Institute Ethics Board approval was obtained.


  Case series Top


Case 1

Mr. A, 41-year-old male residing in a slum, belonging to scheduled community has cough with expectoration for the past 6 months. No history of fever or haemoptysis. None of the family members had similar symptoms. He is a known alcoholic for the past 20 years. Married and having one adolescent daughter. Not a smoker. Known Diabetic (DM) on irregular treatment. On examination, he was undernourished (body mass index 17), pallor present. Sputum microscopy was negative and Cartridge-Based Nucleic Acid Amplification Test (CbNAAT) was positive for Mycobacterium tuberculosis. X-ray was found to have lesions in the left upper lobe. The patient was diagnosed as a “new case” of pulmonary TB (PTB) started on anti-tuberculosis treatment (ATT) under National Tuberculosis Elimination Program (NTEP).

Case 2

Mr. B, 62-year-old male residing in the same community and a neighbour of Mr. A (residing in the same street). He is an already diagnosed case of TB and is not on treatment. Six months before he was diagnosed as having TB, but took only 1 month of treatment and then discontinued. Then once again 6 months before he was diagnosed as having active TB and again started on treatment but did not continue after 2 weeks. He is a known alcoholic and diabetic on irregular treatment for diabetes, living in his own house with two sons and a daughter in law. History of cough was present, no history of hemoptysis or fever. At present his CbNAAT is positive, but not willing to continue the treatment or to do any other further investigations. He is a diagnosed case of “loss to follow-up of PTB.”

Case 3

Mr. C is a 42-year-old male already diagnosed with TB and completed 6 months of ATT and declared as cured after negative sputum microscopy 1 year back. This patient is a known case of DM on treatment and not an alcoholic or smoker. At present, the patient is again having cough with expectoration for the past 4 months. CbNAAT was positive and X-ray showed new lesions. Planned to start treatment based on the culture report. Still, this patient is not willing to start treatment even if the culture is positive.

Lessons learned

Case 1 (new case identification)

The first two cases belong to the same area and both were neighbours and friends. While the program is advocating on household screening of a positive patient, along with that if the neighbors and surrounding area of positive patients are screened, there is a possibility of picking up a new case. Moreover, health workers and tuberculosis health visitors should also be sensitized to carry out frequent active surveys in those active pockets.

Case 2 (loss to follow-up)

Even though this patient is in the programme records, he refuses to take treatment. Program should device strict strategies on such cases to prevent transmission. One of the feasible solutions could be home isolation of these patients and not allowing them to participate in any public gatherings. The patient should be visited by the health worker frequently to find out any possible way of convincing him for taking treatment as well as ensuring preventive measures to protect the community and household members of that individual.

Case 3 (failure)

Even though this patient is a treated case and declared as TB free, this patient didn't turn up to the hospital when the symptoms started again. Even though the patient was informed about this at the completion of treatment, the patient was hesitant to accept if he once again tested positive for TB. Literature shows that there is a high chance of recurrence of TB among the previously treated patients.[6] As one of the elimination strategy, the government may consider to have regular scheduled visits to the already cured individuals to actively screen for PTB.


  Conclusion Top


Our case study has discussed few positive strategies to diagnose missed active cases in the community. Nevertheless, there is a need for high level of dedication and devising of new strategies by the health care delivery system to meet the NTEP goals of eliminating TB from India by 2025.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Global Tuberculosis Report 2018. Geneva World Health Organization; 2018.  Back to cited text no. 1
    
2.
Revised National Tuberculosis Control Programme (RNTCP); Central TB Division; Ministry of Health and Family Welfare; Government of India. Technical and Operational Guidlines for Tuberculosis Control in India. New Delhi; 2016. Available from: https://www.tbindia.gov.in. [Last accessed on 2020 Jan 03].  Back to cited text no. 2
    
3.
Revised National Tuberculosis Control Programme (RNTCP); Central TB Division; Ministry of Health and Family Welfare; Government of India. India TB Report 2018. New Delhi; 2018. Available from: https://tbcindia.gov.in/showfile.php?lid=3314. [Last accessed on 2020 Jan 03].  Back to cited text no. 3
    
4.
Central TB Division of Ministry of Health and Family Welfare under Government of India. National Strategic Plan for Tuberculosis: 2017-2025, Elimination by 2025; 2017. Available from: https://tbcindia.gov.in/WriteReadData/National Strategic Plan 2017-25.pdf. [Last accessed on 2020 Jan 03].  Back to cited text no. 4
    
5.
Mani M, Riyaz M, Shaheena M, Vaithiyalingam S, Anand V, Selvaraj K, et al. Is it feasible to carry out active case finding for tuberculosis in community-based settings?. Lung India 2019;36:28-31.  Back to cited text no. 5
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6.
Shewade HD, Gupta V, Satyanarayana S, Kharate A, Murali L, Deshpande M, et al. Are we missing “previously treated” smear-positive pulmonary tuberculosis under programme settings in India? A cross-sectional study.' F1000Res 2019;8:338.  Back to cited text no. 6
    




 

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