New Delhi: India is the first country which has initiated the process of formulating standardised clinical guidelines for managing extra-pulmonary tuberculosis that occurs in the body other than lung parenchyma.
The Union Health Ministry in collaboration with the AIIMS are in the process of framing standardised clinical guidelines in this regard. According to Medical experts, there are no specific guidelines to diagnose the tuberculosis outside the lungs set by any nation in the world.
"Tuberculosis affects all organs of the human body, and managing it requires good clinical judgement and investigation services. This process of getting clinical guidelines is the first step towards providing high quality TB management services to the large number of people who have TB outside their lungs," said SK Sharma, Head of the medicine department at AIIMS and Professor-in-charge of its newly established Center of Excellence for Managing Extra-Pulmonary TB.
Over 47 medical specialist from across the country will work together to formulate the guidelines. These medical specialists will be divided into five groups, which will look after the occurrence of TB in various other parts of the body. As per AIIMS doctors, the inadequate infrastructure and resources at the peripheral level to identify, diagnose and treat extra pulmonary tuberculosis and non-availability of skilled and trained staff for appropriate sample collection, transportation and diagnosis are some of the major challenges to tackle the extra pulmonary tuberculosis.
Sharma said that while India has been traditionally home to the largest number of people affected by TB, there has been dramatic improvements over the past two decades in reducing deaths due to the disease with the help of constant laboratory, clinical and supervisory services.
Sharma emphasised that due to lack of literature on extra-pulmonary TB, the percentage of people suffering from the disease in India may be between 35 to 40 per cent. "Managing extra-pulmonary TB will require a similar scale up of even more sophisticated diagnostic services, along with team work between medical specialist across disciplines to ensure that morbidity and mortality associated with pulmonary TB is reduced," Sharma said.
Since 2004, cases of extra-pulmonary TB have increased by 3 per cent in 2008 as per RNTCP data. Out of these extra-pulmonary TB, 30 per cent were of pleural effusion, 10 per cent abdominal TB, 8 per cent bone TB, 47 per cent lymph node TB, 2 per cent TB meningitis and 3 per cent TB elsewhere in body except lungs.
More than 11,000 people had died due to extra-pulmonary TB (2005-07) in India alone. In 2011, as per RNTCP data, 226,965 cases of extra pulmonary TB were notified in India.
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