Can Tuberculosis Come Back After Treatment? Doctor Explains Recurrence

Tuberculosis can recur through relapse or new drug-resistant strains, often triggered by incomplete treatment, a weakened immune system, or poor nutrition. Consulting specialists and completing prescribed medication regimens are crucial to preventing recurrence.

Tuberculosis (TB) is the oldest communicable disease, yet it continues to be a throbbing problem worldwide. With the emergence of multidrug resistant, tuberculosis has added onto the crisis and seriousness. One of the most common causes of developing resistance is the discontinuation of medicines due to long course and side effects.

"So does TB come back after treatment and why does this happen?"

Tuberculosis is a disease which can affect any organ in the body except for non-living tissues like hair and nails. The mode of transmission most commonly being droplet infection from cough and other respiratory tract secretions.

"So why does it not spread like COVID and affect everyone?"

Latent TB and the Role of the Immune System

The peculiarity of tuberculosis is the slow incubation period. Our body has an inbuilt immune system which is capable of attacking foreign bodies and microorganisms when they are detected and try to suppress, immune cells eat these organisms and if successful deposit calcium and this might end up as a tombstone with no activity, just scarring seen as an incidental finding in so many chest X-rays or might be suppressed as latent TB, i.e, the Tuberculosis bacilli are sleeping suppressed in the body without any infective potential. The problem arises when the individual has any immune suppression where this defence mechanism is not able to optimally fight, this might be seen in patients suffering from HIV AIDS, patients on chemotherapy or other immunosuppressants like steroids, biological immunomodulators given for autoimmune diseases.

Lifestyle Factors and Reactivation

Interestingly, many of such instances are also reported in people on crash diets involving skipping breakfast and long hours of fasting, this is mainly because of our body working in a catabolic state and stressful milieu for energy production and vitamin D deficiency and protein deficit seen due to improper diet.

During this process, we either can have reactivation or the latent 'sleeping' TB and cause infection, or are prone to secondary infection when exposed in the community due to the high prevalence of TB in India.

Treatment Challenges and Side Effects

When detected, treatment is advised on an average for 6 to 9 months, longer for musculoskeletal and brain involvement. Although now the regimens have been tailored for easy administration and Directly Observed Therapy (DOTS) has made it easy to be compliant. The medicines have a powerful dose; have risk of side effects like liver toxicity leading to jaundice-like symptoms, skin rashes, vomiting, and vision issues.

Although thorough monitoring is done for, the same and not all patients have these side effects it causes non-compliance, fear and discontinuation abruptly. This might lead to failure of therapy and recurrence.

Understanding Relapse and Resistance

The usual mechanism of recurrence is either relapse or resistance. This can occur over a gap of 10 years, hence it is difficult to monitor in some areas. Incomplete treatment regimen as mentioned above causes recurrence due to partially cured disease. The resistance can be from the same endotype or a different strain which is now understood due to an array of tests available like whole genome sequencing which shows whether the patient is affected by the same strain or it's a different strain which has resistance to medicines taken before altogether. We have also come to know of individual drug resistances, which might lead to mono resistant TB, which was easily identified earlier. Therefore, even though the patient is compliant with the medicines, slowly he might develop resistance.

Modern Diagnostics and Following Guidelines

In today's times, there is thorough evaluation during detection itself, thanks to the government lab support so the chances of incidents are quite less provided we follow the guidelines and visit a Pulmonologist or Specialist trained in TB treatment. Gone are the days of empirical TB medicines starting without any microbiological proof based on radiology.

So do not give in to fear mongering, trust your DOTS health care worker and follow their instructions thoroughly.

(By Dr. Udaya S, Consultant Pulmonologist, KMC Hospital, Mangalore)

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