Nagpur: A silent reservoir of 35-40 crore people carrying latent tuberculosis infection in India is the biggest challenge to TB elimination, said Dr Sushant Meshram, chairman of the Maharashtra task force committee for the National TB Elimination Programme (NTEP), on Tuesday.
He warned that asymptomatic carriers can progress to active disease due to malnutrition, diabetes, ageing or immunosuppression. Dr Meshram also flagged that current tests like the Tuberculin Skin Test (TST) and IGRA cannot predict disease progression, stressing the need for targeted screening and preventive therapy in high-risk groups. The remarks came during the country's first dedicated CME programme on tuberculosis infection (TBI) in Nagpur.
CME Programme on TB Infection
Organised under the TB Mukt Bharat Abhiyan by the Maharashtra task force, in collaboration with the National Tuberculosis Elimination Programme (NTEP), the one-day workshop brought together specialists from pulmonology, microbiology, internal medicine and community health. The event was inaugurated by global TB expert Dr Sunil Khaparde.
Dr Meshram said, "Elimination is not possible by treating only active TB. The hidden burden must be addressed." Experts highlighted that the key challenge lies in identifying high-risk individuals, such as those with HIV, diabetes or close contact with TB patients, and offering preventive therapy rather than adopting a universal treatment approach.
Expert Insights on Diagnosis and Treatment
AIIMS Nagpur microbiology professor Dr Meena Mishra explained how the body contains TB infection through immune mechanisms like granuloma formation, while disruption in this balance leads to disease activation. IGGMCH pulmonary medicine professor Dr Gyanshankar Mishra stressed the need for improved molecular diagnostics for early and accurate detection.
Dr Khaparde emphasised ventilation, mask use and adherence to national infection control guidelines. GMCH paediatrics professor Dr Manish Tiwari highlighted diagnostic challenges in children but noted that timely treatment ensures recovery.
Why Latent TB Is Difficult to Manage
- Millions infected, but not all require treatment
- No tool to predict progression to active TB
- Limited resources for large-scale screening
Preventive Treatment Options (NTEP)
- Isoniazid (6-9 months)
- Rifampicin-based short course (3-4 months)
- Weekly Isoniazid + Rifapentine (3HP regimen)
