Tuberculosis in Nepal: A Persistent Challenge

Despite significant progress in global TB control, Nepal continues to face a high burden of tuberculosis. Nepal is classified as one of the high TB burden countries by the WHO. With approximately 69,000 new TB cases estimated annually, TB remains one of the leading infectious disease killers in the country.

The good news: TB is treatable, and with proper diagnosis and adherence to treatment, most patients recover fully.

What Is Tuberculosis?

Tuberculosis is a bacterial infection caused by Mycobacterium tuberculosis. While it primarily affects the lungs (pulmonary TB), it can also affect other organs including the lymph nodes, spine, kidneys, and brain (extrapulmonary TB).

TB spreads through the air when an infected person coughs, sneezes, or speaks. It is NOT spread through touch, sharing utensils, or sexual contact.

Recognizing the Symptoms

Pulmonary (Lung) TB — Classic Symptoms

• Persistent cough lasting more than 2–3 weeks
• Coughing up blood or blood-stained sputum (hemoptysis)
• Chest pain or tightness
• Shortness of breath

Systemic (Whole Body) Symptoms

• Fever, especially in the evenings
• Night sweats (soaking the bedclothes)
• Unintentional weight loss
• Extreme fatigue and weakness
• Loss of appetite

Latent vs. Active TB

Not everyone infected with TB becomes sick immediately. Understanding the difference is important:

• Latent TB: The bacteria are dormant in the body. The person has no symptoms and is NOT contagious. However, latent TB can reactivate, especially if the immune system weakens.
• Active TB: The bacteria are active, causing symptoms and making the person contagious. Immediate treatment is essential.

Diagnosis at NITA Clinic

We offer comprehensive TB diagnosis using the most current methods:

• Sputum Smear Microscopy — traditional, fast, detects active pulmonary TB
• GeneXpert MTB/RIF — highly accurate, results in 2 hours, also detects drug resistance (MDR-TB)
• Chest X-ray — visualizes lung lesions and disease extent
• Tuberculin Skin Test (Mantoux) — screens for latent TB infection
• IGRA Blood Test — modern blood test for latent TB
• TB Culture — gold standard, confirms diagnosis and drug sensitivity (takes 2–8 weeks)

Treatment: The DOTS Strategy

TB is treated with a combination of antibiotics, typically over 6 months. Nepal follows the WHO-recommended Directly Observed Treatment, Short-course (DOTS) strategy.

• First 2 months (Intensive Phase): 4 drugs — Isoniazid, Rifampicin, Pyrazinamide, Ethambutol
• Next 4 months (Continuation Phase): 2 drugs — Isoniazid, Rifampicin

Critical: It is essential to complete the full course of treatment, even if you feel better after a few weeks. Stopping early leads to drug-resistant TB (MDR-TB), which is much harder and more expensive to treat.

Who Is at Higher Risk?

• People living with HIV
• Close contacts of active TB patients
• Malnourished individuals
• Diabetics (3x higher risk)
• Smokers and heavy alcohol users
• Healthcare workers
• People in overcrowded living conditions

Prevention

• BCG vaccination for all newborns — protects against severe forms of TB in children
• Ensure good ventilation in living and working spaces
• Cover mouth when coughing or sneezing
• Complete treatment for latent TB if recommended by your doctor
• Get screened if you've been in close contact with a TB patient

TB is curable. The key is early detection and completing the full course of treatment. Don't ignore a cough that persists for more than 2–3 weeks.

NITA Clinic's TB clinic offers free or subsidized TB testing under government programs. Contact us for details.