TB (Sil) in Pakistan: Symptoms, Tests and the Full Six-Month Treatment

Tuberculosis is not a disease of the past in Pakistan, and the numbers are not small. The WHO's Global Tuberculosis Report 2025 put Pakistan at an estimated 670,000 TB cases in 2024 — 6.3% of the entire global burden, placing it among the five countries that account for most of the world's TB alongside India, Indonesia, the Philippines and China (The News, reporting the WHO figures). WHO's country office puts the daily arithmetic plainly: over 1,800 new cases arise and 140 people die of TB in Pakistan every day.

The more useful number for a reader is the gap. Pakistan notified and treated more than 497,000 people in 2024 — about 74% of the estimated total, up from 63% in 2015. That leaves roughly a quarter of cases undiagnosed, and Pakistan alone accounts for 7.2% of the worldwide gap between estimated TB and diagnosed TB. Those missing patients are not statistics in a report; they are people with a cough that nobody tested.

At a glance

• ~670,000 estimated cases in 2024; 6.3% of global TB (WHO Global TB Report 2025)
• Over 1,800 new cases and 140 deaths every day (WHO EMRO, Pakistan)
• About 74% of estimated cases were diagnosed and treated in 2024 — roughly a quarter were missed
• TB is curable with a full course of treatment, usually six months, and diagnosis and medicines are provided free through the National TB Control Programme's centres
• Stopping treatment early is how ordinary TB becomes drug-resistant TB, which is far harder and longer to treat

TB kya hai?

TB — jise Urdu mein aam taur par "sil" kaha jata hai — ek bacteria se hone wali bimari hai jo zyada tar phephron (lungs) ko lagti hai, lekin gilti (lymph nodes), haddi, pait aur dimagh ko bhi lag sakti hai. Yeh hawa ke zariye phailti hai jab TB ka mareez khansta ya chheenkta hai.

Sab se ahem baat: agar khansi do haftay se zyada rahe, sham ko bukhar aata ho, raat ko paseena aaye, aur wazan kam ho raha ho — to TB ka test zaroor karwayen. Test aur dawai sarkari TB centres par muft milti hai. TB ka ilaj mumkin hai, lekin poora chhe mahine ka course khatam karna zaroori hai. Bahut se log do mahine baad "theek" mehsoos kar ke dawai chhor dete hain — usi se dawai-resistant TB banti hai, jis ka ilaj kai guna lamba aur mushkil hai.

Symptoms

Pulmonary (lung) TB, the most common form, typically shows up as:

• A cough lasting more than two weeks (do haftay se zyada khansi) — the single most important warning sign
• Coughing up sputum, sometimes with blood (balgham mein khoon)
• Low-grade fever, classically in the evening (sham ka bukhar)
• Night sweats (raat ko paseena)
• Unintentional weight loss and loss of appetite (wazan kam hona, bhook na lagna)
• Persistent fatigue and chest pain

Extrapulmonary TB is common too and looks different: a painless swollen lymph node in the neck (gilti), back pain from spinal TB, abdominal swelling, or in children a failure to grow normally. Any of these with weeks of low fever and weight loss deserves testing rather than a course of ordinary antibiotics.

Who is at higher risk

• Household contacts of someone with active TB — the closest and longest exposure
• People living in crowded, poorly ventilated housing
• Malnutrition, which both raises the risk of TB and is worsened by it
• Diabetes, which roughly multiplies TB risk — see our guide to diabetes in Pakistan
• HIV, long-term steroid use, or other causes of a weakened immune system
• Smoking and heavy indoor smoke exposure

How it's diagnosed

TB is confirmed in a laboratory, not by a doctor's guess or an X-ray alone. The usual route is a sputum test — increasingly a rapid molecular test (GeneXpert), which detects the bacteria and checks for rifampicin resistance at the same time, in hours rather than weeks. A chest X-ray supports the picture but cannot by itself distinguish TB from other lung disease. For extrapulmonary TB, a biopsy or fluid sample from the affected site is needed. A general physician or chest specialist can start this, and TB centres run the tests without charge.

Treatment

Standard drug-sensitive TB is treated with a combination of four medicines for the first two months, followed by two medicines for four more — six months in total, taken every single day. Almost everyone feels substantially better within three to six weeks, which is precisely the trap: feeling better is not being cured. Key points:

• Take every dose. Missed doses are how resistance develops
• Never stop at two months because the cough has gone (khansi khatam hone par dawai band na karen)
• Tell the doctor about yellowing eyes, severe nausea, vision changes or numbness — these are known drug side effects that need reviewing, not a reason to quietly quit
• Drug-resistant TB is treated with a different, longer regimen at designated centres — it is still treatable, just harder
• Household contacts, especially children under five, should be screened

When to see a doctor

• Any cough lasting more than two weeks, with or without fever
• Coughing blood — this needs same-week attention, not a wait-and-see
• Weeks of evening fever, night sweats and weight loss together
• A painless neck swelling that has been growing for weeks
• Living with someone diagnosed with TB — get screened even if you feel fine

Prevention

• BCG vaccination at birth, part of Pakistan's routine EPI schedule, which protects infants against the severest forms of TB
• Ventilation — open windows dilute airborne bacteria far more effectively than any disinfectant
• Covering the mouth when coughing, and using a mask in the first weeks of treatment
• Screening household contacts as soon as one person is diagnosed
• Treating diabetes and malnutrition, both of which raise susceptibility

Frequently asked questions

Kya TB poori tarah theek ho jati hai?

Ji haan — drug-sensitive TB ka poora course lene se yeh theek ho jati hai. Shart sirf yeh hai ke dawai bilkul waise li jaye jaise batayi gayi ho, poore chhe mahine.

Is TB hereditary?

No. TB is an infection spread through the air, not an inherited condition. Families often share cases because they share the same rooms and air, not the same genes.

Can someone on treatment infect others?

Infectiousness drops sharply within the first couple of weeks of effective treatment. Until then, ventilation, masks and sleeping in a separate room where possible reduce the risk to the household.

Is the treatment really free?

Diagnosis and the standard drug regimen are provided free through the National TB Control Programme's network of TB centres and participating facilities. Private care is an option, not a requirement.

Sources

• WHO — Global Tuberculosis Report 2025
• The News — "Pakistan among top five countries contributing 6.3pc of global TB cases: WHO"
• WHO EMRO — "Tuberculosis kills 140 people per day in Pakistan"
• "The rising tide of tuberculosis in Pakistan: Factors, impact, and multi-faceted approaches for prevention and control" (PMC)

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