TUBERCULOSIS

BY: SUDEEP KOIRALA

 INTRODUCTION

 Tuberculosis (TB) is an infectious disease usually caused by

Mycobacterium tuberculosis (MTB) bacteria. 
 Tuberculosis generally affects the lungs, but can also affect other parts
of the body.
 Active, drug-sensitive TB disease is treated with a standard 6-month
course of 4 antimicrobial drugs that are provided with information,
supervision and support to the patient by a health worker or trained
volunteer.
 The vast majority of TB cases can be cured when medicines are
provided and taken properly.
 Tuberculosis (TB) is caused by a type of bacterium called
Mycobacterium tuberculosis. It's spread when a person with active TB
disease in their lungs coughs or sneezes and someone else inhales the
expelled droplets, which contain TB bacteria.
.
CONT.…..
 The bacteria usually attack the lungs .
But TB bacteria can attack any part of the body such as the
kidney, spine, and brain . If not treated
properly, TB disease can be fatal . TB disease was once the
leading cause of death in the United States .
 It is very important to remember that only someone with
active TB disease in the lungs can spread the germ. People
with TB infection are not contagious, do not have any
symptoms, and do not put their family, friends and co-
workers at risk.
 Signs and symptoms of active TB include: Coughing that
lasts three or more weeks. Coughing up blood. Chest pain,
or pain with breathing or coughing
CAUSES
 Tuberculosis (TB) is caused by a type of bacterium called Mycobacterium
tuberculosis. It's spread when a person with active TB disease in their lungs
coughs or sneezes and someone else inhales the expelled droplets, which
contain TB bacteria.
 Tuberculosis is caused by bacteria that spread from person to person
through microscopic droplets released into the air. This can happen when
someone with the untreated, active form of tuberculosis coughs, speaks,
sneezes, spits, laughs or sings.
 Although tuberculosis is contagious, it's not easy to catch. We're much more
likely to get tuberculosis from someone you live with or work with than
from a stranger. Most people with active TB who've had appropriate drug
treatment for at least two weeks are no longer contagious.
 Infants and young children (especially those under 2 years) are at greatest
risk of developing severe, disseminated disease associated with high
morbidity and mortality. Most children who become ill with TB have been
infected by an adult – be it a parent or another person in the household.
SYMPTOMS/SIGNS
 Coughing that lasts three or more weeks.
 Coughing up blood.

 Chest pain, or pain with breathing or coughing.

 Unintentional weight loss.

 Fatigue.

 Fever.

 Night sweats.

 Chills.

 Loss of appetite.

 Although our body may harbor the bacteria that cause tuberculosis (TB), your immune
system usually can prevent you from becoming sick. For this reason, doctors make a
distinction between.
 Latent TB. In this condition, you have a TB infection, but the bacteria remain in your
body in an inactive state and cause no symptoms. Latent TB, also called inactive TB or TB
infection, isn't contagious. It can turn into active TB, so treatment is important for the
person with latent TB and to help control the spread of TB. An estimated 2 billion people
have latent TB.
 Active TB. This condition makes you sick and in most cases can spread to others. It can
occur in the first few weeks after infection with the TB bacteria, or it might occur years
later.
RISK FACTORS( AGENT, HOST AND
ENVIRONMENT)
 Mycobacterium tuberculosis (infectious disease agent) is readily spreaded to
susceptible humans (host) through respiratory exposure in communal settings or
public gatherings (environment)
 Weakened immune system like as HIV/AIDS, Diabetes, several kidney disease,
certain cancer, cancer treatment such as chemotherapy, drugs to prevent rejection of
transplanted organs, malnutrition and very young and advance age.
 Traveling or living in certain areas :The risk of contracting tuberculosis is higher for
people who live in or travel to areas that have high rates of tuberculosis and drug-
resistant tuberculosis, including- Africa, Easter Europe etc.
 Poverty and substance use: lack of medical care, substance use, Tobacco use
 Where we work or live: Health care work, Living or working in a residential care
facility, Living in or emigrating from a country where TB is common, Living with
someone infected with TB.
 Complications :Without treatment, tuberculosis can be fatal. Untreated active disease
typically affects your lungs, but it can spread to other parts of your body through your
bloodstream.
RISK FACTORS OF TUBERCULOSIS
 Low Socio-Economic Status
 Crowded living conditions.

 Disease that weakens immune system like as HIV.

 Person on immunosuppressant's like steroid

 Health care workers.

 Migration from a country with high number of cases.

 Alcoholism.

 Recent Tubercular infection within last 2 years.

CONT.……

 HIV infection.
 Children exposed to high risk adults.

 Close contact of person known or suspected to have

active disease.
 Silicosis

 Prolonged corticosteroid therapy.

 Other immunosuppressive therapy.

 Low body weight (10% or more below than ideal).

 Diabetes mellitus.

 Residents and employees of high risk congregate

settings.
 Patients with CRF.
DIAGNOSIS
 A positive TB skin test or TB blood test only tells that a person has
been infected with TB bacteria. It does not tell whether the person
has latent TB infection (LTBI) or has progressed to TB disease.
Other tests, such as a chest x-ray and a sample of sputum, are
needed to see whether the person has TB disease.
 If the skin or blood tests indicate the need for further analysis, your
doctor may order a chest X-ray or CT scan to look for visible signs
of TB in your lungs. They may also check your sputum (coughed-up
mucus) for bacteria, to see whether you have clinically
active TB disease and if so, which strain of TB we have.
CONT.….
TREATMENT
 The most common medications used to treat tuberculosis
include:Isoniazid, Rifampin (Rifadin, Rimactane),
Ethambutol (Myambutol), Pyrazinamide.
 The usual treatment is: 2 antibiotics (isoniazid and rifampicin) for 6
months. 2 additional antibiotics (pyrazinamide and ethambutol) for
the first 2 months of the 6-month treatment period.
 Additionally, a person with tuberculosis should avoid or limit
certain foods and things:
 Alcohol - in any form is bad as it raises the risk of drug toxicity.
 Limit caffeine and carbonated drinks.
 Limit intake of refined products, including sugar, white rice and
white bread.
TREATMENT CONTD..
PREVENTIVE MEASURES
 Stopping the Spreading of TB
 Take all of your medicines as they're prescribed, until your doctor takes you off
them.
 Keep all your doctor appointments.

 Always cover your mouth with a tissue when you cough or sneeze. ...

 Wash your hands after coughing or sneezing.

 Don't visit other people and don't invite them to visit you.

 TB infection control including the use of masks & respirators, which

means preventing the transmission of TB in such settings as hospitals & prisons.
The pasteurization of milk also helps to prevent humans from getting bovine TB.
There is a vaccine for TB, but it makes only a small contribution
to TB prevention.
 The risk of infection can be reduced by using a few simple precautions: good
ventilation: as TB can remain suspended in the air for several hours with no
ventilation. Natural light: UV light kills off TB bacteria. good hygiene: covering
the mouth and nose when coughing or sneezing reduces the spread of TB bacteria.
5 STEPS TO PREVENT TB TRANSMISSION
1. Screen-Early recognition of subjects with suspected or
conformed TB.
2. Educate- Instruct patient on cough hygiene when
sneezing or coughing, provide tissue or masks.
3. Separate-request patient to wait in a separate and well
ventilated area.
4. Provide HIV services
5. Investigate for TB- TB diagnostic should be completed
ASAP.
CONT.….
PREVALENCE
 The report, launched on World Tuberculosis Day,
brings Nepal one step closer to meet the WHO End TB Strategy.
The survey showed around 117,000 people are living
in Nepal with TB. Likewise, 69,000 people developed TB in
2018. The TB incidence (new cases) was found to be higher (1.6
times) than previously thought. 
 In 2018, 1.7 billion people were infected by TB bacteria —
roughly 23% of the world's population. TB is the leading
infectious disease killer in the world, claiming 1.5 million lives
each year. 
 In 2018, the 30 high TB burden countries accounted for 87% of
new TB cases. Eight countries account for two thirds of the total,
with India leading the count, followed by, China, Indonesia, the
Philippines, Pakistan, Nigeria, Bangladesh and South Africa.
CONT.…..
CONT.….
CONT.…..
INCIDENCE
 Worldwide, TB is one of the top 10 causes of death and the leading
cause from a single infectious agent (above HIV/AIDS). In 2018, an
estimated 10 million people fell ill with Tuberculosis (TB)
worldwide. 5.7 million Men, 3.2 million women and 1.1 million
children. There were cases in all countries and age groups.
 A total of 1.5 million people died from TB in 2018 (including 251
000 people with HIV). Worldwide, TB is one of the top 10 causes of
death and the leading cause from a single infectious agent (above
HIV/AIDS).
 In 2018, an estimated 10 million people fell ill with
tuberculosis(TB) worldwide. 5.7 million men, 3.2 million women
and 1.1 million children. There were cases in all countries and age
groups. But TB is curable and preventable.
CONT.…
 In 2018, the 30 high TB burden countries accounted for 87% of new TB
cases. Eight countries account for two thirds of the total, with India leading
the count, followed by, China, Indonesia, the Philippines, Pakistan, Nigeria,
Bangladesh and South Africa.
 Multidrug-resistant TB (MDR-TB) remains a public health crisis and a
health security threat. WHO estimates that there were 484 000 new cases
with resistance to rifampicin – the most effective first-line drug, of which
78% had MDR-TB.
 Globally, TB incidence is falling at about 2% per year. This needs to
accelerate to a 4–5% annual decline to reach the 2020 milestones of the End
TB Strategy.
 Globally in 2018 there were an estimated 10 million incident cases of TB
(range, 9 million to 11.1 million), equivalent to 132 cases per 100 000
population. Most of the estimated number of cases in 2018 occurred in the
WHO South-East Asia Region (44%). The 30 high TB burden countries
accounted for 87% of all estimated incident cases worldwide and eight of
these countries accounted for two thirds of the global total: India (27%),
China (9%), Indonesia (8%), the Philippines (6%), Pakistan (6%), Nigeria
(4%), Bangladesh (4%) and South Africa (3%)
CONT.….
 An estimated 58 million lives were saved through TB
diagnosis and treatment between 2000 and 2018.
 Ending the TB epidemic by 2030 is among the health
targets of the Sustainable Development Goals.
https://www.who.int/news-room/fact-sheets
CHALLENGES IN CONTROLLING TB
Major challenges for TB control includes:
 Maintaining and improving the quality of basic TB
control services: ensuring access to high quality
diagnosis and treatment services, including services for
children.
 Slow progress in improving PMDT.

 Slow progress in increasing TB–HIV collaborative

activities.
 Inadequate laboratory capacity.
CONT…
 Overstretched health systems, including major
challenges related to the quality and quality of the health
workforce.
 Insufficient resource mobilization.

 Involvement of big hospitals and private providers.

 Limited involvement of NTPs in decision-making related

to the health sector reform processes.
NATIONAL AND INTERNATIONAL
POLICIES
 The vision for the post - 2015 global tuberculosis strategy is “a world free
of tuberculosis”, also expressed as “zero deaths, disease and suffering due
to tuberculosis”. The goal is to end the global tuberculosis epidemic.
 The Tuberculosis action plan for the WHO European Region 2016–2020
aims to end TB and ensure that no affected family faces catastrophic costs
due to the disease.
 This vision is based on the principle of equity and on leaving no one
behind, in line with the Sustainable Development Goals, and is consistent
with the global End TB Strategy and the Health 2020 European health
policy framework.
 Theaction plan sets the following regional targets to end TB by
2020:
 35% reduction in TB deaths;

 25% reduction in the TB incidence rate; and

 75% treatment success rate among drug-resistant TB patients.

CONT.….
 Implementing the action plan would:
 save an estimated 3.1 million lives;

 cure 1.4 million patients; and

 prevent 1.7 million new cases of all forms of TB.

 With an estimated cost of US$ 15 billion, the action plan

should prove highly cost-effective, resulting in savings of
US$ 48 billion in terms of lives saved and avoidable
suffering prevented.
 There was some progress in testing, detection and treatment
of MDR/RR-TB between 2017 and 2018. Globally in 2018,
51% of people with bacteriologically confirmed TB were
tested for rifampicin resistance where as in 2017, this count
was 41%.
CONT.…..
 For each of the 3 pillars of the global End TB Strategy (integrated patient-
centred care and prevention; bold policies and supportive systems; and
intensified research and innovation), the action plan details:
 a set of clear actions for all countries (including those with low numbers of
new TB cases), for partners and for WHO; and
 Multisectoral interventions to address social determinants and prevent and
manage TB/HIV co infection and other comorbidities through health system
and public health approaches that are disease-specific.
 The action plan was developed by WHO/Europe through a participatory
process and endorsed by Member States in 2015. WHO/Europe also created
a roadmap to support its full implementation, monitoring and evaluation.
 The European Technical Advisory Group on Tuberculosis Control (TAG-TB)

 WHO/Europe’s TB policy benefits from advice from TAG-TB. This group

provides independent reviews and technical opinions on TB to the WHO
Regional Director for Europe, particularly on areas related to TB prevention
and care in the European Region.
REFERENCES:
 https://www.euro.who.int/en/health-topics/communicable-diseases/tubercul
osis/publications/2016/roadmap-to-implement-the-tuberculosis-action-plan-
for-the-who-european-region-20162020.-towards-ending-tuberculosis-and-
multidrug-resistant-tuberculosis-2016
 http://www.un.org/en/ga/search/view_doc.asp?symbol=A/RES/73/3
 https://www.who.int/news-room/fact-sheets
 https://apps.who.int/iris/handle/10665/206505
 https://apps.who.int/iris/handle/10665/205913
 https://www.saarctb.org/new/saarc-epidemiological-response-on-tuberculosi
s-2019/
 https://www.saarctb.org/new/saarc-guidelines-for-private-public-mix-appro
ach-for-national-tb-control-programmes/
 https://www.saarctb.org/new/annual-report-2016/
 https://www.saarctb.org/new/stac-at-a-glance-2/
 https://www.saarctb.org/new/saarc-regional-strategy-on-tb-control
THANK YOU