TUBERCULOSIS

WHAT IS
TUBERCULOSIS

• Tuberculosis (TB) is an infectious disease

caused by the bacterium Mycobacterium
tuberculosis.

• It primarily affects the lungs but can also

affect other parts of the body, such as the
kidneys, spine, and brain.
 TYPES OF TUBERCULOSIS
Pulmonary TB Extra-pulmonary TB

TB can also affect other parts of the body

This is the most common form of TB,
besides the lungs, such as the kidneys,
affecting the lungs. spine, brain, lymph nodes, and bones.
Examples include:
TB lymphadenitis
TB meningitis
TB osteomyelitis
Genitourinary TB
TRANSMISSION

1. Transmitted through the air when an

infected person with active TB disease
coughs, sneezes, speaks, or sings.
2. Close and prolonged contact with an
infectious individual increases the risk
of transmission.
 02 weeks to
INCUBATION PERIOD several years
RISK FACTORS

• Close contact with someone who has active TB.

• Weakened immune system.
• Living in crowded or poorly ventilated environments.
• Malnutrition and poor access to healthcare.
• Substance abuse.
• Age
• Tobacco smoking.
SYMPTOMS
1. Persistent cough that lasts more than three
weeks
2. Coughing up blood or sputum
3. Chest pain
4. Weakness or fatigue
5. Weight loss
6. Fever and chills
7. Night sweats
8. Loss of appetite
TUBERCULOSIS IN INDIA
•India bears a significant burden of tuberculosis
(TB) and is among the countries with the
highest TB incidence globally. Here are some
key points regarding the TB burden in India:
•High TB incidence
•Multidrug-resistant TB (MDR-TB)
•Large population
•Challenges in Government initiatives
•India has a comprehensive tuberculosis (TB)
control program called the Revised National
Tuberculosis Control Programme (RNTCP),
which was later renamed as the National
Tuberculosis Elimination Programme (NTEP).
Here's an overview of the program
TOOLS FOR DIAGNOSIS

Sputum Smear Microscopy (for AFB)

- Culture
Rapid Molecular diagnostic testing
- Line Probe Assay
CBNAAT
X RAY CHEST
MONTOX TEST
AIMS OF TREATMENT

10 To cure the patient of 18.

To prevent death from active TB or its late effects.
To prevent relapse of TB
To decrease transmission of TB to others.
 ANTITUBERCULER DRUGS

GROUP 2 GROUP 3
GROUP I: (FIRST-LINE ORAL (INJECTABLES): (FLUOROQUINOLONES):-
ANTITUBERCULAR DRUGS)
• Isoniazid (H). • Kanamycin (Km).
• Amikacin (Amk). • Levofloxacin (Lfx)
• Rifampicin (R). • Moxifloxacin (Mfx)
• Capreomycin
• Ethambutol (E) • Ofloxacin (Ofx)
(Cm).
• Pyrazinamide (z). • Streptomycin .

• Rifabutin (Rfb).
 GROUP 5
Antituberculosis drugs with unclear efficacy or
unclear role in MDR-TB treatment (not
GROUP 4 (ORAL recommended by WHO for routine use in MDR-
BACTERIOSTATIC SECOND- TB patients)
LINE DRUGS) • Protionamide (Pto) ( ac)
• Cycloserine (Cs)
• Ethionamide (Eto) •Terizidone (Trd)
•P-aminosalicylic acid (PAS)
•Clofazimine (Cfz)
•Linezolid (Lad)
•Clarithromycin (Cir)
•Amoxicillin/clavulanate (Amx/Clv)
•Imipenem (Ipm)
•Thicacetazone (Thz)
DOTS TREATMENT

. Supervised drug therapy as an indoor patient is

not entitled and feasible for families and ex-
servicemen, they should be advised and
encouraged to take treatment from nearest
DOTS centre. Community medicine needs to
play an important role in spreading awareness
about DOTS programme and should work in
close association with DOTS centre.
PREVENTION
AND CONTROL

•Early diagnosis and screening

•Prompt treatment
•Precautions in health care settings
•Training of health care staff
•Health education
•Monitoring and follow up
DRUG-SENSITIVE TB

- First-line drugs include Isoniazid (H),

Rifampicin (R), Pyrazinamide (Z), Ethambutol
(E), and Streptomycin (S).
- The standard treatment duration is typically 6
months, consisting of an initial intensive phase
of 2 months (HRZE) followed by a continuation
phase of 4 months (HR).
MULTIDRUG-RESISTANT TB
(MDR-TB)

• Use at least 4 drugs certain to be effective as found by DST or if the drug has not
been used before for more than a month.
• Do not use drugs for which there is possibility of cross resistance.
• Include drugs from Gp 1-5 in a hierarchical order.
• Use any of the first line oral agents (Group 1) that are likely to be effective.
• Use one injectable drug (Gp-2).
• Use a fluoroquinolone (Gp-3).
• Use the remaining Gp 4 drugs to complete a regimen of at least four effective drugs.
STANDARD REGIMENS FOR NEW
TB PATIENTS

INTENSIVE PHASE TREATMENT WITH HRZE

Minimum 2 months extendable to 3 months duration

CONTINUATION PHASE WITH HR

4 months duration.
Because of high levels of isoniazid resistance, families and ex-servicemen in
whom DST has not been performed, continuation of HRE in the continuation
phase is an accept- able and justifiable alternative to HR. However, in case of
serving personnel if DST does not reveal resistance to Isoniazid and Rifampicin,
switch HR only
SIDE EFFECTS OF ANTI TB DRUGS

•Itching without rash

•Skin rash
•Drug induced hepatitis
 DISPOSAL OF CASES OF
PULMONARY TUBERCULOSIS

All suspected cases suffering from pulmonary tuberculosis are to be transferred to

respiratory centres with TB beds for establishing diagnosis and Attributability Medical
Board (AMB). After detailed evaluation, the diagnosis must be confirmed and an AMB
should be held within 60 days of transfer to respiratory centre with TB beds.
oThe respiratory centers with TB beds are
o MH (CTC),
oMH Namkum
o MH Dehradun
oThe respiratory centers without TB beds are
o AH (R&R)
oBHOC
oCHs Lucknow, Kolkata, Chandimandir
oCH (AF) Banglore
o INHS Asvini.
 THE DEPENDENCY OF TB BEDS IS
AS UNDER

Officers:
From all commands except Eastern, Western & Central Command [less UB Area) to MH
(CTC), Pune.
From Eastern, Western & Central Command (less UB Area) to MH Namkum.
JCOS/ORS
From Southern Command, Southwestern Comd, and 14 & 15 Corps 2 of Northern
Command to MH (CTC) Pune.
From Eastern, Western & Central Command (less UB Area) to ΜΗ Namkum.
From UB Area and other sectors of Northern Command to MH Dehradun.
DURATION OF HOSPITALIZATION

•The intensive phase under supervision of chest physician in a respiratory centre with
TB beds and the patient should remain hospitalized till sputum becomes negative,
•military hospital under the care of medical specialist for the remaining period till
declared cured or treatment completed.
•If the patient, during continuation phase does not show satisfactory
clinical/radiological/ bacteriological response or develops complications he/she
should be transferred back to the respiratory centre where he/she had completed
his/her intensive phase.
 DISCHARGE FROM THE HOSPITAL AND
DISPOSAL
•If the patient of pulmonary tuberculosis has been declared cured or treatment completed he
should be placed in LMC P3 (T-24) and discharged to unit. The patient should remain in
medical category P3 until he has been declared cured or treatment completed or maximum
of one year.

•Subsequent categorisation in case treatment is completed & cure achieved before one year
and there is no relapse of disease, no residual significant structural or functional deficit, he
can be considered for up gradation to P2 (T-24) category and subsequently to P1.

•TMI, If the individual cannot be upgraded to category P2 after remaining in category P3 for
one year he will be transferred to nearest respiratory centre for detailed evaluation. if he is
found unfit for up gradation to category P2, he may be considered for invalidment.
THANK YOU!!!