TB, or tuberculosis, is a disease caused by a bacterium called

Mycobacterium tuberculosis

The bacteria can attack any part of the body, but most frequently

attacks the lungs

TB should be suspected when a person has cough for two weeks or

more

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 In 2009 there were 9.4 million new TB cases

More than two billion people, or approximately one-third of the

world's population, are infected with TB

TB is contagious and spreads through the air. If not treated, each

person with active TB disease infects on average 10 to 15 people
each year

1 in 10 people infected with TB will become sick with active TB in

their lifetime

TB is the leading infectious killer of people who are HIV-infected.

5% of all TB cases have multidrug-resistant TB (MDR-TB)

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 500,000

TB kills more adults than

any other infectious
disease

Because it affects adults,

tuberculosis causes
enormous social and
economic disruption

The burden of TB is 0
enormous but is hidden

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by stigma and poor
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diagnostic quality

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Estimated number of deaths, India 1999

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 800
TB kills more women in India
than any other infectious 605
600
disease 538
493

TB is among the three greatest

400
cause of deaths in women
aged 15 – 45 years
200
Women with tuberculosis are
often severely stigmatized; a 48
recent study in India suggests 0
that more than 100,000 women Tropical Maternal Malaria TB
Diseases Mortality
are rejected from their families
each year on account of TB.
Thousands of deaths per year globally

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 TB of the lungs and throat is infectious

Bacteria settle
in lungs
Infected person
sneezes / coughs Bacteria inhaled by other
person

May spread via blood to Pulmonary TB

Kidneys Brain Spine

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 Air borne Infection

People with good immunity People with weakened immunity

Can fight infection Failure of immune system to control Infection

Active disease
No active disease

Bacilli multiply and cause damage

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 There are three main types of TB :

Primary TB -- the bacteria are rapidly multiplying and invading the tissues
-- transmission to others through air

Miliary TB -- rare form

-- bacteria find their way into the bloodstream and hence affect
multiple organs
-- may be rapidly fatal

Latent TB -- in people who are infected but do not develop the overt disease
-- are symptomless
-- risk that the infection may escalate to active disease
-- increased risk by other illnesses such as HIV and medications that
suppress the immune system

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 The most common symptoms of TB are:

Cough (at least 2 weeks duration)

Fever, especially rising in the evening

Night sweats

Chest pain

Weight loss

Loss of appetite

Coughing up of blood.

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 Sputum Examination - The best way to get tested for lung TB
Germs of TB or TB bacilli can be seen through a microscope.
Three samples of sputum should be examined for accurate diagnosis
This facility is available at all public health facilities in India

Chest X Ray – lesions, cavity etc can be identified on CXR

NAAT – Fully automated Nucleic Acid Amplification Test

Newer test
Three fold increase in diagnosis of patient with drug resistant TB
Expensive, not available everywhere

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 Yes !!
TB can be cured if the full course of the prescribed drugs is taken regularly, and

without interruption.

DOTS (directly observed treatment short-course) is available throughout India

-- WHO approved standard treatment

-- supervised, hence rate of non compliance is reduced

-- cost effective

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 TB treatment involves taking multiple drugs

Drugs commonly used for treatment are

Isoniazid

Rifampicin

Pyrazinamide

Ethambutol

Streptomycin

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 Very few people develop side-effects to TB drugs

Minor side-effects :
-- vomiting, nausea, loss of appetite, joint pain, orange/red urine, or skin rash -
-- managed by using simple medicines or adjusting the dosages of the drugs.

Major side-effects :
-- deafness and dizziness (Streptomycin);
-- jaundice, vomiting (mainly Rifampicin and Isoniazid);
-- visual impairment (Ethambutol), shock, purpura, or
-- acute renal failure (Rifampicin).

These side-effects need to be managed by a trained physician and may

require hospitalization.
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 TB bacteria die very slowly

-- It takes at least six months to kill all the TB bacteria

-- You must continue to take your medicine until all the TB bacteria are dead,
even though you may feel better and have no more symptoms of TB disease

-- On discontinuation

TB bacteria starts growing again person will become sick again

bacteria may become resistant to the drugs

different drugs are used to kill the TB bacteria

(new drugs must be taken for a longer time and have more serious side-effects)

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 BCG is a vaccine for TB

This vaccine is given to infants and small children

BCG vaccine protects against the severe, life-threatening forms of TB such

as TB meningitis and miliary TB in childhood

However, it does not protect people from TB later in their life

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 The most important way --- take all your medicines correctly

Get a sputum test at various time points of your treatment

This test will show whether the treatment is effective

You can further lessen the risk of spreading the infection by:

Covering your
mouth when you Remember, TB is spread through the
cough air

Avoiding close People cannot get infected with

contact with other TB bacteria through handshakes,
people while sitting on toilet seats, or sharing
coughing, sneezing plates and utensils with someone
who has TB!!
Staying in a room
with good
ventilation
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