TUBERCULOSIS

Presented By: Dr. Tahseen Haider Kazmi Shahida Rasheed

Etiology

Mycobacterium tuberculosis Mycobacterium bovis

Mycobacterium africanum
Atypical mycobacterium

Epidemiology

Prevalent in more than 100 countries 8 million new cases of TB each year TB kills two million each year 95% of all the new cases and 98% of all deaths in the developing countries

Epidemiology

3 million TB cases per year in south east Asia Every second someone is newly infected with TB in the world

Each infected TB patient can infect on average between 10-15 people every year
300,000 new cases of TB every year in Pakistan

Who Should be suspected for TB

Fever (for 3 weeks or more) Cough (for 3 weeks or more)

Weight loss
Chest pain (for 3 weeks or more)

Who should be suspected for TB

Shortness of breath Coughing up blood

Tiredness
Night sweats

History of contact

Mode of transmission

Droplet infection Oral in bovine TB

Through skin
Only 10% of infected persons develop

disease

Risk factors for Tuberculosis

Poverty Overcrowding Malnutrition

Diabetes
Smoking

Silicosis

Risk Factors for Tuberculosis

HIV / AIDS Corticosteroid therapy Immuno compromised Measles Pertussis Alcoholics

Screening for Tuberculosis

Mantoux Test Sputum Smear Microscopy Sputum Culture Bronchoscopy X-Ray Chest PCR

Why WHO Recommends Sputum Smear Microscopy

Cost Effective Easy to Perform Detect Sputum Smear positive cases who are most infectious Sputum Smear negative cases and Extra Pulmonary cases can very rarely transmit the disease to others

Complications of Tuberculosis

Pleural effusion Lung abscess

Brochiectasis
Fibrosis of lungs

Collapse of lungs

Complications of Tuberculosis

Respiratory failure Pericardial effusion Meningitis Miliary tuberculosis Arthritis TB of any organ

Control of Tuberculosis

BCG vaccination (Type of vaccine?) Early case detection DOTS therapy for 6-8 months Surveillance Improved living conditions Prophylaxis for high risk persons

BCG Vaccine
Dose of BCG for Children less than 1 year & more than 1 year? What is the solvent of BCG? Route of administration? Site of BCG inoculation? Adverse reactions to BCG vaccine? Contraindications?

Anti Tuberculosis drugs

Isoniazid (5mg / Kg , max. 300mg / day) Rifampicin (10 mg / Kg , max. 600mg / day) Pyrazinamide (25 mg / Kg , max. 2500 mg / day) Ethambutol (15 mg / Kg, max. 1600 mg / day) Thiacetazone (2.5 mg / Kg, max. 150 mg / day) Sreptomycin ( 15 mg / Kg , max 1gm)

MDR - TB

Amakacin Kanamycin PAS Quinolones Capreomycin Cycloserine

NEW CASES
Initial Intensive Phase Isoniazid, Rifampicin, Pyrazinamide, Ethambutol 2 Months
Check Sputum Smear

If Negative Continuation Phase Isoniazid, Ethambutol

6 Months

If Positive
Give initial Intensive Phase for another 1 Month Continuation Phase Isoniazid, Ethambutol 5 Months

Re-Treatment Cases
Initial Intensive Phase Isoniazid, Rifampicin, Pyrazinamide, Ethambutol, Streptomycin 2 Months Then Isoniazid, Rifampicin, Ethambutol, Pyranzinamide 1 Month Check Sputum Smear If Negative Continuation Phase Isoniazid, Rifampicin & Ethambutol 5 Months Continuation Phase Isoniazid, Rifampicin & Ethambutol 4 Months If still smear +ve at the end of the treatment Chronic case Refer to Chest Institute If Positive Give Initial Intensive Phase for another 1 Month

GOAL:

Detect 70% of new cases. Successful treatment of 85% of newly detected cases through DOTS.

Objectives

Improved availability of TB drugs at all facilities, BHU, RHC. Training & supervision of each type of health workers. Sputum smear examination. Supervision and monitoring of health workers.

Objectives

Recording and reporting on patient cards and registers. DOTS by a community or health facility worker. Ensuring that health education material regarding TB control are available and used.

Objectives

Involving NGOs, CBOs, and other private organizations. Better provincial and district TB program organization.