INTRODUCTION

Tuberculosis (TB) is contagious infection caused by

bacteria that usually affect the lungs. It is a disease of
poverty affecting mostly young adults in their most
productive years.
TB can be passed on to another person through tiny
droplets spread by coughing and sneezing.
Tuberculosis can affect other organs of the body, such
as the kidneys, spine or brain. Symptoms depend on
the organ affected. TB of the spine causes severe back
pain, while TB of the kidneys can cause bloody urine.
ETIOLOGIC AGENT
MYCOBACTERIUM TUBERCULOSIS
slender, aerobic, non-sporulating,
non-motile organism.
Cell wall composed of mycolic acid,
which makes them acid fast; they
will retain stains even on treatment
with a mixture of acid and alcohol.
Slow grower
Mycobacteria stain weakly positive
with Gram stain.


1. Agent
(Mycobacterium tuberculosis)

2. Reservoir
(Human/surrounding
environment/cattle)

3. Mode of Escape
coughing, sneezing,
talking

4. Mode of Transmission
(Aerosol droplets, dust particles)
5. Mode of Entry
Inhalation/Aspiration
In the respiratory tract,
Ingestion,Skin contact
6. Host
Human
EPIDEMIOLOGIC
CHAIN
EPIDEMIOLOGY
WHO: Philippines ranks fourth in the world for
the number of cases of tuberculosis and has
the highest number of cases per head in South
East Asia.
The disease kills 68 people daily in a country
1.7 million people died from TB in 2009,
including 380,000 people with HIV, equal to
4700 deaths a day


EPIDEMIOLOGY
The Philippines is among the 22 high-burdened
countries in the world according the WHO.
6th leading cause of illness and the 6th leading
cause of deaths among the Filipinos.
Most TB patients belong to the economically
productive age-group (15-54 years old)

RISK FACTORS
There are number risk factors for tubercolosis
infection:
1.Silicosis
2 HIV
3 Nutrition
4 Crowding
5 Diabetes mellitus
6 Other
7 Genetics
8 Weak Immune System
9 Native Country
10 Poor Health Care

Silicosis

Silica particles irritate the respiratory
system, causing immunogenic responses such
as phagocytosis, which results in high
lymphatic vessel deposits. It is probably this
interference and blockage of macrophage
function that increases the risk of
tuberculosis. Persons with chronic renal failure
and also on hemodialysis have an increased
risk
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HIV
HIV is a major risk factor for tuberculosis.
The risk of developing TB is estimated to be
between 20-37 times greater in people living
with HIV than among those without HIV
infection. TB is a leading cause of morbidity
and mortality among people living with HIV.

Nutrition

A body mass index (BMI) below 18.5
increases the risk by 2 to 3 times. An increase
in body weight lowers the risk. Other clinical
conditions that have been associated with
active TB include gastrectomy with attendant
weight loss and malabsorption, jejunoileal
bypass, renal and cardiac transplantation,
carcinoma of the head or neck, and other
neoplasms (e.g., lung cancer, lymphoma, and
leukemia).
Crowding

Prisoners are particularly vulnerable to infectious
diseases such as HIV/AIDS and TB. Imprisonment
facilities provide conditions that allow TB to spread
rapidly due to overcrowding, poor nutrition, and a lack
of health services. Those who live with a friend,
relative or roommate infected with tuberculosis are
more susceptible to contracting TB through close and
continuous exposure to the infection. The same applies
to people who work in overcrowded environments
with inadequate ventilation and/or a population of
people at higher risk of having TB, such as an
immigration center, nursing home, prison, or health-
care facility like a hospital.

Diabetes mellitus

There is also a very high 3 fold increased
risk of infection with TB for patients who have
diabetes mellitus The correlation between
diabetes mellitus and TB concerns public
health as it merges communicable and non-
communicable diseases.

Other
Other conditions that increase risk include the sharing
of needles among IV drug users, recent TB infection or a
history of inadequately treated TB, chest X-ray suggestive
of previous TB, showing fibrotic lesions and nodules,
prolonged corticosteroid therapy and other
immunosuppressive therapy, compromised immune system
(3040% of people with AIDS worldwide also have TB),
hematologic and reticuloendothelial diseases, such as
leukemia and Hodgkin's disease, end-stage kidney disease,
intestinal bypass, chronic malabsorption syndromes,
vitamin D deficiency, and low body weight.

Genetics
There is also genetic susceptibility

Weak Immune System

Anything capable of weakening the
immune system can increase a person's
vulnerability to tuberculosis.
Native Country

According to the Centers for Disease
Control and Prevention, the rate of TB among
people who lived in the United States in 2006
was more than 9.5 times higher for foreign-
born individuals as opposed to those born in
the country. In 2007, 58 percent of all TB cases
in the United States were people born in other
countries, with the most frequent birth
countries being China, India, Mexico, the
Philippines and Vietnam
Poor Healthcare

Individuals who don't have sufficient
access to quality medical care -- such as those
who have a low income or are homeless -- are
at risk for tuberculosis simply because
diagnosing and treating the infection are less
likely.

MANIFESTATIONS OF TB
Cough: 2 or more weeks with or without the ff
symptoms:
Fever
Chest pain/back pains
Hemoptysis
Weight loss
Sweating
Fatigue
Shortness of Breath

CLASSIFICATION OF TB
Pulmonary TB
Smear Positive
Px with 2 positive sputum specimen w/ or w/o abnormalities
in chest x-ray consistent with TB
1 sputum specimen positive with chest x-ray abnormalities
consistent with Active TB
Smear Negative
3 negatIve sputum specimen with Chest x-ray abnormalities
consistent with Active TB
Extra Pulmonary TB
Px with at least 1 mycobacterial smear positive from an
extra-pulmonary site
TYPES OF TB
NEW
A px who has never had treatment for TB or who
has taken anti-TB drugs for <1month
RELAPSE
A px previoulsy treated for TB who has been
declared cured and is diagnosed w/
bacteriologically positive TB
TREATMENT FAILURE
A px who is while on treatment is sputum smear
positive at 5 months or later during the course of
treatment
TYPES OF TB
RETURN AFTER DEFAULT
A px who returns to treatment w/ positive
bacteriology (smear/culture) following
interruption of treatment for 2 months or more
TRANSFER-IN
A patient who has been transferred from another
facility adopting NTP policies w/ proper referral
slip to continue treatment
OTHERS
All cases who do not fit into above definitions


TB PATHOGENESIS


Pathogenesis
Pathogenesis
Pathogenesis
Pathogenesis
Pathogenesis

TB Virulence Genes
KatG encodes for catalase/peroxidase
enzymes that protect against oxidative
stress
rpoV main factor initiating transcription
of several genes
Erp encodes protein required for
multiplication
Beijing/W gene identified in outbreak
conditions; associated with higher
mortality rates and chances of developing
MDR TB
TREATMENT
NTP TREATMENT REGIMENS
TB Treatment
Regimen
TB Patients To Be
Given Treatment
DRUGS AND DURATION
Initial Phase Continuation
Phase
I New smear-positve PTB; new smear-
negative PTB with extensive
parenchymal lesions on CXR as
assessed by TBDC; extra-pulmonary TB;
severe concomitant HIV disease
2 HRZE 4 HR
II

Treatment failure; Relapse; treatment
after interruption; RAD; others
2 HRZES/ 1
HRZE

5 HRE
III New smear-negative PTB with minimal
lesions on CXR as assessed by TBDC
(other than in Category I)
2 HRZE 4 HR
IV Chronic case (still sputum-positive after
supervised re-treatment)
Refer to specialized centers
with access to second line
drugs

Recommended dosages (mg/kg body
weight):

Drugs Daily Thrice-weekly
Isoniazid 10
Rifampicin 10 (8-12) 10 (8-12)
Pyrazinamide 25 (20-30) 35 (30-40)
Ethambutol 15 (15-20) 30 (25-35)
Streptomycin 15 (12-18) 15 (12-18)
How can TB be prevented
?
1. Early diagnosis and treatment: TB should be treated early in order to prevent
deterioration of the disease and spread of the infection. Patients with active
pulmonary tuberculosis can attend any government chest clinic for treatment.
2. Examination of close contacts: The close contacts of TB patients, usually the
household contacts, should be examined. This includes tuberculin skin testing and/or
chest x-ray examination for young children and chest x-ray examination for older
children and adults.
3. Leading a healthy life style: The germs attack the lungs when a person's body
resistance is reduced. So try to guard yourself by leading a healthy lifestyle in order
to minimize the chance of contracting the illness. This includes:
- adequate exercise
- enough rest and sleep
- balanced diet
- avoidance of smoking and alcohol
- breathing fresh air and maintaining good indoor ventilation
- good personal hygiene (e.g., avoid coughing and sneezing directly
at other persons)
4. BCG (Bacille Calmette-Guerin) vaccination




PROGNOSIS
With treatment, most are able to make a full recovery. In
addition, some may survive without treatment and may even fully
recover from the disease. Without treatment, approximately half of
those infected with active TB will eventually die within 5 years of
the infection. This is because TB bacteria multiply quite slowly
compared to most other bacteria, and active TB bacteria can cause
an illness to worsen overtime, leading to other complications.

Patients infected with drug-resistant TB may have a lower
possibility of being cured. The percentage recovery is dependent on
the drugs they are resistant to and also, the amount of lung damage
they have before the start of effective treatment.

If tuberculosis is coupled with other diseases such as
HIV/AIDS or other serious illness, the resultant outlook is more
inclined to worsen.