Professional Documents
Culture Documents
TB
GROUP MEMBERS :
SHAISTA PERVEEN
HAJRA SOHAIL
KIRAN JAMIL
MOBEEN ARSHAD
QURATUL AIN
TB
Definition
Types
Epidemiology
triad
Dynamics of transmission
National
case management
Diagnosis
Treatment
Co-morbidities
Levels of prevention
DEFINITION
TYPES OF TB
WORLDWIDE PREVALENCE:
PREVALENCE IN PAKISTAN :
host
Epidemiological
Triad
environment
agent
AGENT:
Host
Man is the host for TB. Host factors that makes him
susceptible for the disease are as follows:
Age
Nutrition
Education
Occupation
ENVIRONMENT
1- Overcrowding:
2- Economic status:
Crowding
Malnutrition
poor sanitation
Source of infection:
Mode of transmission:
o
o
o droplet nuclei
o
fomites,
dishes or other articles used by the patient.
Point of entry:
NATIONAL CASE
MANAGEMENT
GUIDELINES
1.Case detection
2. Treatment
3. Follow-up
4. Recording and reporting system
1)CASE DETECTION
1. CASE DETECTION
MAKING THE DIAGNOSIS OF TB FOLLOWS THE BASIC PRINCIPLES OF
DETAILED HISTORY, EXAMINATION AND INVESTIGATIONS.
HISTORY: THE FOLLOWING SYMPTOMS HAVE TO BE ASKED ABOUT:
1-COUGH: DURATION, WHETHER MORE OR LESS THAN TWO WEEKS.
2-SPUTUM: ITS COLOUR AND WHETHER BLOOD STAINED.
3- FEVER: ITS INTENSITY, DURATION, TIMING, I.E IN DAY OR NIGHT.
WHETHER ASSOCIATED WITH NIGHT SWEATS.
Examination:
Investigations:
1-Sputum smear examination:
It is the first line test for the diagnosis of TB. Sputum
examination is the most specific, cost effective and
reliable test for diagnosis of pulmonary TB. Sputum
microscopy is available in BMUs (hospitals and RHCs). The
National TB Control Program has recommended training
laboratory technicians in all the diagnostic centres.
2-Chest X-ray:
The chest X-ray is no longer the best first line investigation for Pulmonary TB
and most patients with TB who are diagnosed by sputum smears do not need
a chest X-ray.
The chest X-ray appearances are not specific to TB. Chest X-ray is only
indicated if a patient is found to be sputum smear negative, and we need to
rule out smear negative pulmonary TB.
CULTURE TEST:
This test uses your sputum or tissue sample to grow any TB
bacteria that may be there.
It tells whether you are infectious and also whether your
TB is resistant to any antibiotics.
This helps ensure they put you on a combination of drugs
that will cure you. As TB culture grows slowly, it may take
up to eight weeks to get some of the results.
PCR:
Other mycobacteria are also acid-fast.
If the smear is positive,PCRor gene probe tests can
distinguishM. tuberculosisfrom other mycobacteria.
Even if sputum smear is negative, tuberculosis must be
considered and is only excluded after negative cultures.
TB Suspect
One or 2 Sputum
Smear positive
Give broad-spectrum
antibiotic for 7 10
days and re-assess
If responds to antibiotics
then re-assure
If no response to antibiotics, do
chest X-Ray (CXR).
Type of patient
Smear positive
Smear negative
New case
Smear positive
Relapse
Transferred-in
Smear positive
Smear negative
Treatment After
Failure
Smear positive
Smear Negative
Others
Smear positive
Smear negative
Others Positive
Others Negative
DURATION OF THERAPY:
TREATMENT REGIMENS
The standard treatment regimen for all
patients is made up of
an intensive phase lasting 2 months in cat-1
patients three months in cat-2
and a continuation phase lasting 4 months
INTENSIVE PHASE
4 drugs are used to rapidly kill the tubercle
bacilli.
(isoniazid,
rifampicin,
pyrazinamide,
and ethambutol)
Infectious patients become less infectious within
approximately 10-14 days of starting treatment
and symptoms abate. However, the majority of
patients with sputum smear-positive TB will
become smear-negative within 2 months.
CONTINUATION PHASE
2 drugs are used, over a period of 4 months.
(isoniazid,
rifampicin)
The sterilizing effect of these drugs eliminates
the remaining bacilli and prevents
subsequent relapse.
Anti TB
drugs
Mode of
action
dosage
Common drug
preparation
isoniazid
bectericidal
5mg/kg
Tab:100mg
rifampicin
10mg/kg
Tab:150,300,
450
pyrazinamide
25mg/kg
Tab:500mg
streptomycin
15mg/kg
amp-:1000mg
ethambutol
becteriostatic
15mg/kg
Tab:400mg
Disease
classification
pulmonary
Patient type
new
category
CAT-1
retreatment:
relapse
Rx. After failure CAT 2
Rx. After default
other (s+ only)
Nagative
pulmonary or
extra pulmonary
new or other
(s- only)
CAT 1
category
Intensive phase
Continuation phase
Duration
in month
drugs
Duration
in months
drugs
CAT-1
HRZE
RH
CAT-2
HRZR +
( S**)
RHE
3)FOLLOW UP
FOLLOW-UP
TB patient is being followed up for the
following reasons: 23
1-Compliance of the patient:
Regularity of drug intake is ascertained. If
patient is not taking it regularly, then
reasons for it is enquired and the problem is
sorted out.
Joint pains
Aspirin
Itching of skin
Anti histamine
AFB smear
examination
CATEGORY I
(NEW SMEAR
POSITIVE
no history of
previous ATT
month
result
positive
End of 2M
Negative
Continue treatment
Positive
Negative
Positive
End of 6M
Management
Category I (smear
negative)
Result
0-month
Negative
End of 2M
Negative
Positive
Category of Patient
Category II
All retreatment
cases after failure ,
default or relapse
AFB smear
examination
Management
Month
Result
0.Month*
Positive
End of 3
Month#
Negative
Positive#
Neg
Positive
Negative
Positive
End of 5M
End of (8
Month)
TREATMENT OUTCOMES:
4)RECORDING AND
REPORTING SYSTEMMONITORING OF TB
PATIENT:
PREVENTION OF TB
PREVENTION
PRIMARY PREVENTION
TB stigma ;focused health education
Specific protection: Certain measures can be taken to protect a
person from tuberculosis. These are:
(a)Vaccination:
()Bacille Calmette Geurin (BCG) is the vaccine used for the control
of TB.
()It
(b) Chemoprophylaxis:
Early diagnosis:
As TB is an insidious disease by the time person identify of infected
by TB ,has already infected many others.
So in order to prevent its spread its early diagnosis is imperative.
Following investigations are performed to detect a case of TB:
Sputum examination
PATIENT EDUCATION
AND LIFE STYLE
MODIFICATION
LIFESTYLE MODIFICATION
Components of lifestyle modification include;
Before the initiation of IVF, importance of
lifestyle modification should be stressed
particularly
Weight loss monitoring
Increase exercise
Smoking cessation
Reduced alcohol consumption
CASE STUDY
CASE STUDY
Diagnosis:Pulmonary tuberculosis
MEDICATIONS:
Tab. Myrin P
: 705mg (3-OD)
Calan( verapamil):40mg
Tab. Vita 6
:1-OD
Tab. Leflox
:750mg -OD
Syp. Hydraline
:1 tbs -TD
QUERIES
ANSWERS
Answer 1:
Possible Interactions:
1) INH+Verapamil= INH increase verapamil level
(both are hepatotoxic,so moniter these two drugs
closely)
2)Rifampin decreases verapamil level when both are
given at same time,so use alternative
Answer 2:
first line therapy include Myrin P
(ethambutol,pyrazinamide,INH,rifampin)
Answer 3:
Contraindications:
Verapamil
heart failure
INH
drug induced liver disease
Rifampin
acute jaundice
Pyrazinamide
nephrotoxcity
Answer 4:
1. X-ray (chest/sputum test)
2. Culture & sensitivity test(C & S)
3. Purified protein derivative test (PPD)
Answer 5:
DOT therapy: It is known as directly observed
therapy,it starts when patient compliance
decreases and drug resistance increases.In this
therapy Physician, Nurse or Clinical technician
directly moniter patient and hence improve
patient compliance.