Tuberculosis
Sudesna Chowdhury
ID: 2025174
DEFINITION
Tuberculosis (TB) is a potentially fatal contagious disease
that can affect almost any part of the body but is mainly an
infection of the lungs.
Origin:
- Neo Latin Word
Tubercle – ROUND NODULE
Tuberculosis
Osis - CONDITION
HISTORY OF TUBERCULOSIS:
Dr. Robert
Koch
discovered the
bacteria that
Found in the cause TB-
ancient Mycobacteriu
mummies of m
Egypt Tuberculosis
1550–-1080 24 Mar. 1882
EPIDEMIOLOGY
2019:
- Globally 10 million people were affected with TB.
- 87% of new cases: identified in 30 high TB burden countries.
- A total of 1.4 million people died from TB .
Eight countries account for 2/3 of the total with India leading the count,
followed by:
- Indonesia
- China
- The Philippines,
- Pakistan
- Nigeria
- Bangladesh &
- South Africa.
TB incidence is falling at about 2% per year globally between 2015 and
2019.
An estimated 60 million lives were saved through TB diagnosis and
treatment.
WORLD PERCENTAGE
3
4.3
7.7 Asia
Africa
Eastern Mediterian region
26
59
European Region
America
TUBERCULOSIS IN BANGLADESH
Bangladesh is in It accounts for The incidence Mortality rate is 24
Top 30 - TB 3.6% of the global rate is 221 per per
burden countries. total infection. 100,000. 100,000population.
TB is the number 361,000 estimated people
who developed TB 38,150 people
3 causes of death among them 33,000 were
in Bangladesh. children in 2019.
died due to TB.
CAUSATIVE ORGANISMS:
Human Animal
Mycobacterium Mycobacterium
Tuberculosis Bovis
Mycobacterium tuberculosis complex:
M. Tuberculosis
M. Bovis
M. Africanum
M. Microti
OTHER MYCOBACTERIUM ASSOCIATED WITH HUMAN DISEASES:
Atypical Anonymous Nontuberculous
Mycobacteria Mycobacteria Mycobacteria
MOTT
Tuberculoid Opportunist (Mycobacteria other
Mycobacteria Mycobacteria than tubercule
bacilli)
TUBERCULOSIS IS CAUSED BY-
MYCOBACTERIUM TUBERCULOSIS
Mycobacterium Tuberculosis Characteristics:
-Gram Positive
-Obligate aerobe
-Non-Spore-Forming
-Non-motile rod
- Mesophile
- 0.2 to 0.6 x 2-4 um²
-Slow generation time: 15-20 hours
- Lipid rich cell wall contains mycolic acid- 50% of cell wall dry
weight:
i) Responsible for many of this bacterium’s characteristics
properties
ii) Acid Fast- retains acidic stains
iii) Confers resistance to detergents antibacterial
SPREAD OF TUBERCULOSIS
PATHOGENESIS
Severe Symptoms:
Shortness of breath
Urine discoloration
Cloudy & reddish urine
Fever with chills.
Fatigue
Diagnosis:
[Link] test:
a. Zeihl-Neelsen stain
b. Auramine stain(fluorescence microscopy)
2. Sputum culture test:
a. Lowenstein –Jensen(LJ) solid medium: 4-18 weeks
b. Liquid medium : 8-14 days
c. Agar medium : 7 to 14 days
[Link]:
Chest X-Ray(CXR)
[Link] acid amplification:
i) Species identification ; several hours
ii) Low sensitivity, high cost
iii) Most useful for the rapid confirmation of
tuberculosis in persons with AFB-
positive sputa
iv) AFB-negative pulmonary tuberculosis
v) Extra pulmonary tuberculosis
[Link] skin test (PPD)
Injection of fluid into the
skin of the lower arm.
48-72 hours later –
checked for a reaction.
Diagnosis is based on
the size of the wheal.
1 dose = 0.1 ml contains 0.04μg
Tuberculin PPD.
TUBERCULIN TEST INTERPRETATION
6. Other biological examinations:
i) Cell count(lymphocytes)
ii) Protein(Pandy and Rivalta tests) – Ascites,
pleural effusion and meningitis.
BCG VACCINE:
- BACILLE CALMETTE GUERIN (BCG).
- FIRST USED IN 1921.
- ONLY VACCINE AVAILABLE TODAY FOR PROTECTION AGAINST
TUBERCULOSIS.
- IT IS MOST EFFECTIVE IN PROTECTING CHILDREN FROM THE DISEASE.
- GIVEN 0.1 ML INTRADERMALLY.
- DURATION OF PROTECTION 15 TO 20 YEARS
- EFFICACY 0 TO 80%.
- SHOULD BE GIVEN TO ALL HEALTHY INFANTS AS SOON AS POSSIBLE
AFTER BIRTH
- UNLESS THE CHILD PRESENTED WITH SYMPTOMATIC HIV INFECTION
MANAGEMENT:
FIRST LINE DRUGS: SECOND LINE DRUGS:
- ISONIAZID - CYCLOSERINE
- RIFAMPICIN - ETHIONAMIDE
- ETHAMBUTOL - STREPTOMYCIN
- PYRAZINAMIDE - AMIKACIN
- RIFAPENTINE - CAPREOMYCIN
- RIFABUTIN
DOSAGE REGIMEN:
INTENSIVE PHASE + CONTINUATION PHASE
HREZ (2 MONTHS) + HRE (4 MONTHS
TREATMENT REGIMEN ACCORDING TO WHO
ISONIAZID (H) RIFAMPICIN (R) PYRAZINAMIDE (Z)
ETHAMBUTOL (E) STREPTOMYCIN
DOTS - DIRECTLY OBSERVED TREATMENT SHORT COURSE
DOTS means that a trained health care worker or other
designated individual provides the prescribed TB drugs and
watches the patient
swallow every dose.
MULTI-DRUG RESISTANCE TB:
TB caused by strains of Mycobacterium
tuberculosis that are resistant to at least isoniazid and
rifampicin, the most effective anti- TB drug.
Globally, 3.6% are estimated to have MDR-TB.
Almost 50% of MDR-TB cases worldwide are
estimated to occur in China and India
TUBERCULOSIS AND HIV:
Worldwide the number of people infected with both
HIV and TB is rising.
The HIV virus damages the body’s immune system and
accelerates the speed at which TB progresses from a
harmless infection to a life threatening condition.
The estimated 10% activation of dormant TB infection
over the life span of an infected person, is increased to
10% activation in one year, if HIV infection is
superimposed.
It is the opputunistic infection that most frequently
kills HIV-positive people.
PREVENTIVE MEASURES:
1) Use Personal Preventive Protective
Device.
2) BCG vaccine
3) Regular medical follow up
4) Isolation of Patient
5) Ventilation
6) Natural sunlight
7) UV germicidal irradiation
THANK YOU ALL
