Tuberculosis
• Tuberculosis is considered as the world’s
deadliest disease and remains to be one of the
major health problems in the Philippines.
• It doesn’t affect only the respiratory tract, but it
can also lodge to other organs of the body,
such as the meninges, joints and bones which is
now cold miliary tuberculosis. The focal point
of this report will be on the more common type
of TB, which is the pulmonary tuberculosis.
• The estimated incidence of all TB cases in the
Philippines is 243 / 100, 000 population / year
(WHO Report 2006).
Etiology:
• The pulmonary tuberculosis is caused by an
aerobic, rod-shaped, acid-fast bacilli called as
Mycobacterium tuberculosis.This bacteria can
be aerosolized droplet nuclei produced by an
infected individual. These droplets are
expelled in the environment by the infected
host through activities such as coughing,
sneezing, laughing or singing
Infectious Agents:
• Mycobacterium tuberculosis from humans
• Mycobacterium africanum from humans
• Mycobacterium tuberculosis from cattle
Causes
• Pulmonary tuberculosis (TB) is caused by the
bacteria Mycobacterium tuberculosis (M.
tuberculosis). You can get TB by breathing in air
droplets from a cough or sneeze of an infected
person. This is called primary TB.
The following people are at higher risk for active TB:
• Elderly
• Infants
• People with weakened immune systems, for
example due to AIDS, chemotherapy, or
antirejection medicines given after an organ
transplant
Your risk of contracting TB increases if you:
• Are in frequent contact with people who have the
disease
• Have poor nutrition
• Live in crowded or unsanitary living conditions
• Tuberculosis Classification System
Symptoms
The primary stage of the disease usually doesn't
cause symptoms. When symptoms of
pulmonary TB occur, they may include:
• Cough of two weeks or more
• Fever
• Chest or recurrent blood-streaked sputum
• Significant weight loss, sweating, fatigue, body
malaise, and shortness of breath
Mode of Transmission:
• airborne droplets
• direct invasion through mucous membranes or
breaks in the skin may occur, but extremely
rare
• ingestion of unpasteurized milk or other dairy
products from infected cattle with bovine
tuberculosis
Exams and Tests
Tuberculosis Diagnosis
• The doctor will complete the following tests to diagnose
tuberculosis. You may not be hospitalized for either the
initial tests or the beginning of treatment.
• Chest X-ray: The most common diagnostic test that
leads to the suspicion of infection is a chest X-ray.
– In primary TB, an X-ray will show an abnormality in the mid
and lower lung fields, and lymph nodes may be enlarged.
– Reactivated TB bacteria usually infiltrate the upper lobes of
the lungs.
– Miliary tuberculosis exhibits diffuse nodules at different
locations in the body.
• The Mantoux skin test also known as a tuberculin
skin test (TST or PPD test): This test helps identify
people infected with M. tuberculosis but who have no
symptoms. A doctor must read the test.
• QuantiFERON-TB Gold test: This is a blood test that is
an aid in the diagnosis of TB. This test can help detect
active and latent tuberculosis.
• Sputum testing: Sputum testing for acid-fast bacilli is
the only test that confirms a TB diagnosis. If sputum
(the mucus you cough up) is available, or can be
induced, a lab test may give a positive result in up to
30% of people with active disease.
• Medical Treatment
Doctors will prescribe several special medications
that you must take for six to nine months.
Standard therapy for active TB consists of a six-
month regimen:
• two months with Rifater (isoniazid,rifampin,
and pyrazinamide);
• four months of isoniazid and rifampin (Rifamate, Rimactane);
• and ethambutol (Myambutol) or streptomycin added until
your drug sensitivity is known (from the results of bacterial
cultures).
• Methods of Control:
Prompt diagnosis and treatment
BCG vaccination
Health education
Improving social conditions
Provide public health nursing and
outreach services for home supervision
of patients
National TB Program by DOH (DOTS)
TB-DOTS
• The WHO-recommended treatment strategy
for detection and cure of TB is "Directly
Observed Treatment, Short-course" (DOTS).
DOTS combines five elements: political
commitment, microscopy services, drug
supplies, surveillance and monitoring systems
and use of highly efficacious regimes with
direct observation of treatment.
• Once patients with infectious TB (bacilli visible in a
sputum smear) have been identified using microscopy
services, health and community workers and trained
volunteers observe and record patients swallowing
the full course of the correct dosage of anti-TB
medicines (treatment lasts six to eight months). The
most common anti-TB drugs are isoniazid, rifampicin,
pyrazinamide, streptomycin and ethambutol.
• Sputum smear testing is repeated after two months,
to check progress, and again at the end of treatment.
A recording and reporting system documents
patients' progress throughout, and the final outcome
of treatment.
• DOTS produces cure rates of up to 95 percent
even in the poorest countries.
• DOTS prevents new infections by curing
infectious patients.
• DOTS prevents the development of MDR-TB by
ensuring the full course of treatment is followed.
• A six-month supply of drugs for DOTS costs US
$11 per patient in some parts of the world. The
World Bank has ranked the
• DOTS strategy as one of the "most cost-effective
of all health interventions."
