Explore the specifics of Tuberculosis, a disease primarily affecting the lungs and causing significant health and economic burdens, especially in India. Learn about the prevalence, mortality rates, and case definitions related to TB.
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Presentation Transcript
TUBERCULOSIS Dr Suma Rajaput Assistant professor Dept: Swasthavritta KAHER s Shri BMK Ayurveda Mahavidyalaya Shahapur Belagavi
Introduction Tuberculosis is a specific infectious disease caused by M. tuberculosis The disease primarily affects lungs and causes pulmonary tuberculosis It can also affects intestine, meninges, bones and joints, lymph glands, skin and other tissues of the body The disease also affects animals like cattle: this is known as Bovine tuberculosis
Problem statement About 1/3rdof the current global population is infected asymptomatically with tuberculosis of whom 5-10% will develop clinical disease during their lifetime Patients with infectious pulmonary tuberculosis disease can infect 10-15 persons in a year India is the highest TB burden country in the world in terms of absolute number of incident cases that occur each year
Contd Overall the age distribution of TB diagnosed incident cases shows a predominance in adolescent and young adult age groups between 15-30 years TB also causes an enormous socio economic burden to India Nearly 1/3rdof female infertility in India is caused by Tuberculosis Tuberculosis is one of the earliest opportunistic disease to develop amongst persons infected with HIV, it increases morbidity and mortality in HIV infected persons
Contd.. In India TB is mainly a disease of the poor The majority of the victims are migrant laborers, slum dwellers, residents of backwards areas and tribal pockets Poor living conditions, malnutrition, shanty housing and overcrowding are the main reasons for spreading of the disease
Epidemiological Indices Incidence Prevalence Mortality Case fatality rate Case notification rate Case detection rate Prevalence of drug resistance cases
TB Case definition A) a bacteriologically confirmed TB case is one form whom a biological specimen is positive by smear microscopy, culture or WRD (WHO recommended rapid diagnostic test ) B) A clinically diagnosed TB case is one who does not fulfil the criteria for bacteriological confirmation but has been diagnosed with active TB by Clinician or other medical practitioner who has decided to give the patient a full course of TB treatment This definition includes cases diagnosed on the basis of X-ray abnormalities or suggestive histology and extra-pulmonary cases without laboratory confirmation
Classification Bacteriologically confirmed or clinically diagnosed cases of TB are also classified according to: 1. Anatomical site of disease; 2. History of previous treatment 3. Drug resistance 4. HIV status
Based on anatomical site A) Pulmonary tuberculosis bacteriologically or clinically diagnosed case of TB involving the lung parenchyma or the trachea bronchial tree B) Extra pulmonary Tuberculosis - bacteriologically or clinically diagnosed case of TB involving organs other than the lungs eg : pleura, lymph nodes, abdomen, genitourinary tract, skin, joints and bones, meninges
Based on history of previous TB treatment They focus only on history of previous treatment and are independent of bacteriological confirmation or site of disease. New patients: Patients who have never been treated for TB or have taken anti-TB drugs for less than 1 month. Previously treated patients: Patients who received 1 month or more of anti-TB drugs in the past. a. Relapse patients b. Treatment after failure patients c. Treatment after loss to follow-up patients d. Other previously treated patients e. Patients with unknown previous treatment history
Classification based on drug resistance Cases are classified in categories based on drug susceptibility testing (DST) of clinical isolates confirmed to be M. tuberculosis: a . Monoresistance b. Polydrug resistance c. Multidrug resistance d. Extensive drug resistance e. Rifampicin resistance
Host factors Age: affects all ages 2% in 0-14 years age group 20% in 15-24 years age group Disease now more common in elderly
Contd Sex : more prevalent in males than in females Heredity : not hereditary Nutrition : malnourished people are more prone Immunity : immune comprised people are more prone
Social factors Poor quality of life Poor housing Overcrowding Population explosion Under nutrition Smoking Alcohol abuse Lack of awareness
Mode of transmission Tuberculosis is transmitted mainly by droplet infection and droplet nuclei generated by sputum positive patients with pulmonary tuberculosis The frequency and the vigor of the cough and the ventilation of the environment influence transmission of infection Tuberculosis is not transmitted by fomites, such as dishes and other articles used by the patients Patients with extra pulmonary tuberculosis or smear negative tuberculosis constitute a minimal hazard for transmission of infection
Pathology After entering the body through respiratory route the bacilli reach the small bronchioles in the lungs, and lodge in the sub pleural part 2/3rdof the right lung, where ventilation is best and exposure to contaminated inspired air is the greatest. Bacilli multiply there and then reach regional lymph nodes and multiply there also Usually by the time the pathogen reach and multiply in regional lymph nodes, cell mediated immunity develops and multiplication dropdowns resulting in caseation and necrosis In 95% the cases the primary lesion heals by a combination of resolution, fibrosis and calcification within 1-2 months
Complications Hemoptysis Spontaneous pneumothorax Pleural effusion Empyema Bronchiectasis Fibrosis of the lung TB melingitis
Incubation period The development of positive tuberculin test ranges from 3-6 weeks and there after development of disease depends upon the closeness of the contact, extent of the disease and sputum positivity of the source case and host
Symptoms Chronic cough with expectoration Hemoptysis Pyrexia of unknown origin (evening rise of temperature ) Weight loss Night sweating Loss of appetite Breathlessness General debility
Microbiological tests Sputum smear microscopy Zeil neelsen staining Fluorescence staining Culture Solid media Automated liquid culture system
Contd Drug sensitivity testing Modified proportionate sensitivity testing (PST) for MGIT 960 systems Economic variant of PST using LJ medium] Rapid molecular diagnostic tests Nucleic acid amplification test (NAAT) (CBNAAT/ truenat)
Tuberculin test It is an intradermal hypersensitivity test, discovered by Von Pirquet in 1907 Mantoux test : It is carried out by injecting 0.1ml of 1 TU ( tuberculin units) of PPD (Purified protein derivative) intra dermally on the flexor surface of the left fore arm, mid way between elbow and wrist the injection should be made with a tuberculin syringe with the needle bevel facing upward When placed correctly, injection should produce a pale wheal of the skin, 6-10 mm in diameter The result of the test is read after the 48-96 hour but 72 hours is ideal
Contd.. Tuberculin reactions consists of erythema and induration Reactions exceeding 10mm are considered positive, those less than 6mm are considered as negative Those between 6-9mm are considered as doubtful If there is no induration the result should be recorded as 0
Sputum examination A pulmonary tuberculosis suspect should submit two sputum samples collected in the early morning for microscopy Secretions build up in the airways overnight are more likely to contain TB bacilli than one taken later in the day
Slide reporting Number of bacilli No AFB per 100 oil immersion fields 1-9 AFB per 100 oil immersion fields 10-99 AFB per 100 oil immersion fields 1-10 AFB per oil immersion fields > 10AFB per oil immersion fields Result reported 0 Scanty 1+ 2+ 3+
First-generation immigrants from high-prevalence countries Close contacts of patients with smear-positive pulmonary TB Overcrowding (prisons, collective dormitories); homelessness (doss houses and hostels) Smoking: cigarettes and bidis Tobacco Alcohol Immunosuppression: HIV, anti-TNF therapy, high-dose corticosteroids, cytotoxic agents Malignancy (especially lymphoma and leukaemia) Silicosis Gastrointestinal disease associated with malnutrition (gastrectomy, jejuno-ileal bypass, cancer of the pancreas, mal-absorption) Deficiency of vitamin D or A Recent measles: increases risk of child contracting TB
