Globally, TB is a leading cause of death from an infectious disease worldwide, second only to AIDS.

It is
also known as a disease of poverty, affecting mainly young adults in their most productive years, with
two-thirds of cases estimated to occur among people aged 15-59. In 2011 there were 8.7 million new
cases of TB and 1.4 million deaths (this includes 430,000 deaths among people who were HIV-positive).
The vast majority of deaths from TB –over 95 percent - are in the developing world.

Occurrence of active tuberculosis (TB) in prisons is usually reported to be much higher than the
average levels reported for the corresponding general population [1],[2]. In prisons located in
developing countries TB has been reported as the most common cause of death [3]. High levels
of TB in prison populations are likely to be attributable to the fact that a disproportionate number
of prisoners are from population groups already at high risk of TB infection and TB disease (for
example, alcohol or drug users, homeless people, mentally ill individuals, former prisoners, and
illegal immigrants from areas characterized by high TB prevalence). Furthermore, the prison
setting, where segregation criteria are based on crime characteristics rather than on public health
concerns, may facilitate transmission. In addition, overcrowding, late case detection, inadequate
treatment of infectious cases, high turnover of prisoners, and poor implementation of TB
infection control measures are all known factors contributing to transmission of Mycobacterium
tuberculosis. Finally, prisoners may be at risk of rapid progression of latent TB infection (LTBI)
to TB disease following recent infection or reactivation of latent infection through coexisting
pathology, particularly HIV infection, intravenous drug use, and poor nutritional status [3],[4].

Moreover, prisons represent a reservoir for disease transmission to the community at large; the
TB infection may spread into the general population through prison staff, visitors, and close
contacts of released prisoners [5]. The transmission dynamics between prisoners and the general
population has been hypothesized to play a key role in driving overall population-level TB
incidence, prevalence, and mortality rates [4].

Overlooking TB prevention and control in prisons settings can carry serious consequences for
both prisoners and the general community, in particular in those countries where poor TB
control, lack of TB infection control measures, and incarceration rates are high [3].

The main objectives of the present study were to assess, by reviewing the published literature,
the consequences of within-prison spread of TB, estimating the relative risk and risk difference
for incident latent TB infection (LTBI) and TB disease in prisons worldwide, as compared to the
incidence in the corresponding local general population and the fraction (percent) of LTBI and
TB in the general population attributable (PAF%) to the exposure in prisons. The aim of this
study is to provide relative and absolute estimates of the risk of TB associated with incarceration,
and of the potential impact of specific preventive measures to control TB transmission in the
prison setting.
Tuberculosis (TB) has a long history. It was present before the beginning of re-corded history
and has left its mark on human creativity, music, art, and literature;and has influenced the
advance of biomedical sciences and healthcare. Its causativeagent,
Mycobacterium tuberculosis,
may have killed more persons than any other microbial pathogen (Daniel 2006)

TB is an infectious disease caused by the bacillus

Mycobacterium tuberculosis
. It typically affects the lungs (pulmonary TB) but can affect other sites as well
(extrapulmonary TB). The disease is spread in the air when people who are sick
with pulmonary TB expel bacteria, for example by coughing. In general, a relatively small
proportion of people infected with
Mycobacterium tuberculosis
 will develop TB disease; however, the probability of developing  TB is much higher among
people infected with the human immunodeficiency virus (HIV). TB is also more common
among men than women, and affects mostly adults in the economically productive age
groups.Without treatment, mortality rates are high. In studies of the natural history of
the disease among sputum smear-positive and HIV-negative cases of pulmonary TB,
around 70% died within 10 years; among culture-positive (but smear-negative)
cases, 20% died within 10 years.
 The most common method for diagnosing TB worldwide is sputum smear microscopy
(developed more than 100 years ago), in which bacteria are observed in sputum samples
examined under a microscope.

T u b e r c u l o s i s ( T B ) h a s b e e n a m a j o r h e a l t h p r o b l e m i n penitentiary
systems all over the world. The extent of TB inprisons, which is much
g r e a t e r t h a n i n t h e c o m m u n i t y , i s o f t e n underreported. Prevalence of TB in
prison is often five to 10 timeshigher than the national rates [1,2,3] in some cases,
by as much as3 0 t o 5 0 - f o l d s [ 4 , 5 ] . T h e h i g h n u m b e r o f i m p r i s o n e d
p e r s o n s , extremely overcrowded conditions, inadequate ventilation, and poor general
health of inmates facilitate the spread of tuberculosis.P r i s o n s r e p r e s e n t a h i g h r i s k
s e t t i n g f o r d e v e l o p m e n t a n d transmission of multidrug-resistant (MDR)
T B [ 6 ] . I n m a n y countries where the incidence of tuberculosis is very high,
prisonshave been found to play a significant role in the epidemiology of  drug
resistant tuberculosis [1,7,8]. Data on the prevalence of TB inp r i s o n s i n B a n g l a d e s h a r e
l i m i t e d . T h e B a n g l a d e s h N a t i o n a l Tuberculosis Control Programme (NTP) has
taken initiatives toimplement directly observed treatment – short course (DOTS)
insome prisons of Bangladesh in 2002. These are the cases that cometo the outpatient service
of the prison hospital seeking treatment.Drug resistance patterns in these cases are
not known as cultureand sensitivity-testing of sputum samples are not performed in
theprison setting.The aim of this study was to determine the prevalence of TB a n d
d r u g - r e s i s t a n t T B i n t h e l a r g e s t p r i s o n i n B a n g l a d e s h , t h e Dhaka Central Jail,
and to assess risk factors associated with thedevelopment of TB among the
prisoners.

http://www.scribd.com/doc/63048802/Pulmonary-Tuberculosis-and-Drug-Resistance-in-Dhaka-Central-
Jail-the-Largest-Prison-in-Bangladesh