TUBERCULOSIS(TB)

MAJOR GLOBAL HEALTH

THREAT

DR. S MAHMUD MISHU (SMM1)

LECTURER,
DEPARTMENT OF PUBLIC HEALTH
SCHOOL OF HEALTH AND LIFE SCIENCE
NORTH SOUTH UNIVERSITY
 LEARNING OBJECTIVES

✔After the end of the session, we will learn about:

✔Global TB situation

✔How TB spreads and how it causes the disease

✔Treatment and Prevention

✔The current status of TB in Bangladesh

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Lets Flashback…
Which ones are best suitable for TB?

✔ What do you understand by communicable

disease?
✔ Emerging Infectious disease or
Re-emerging infectious disease?
✔ Name the route of transmission for
infectious disease?
✔ Respiratory infection or Intestinal
infection?
✔ Spread through Droplet? Fomite? Vector?
“ GLOBAL EPIDEMICS OF TB

Leading cause of death from a single infectious

agent

1.7 billion (23% of World’s population) are

currently infected with TB

10 million new cases developed in 2017

In 2017, 1.3 million HIV- TB patient died and

300,000 more who were HIV+

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The picture is not so bleak…
Globally, TB incidence is falling at about 2%
per year

54 million deaths averted from 2000-2017

Absolute number of death dropped by 29% from

2000-2017

45% decline in mortality rate from 1990

……..but much progress to be made to…

Reduce TB related death by 90% before 2030 (SDG)

and by 95% before 2035 (End TB, WHO) from 2015

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 TB is caused by a bacteria Myobacterium tuberculosis (MTB). Also
known as Acid fast bacilli (AFB)

• Robert Koch isolated MTB in 1882 which won

him the Nobel Prize in 1905. MTB is also
called Koch’s bacillus

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Fate of TB infection
✔TB travels to lung

✔“Engulfed” by immune cells

✔Spread is prevented by formation of

“granuloma”

✔later progress to active TB

✔Some can reach blood and grow in

other parts (kidney, spine, and
brain) 🡪 not infectious

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Pulmonary TB (PTB) vs. Extra pulmonary TB (EPTB)
Criteria PTB EPTB

Site Lung Other than lung (Brain,

spine, bone, lymph
node)
Symptoms Cough, blood in General symptoms plus
cough, chest pain Specific to location

Spreading TB Can spread TB Cannot spread TB

Test results Sputum + Sputum –

skin test + Skin test +
Chest X ray + Chest X ray -

Treatment duration Shorter Longer

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Sites of
Extra Place your screenshot here

pulmonary TB
(EPTB)

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✔Persons infected with HIV;
✔Children younger than 5 years of age; RISK FACTORS OF
✔Persons infected with M. tuberculosis in the
past 2 years TB
✔Persons who are receiving immunosuppressive
therapy
✔Persons with diabetes, kidney disease,
pre-existing lung disease
✔Persons who lower than their ideal body weight;
✔Cigarette smokers, drug abusers, alcoholics
✔Medically underserved, low income populations

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 SYMPTOMS OF ACTIVE TB
✔Evening rise of temperature

✔Cough lasting 3 weeks or longer

✔Chest pain

✔coughing up blood or sputum

✔weakness or fatigue

✔weight loss/no appetite

✔Chills and sweating at night

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 DIAGNOSIS
Skin test/Tuberculin skin test (TST)/Mantoux test (MT)
Diagnosis for TB disease/Active TB
● Sputum for bacteria (smear/culture media)
● Chest X ray

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 TREATMENT

TB can be effectively treated

with current drugs available
Treatment required for 6-9
months
choice of drugs:

✔Isoniazid
✔Rifampicin
✔Ethambutol
✔Pyrazinamide
Treatment required for 6-9 months
medication should be taken continuously with out any
interruption
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Prevention
Prevention of LTBI 🡪 Active TB by treating
LTBI

Can you think of a problem?

Vaccine
BCG (bacille Calmette-Guérin) is mostly used
vaccine

Being used for 8o years, in many countries

including Bangladesh

Prevents severe TB in children, also TB

meningitis

Research on new experimental vaccines going

on
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 What about us???
Bangladesh one of 8 countries sharing 2/3 of global
TB burden

In 2017, a total of 364,000 new cases were detected

and 59,000 deaths were attributed to TB. MDR cases
reported 5,800

Have been implementing Directly Observed

Chemotherapy, Short Course (or DOTS) since 1993

A treatment success rate of 93% has been achieved

among TB cases. MDR-TB treatment success rate is also
high at 73% (greater than 55% globally)

Challenges: ensuring universal access to TB care,

Lack of engagement of private health practitioners
and lack of awareness
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TB TREATMENT FACILITIES/DOTS

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That’s all for today … 21