NATIONAL TUBERCULOSIS TB CONTROL PROGRAM

TUBERCULOSIS (TB)
 TB is an infectious disease caused by the bacteria called Mycobacterium Tuberculosis
(cannot classified as gram positive and gram negative. It called gram variable) (acid-
fast bacilli)
LEGAL BASIS of NTP
 RA 10767: Comprehensive TB Elimination Plan Act of 2016
o Lungs are commonly affected but it could also affect other organs such as the kidney,
bones, liver and others
o Pulmonary TB- lungs
o Extrapulmonary TB
 Pott’s disease- thoracolumbar TB of the bone particularly in the spine)
 Milliary TB- kidney, liver, lungs

 Incubation Period (gaano katagal bago malabasan an symptoms)

o 2 to 10 weeks
 Mode of Transmission:
o Direct: Airborne through droplet nuclei (sneezing, coughing) (transmission of
droplet is 3 fit)
o Indirect: continuous exposure to infected persons within the family
o Source of Infection: sputum (plema), blood from hemoptysis (blood when
you cough), nasal discharges and saliva (active cases- those showing signs and
symptoms)
SIGNS AND SYMPTOMS
 Cough of at least 2 weeks duration with or without the following symptoms:
o Significant & unintentional weight loss
o Unexplained fever (afternoon rise)
o Bloody sputum (hemoptysis)- pathognomonic (mnemonic of TB)
o Chest/ back pain not referable to any musculoskeletal disorders
o Easy fatigability or malaise (bec. of poor oxygenation)
o Night sweats
o Shortness of breath or difficulty of breathing
 o +AFB (acid fast bacilli test) macrobacterium

DIAGNOSIS (paano malalaman kon may TB)

 Direct Sputum Smear Microscopy (cheapest)- Ziehl-Neelsen microscopy (check if
the sputum has acid fast bacilli)
o Checks if (+) Acid-fast bacilli
o Results take about 3 weeks to confirm
o Sputum sample should be taken 1 thing in the morning upon arising (bawal mag
st

toothbrush & mouthwash because they have antibacterial properties so banging mapatay na nira an
bacteria ha sputum)
o 3 specimens (label cups 1st, 2nd, 3rd)
 Clean mouth. Brushing with water
 Breathe deeply, hold breath for a second or two and exhale slowly (3x)
 Cough strongly after inhaling deeply for the third time and try to bring up sputum
from deep within the lungs
 Collect at least 1 teaspoonful sputum
o 1st- on the spot= HC
o 2nd- upon arising the following morning = Home
o 3rd- on the spot = HC

DIAGNOSIS
 Sputum Culture and Sensitivity (confirmatory) (pinaadami)
 Chest X-ray – (extent of damage) (gin kikita kon gaano na kalala an TB)
 Tuberculin Test
o PPD- Purified Protein Derivative- Mantoux Test (skin test)
 Intradermal injection into the inner aspect of forearm to direct
exposure to TB (so dire hiya nag coconfirm kon may TB, nagpapakita
la kon na exposed ha ha ma TB)
 Localized reaction- detected in 48 to 72 hours (e.g., if tested on
Monday, pt will return on Thursday)
 (+) Mantoux test= induration of 10mm or above + For
immunocompromised+ >5mm (ex of immunocompromised pt- AID’s
patient)
REGISTRATION GROUPS (classification groups of pt with TB) basis of treatment hiya
 New- has never had TB, or has taken anti-TB drugs for <1month
 Relapse- previously treated, has been declared cured, & is presently diagnosed with
TB (relapse meaning bumalik)
 Treatment after Failure- previously treated but failed
 Treatment after Lost to follow-Up (TALF)- previously treated but was lost to follow-
up for 2 months or more and presently diagnosed with TB

TREATMENT/MEDICATIONS
 R-rifampicin (R)
o Side-effects- reddish to orange colored urine (reassure patient it’s normal), GI
upset, jaundice & thrombocytopenia (decreased thrombocyte/ platelets) Multidrug
(discontinue drug)
o Rifampicin decreases effectiveness of oral contraceptive (pills)
o Can be used prophylactically (prevention)
 I-isoniazid (H)
o Used prophylactically to patient (+) of PPD
o Side-Effects- peripheral neuritis namamaga, namamanhid so gin sasabayann hiya hin (give
Vitamin B6 [Pyridoxine]) 500-100mg, rashes (give anti-histamines), jaundice
(hepatotoxicity-discontinue drug)
 P- pyrazinamide (Z)
o Side-effect- hyperuricemia (increased uric acid), arthralgia joint pains(give
NSAIDs)
 Management- increase fluid intake
 E- ethambutol (E)
o Side-effect- optic neuritis (decreased visual acuity) asya bawal ha bata kay dire hira makaka
yakan if clear pa an ira vision
o Give Vitamin B6 (pyridoxine)
 S- streptomycin (S) given through IM. Category 2
o Side-effects- Ototoxicity aminoglycosides can be auto toxic (nakaka-bingi) (8tth cranial
nerve damage)- tinnitus ringing of the ear, dizziness, nausea & vomiting-
(discontinue drug)
o Rifampicin decreases effectiveness of oral contraceptives (pills)
(TB bacilli madali mag resist asya kailangan `damo it meds)
Drug therapy is important with TB patients, to prevent drug resistance of TB bacilli

DIRECT OBSERVED TREATMENT SHOWN COURSE STRATEGY (DOTS)

 DOTS (directly-observed therapy, short-course) means that the patient taking the
medicine should be observed by a nominated person, and the taking of the medicine
should be recorded
 The patient will meet with a health care worker every day or several times a week.
This can be at the TB clinic, your home or work or any other convenient location.
You will take your medications at this place while the health care worker observes.
Why do we use multi-drug treatment for TB?
Multiple drugs are needed to prevent the development of drug-resistant TB disease
MANAGEMENT
 MAINTAIN RESPIRATORY ISOLATION negative pressure room, an hangin
permi pasakob
 Administer medicine as ordered
 Always check sputum for blood and purulent expectoration
 Encourage questions and conversation so that the patient can air his or her
feeling
 Teach or educate the patient all about PTB
 Encourage patient to top smoking (smoking does not cause TB because TB is
microbial, pero pwede hiya makadagdag symptoms)
 Teach how to dispose secretion properly (cough/sneeze into tissue paper, the
dispose properly)
 Advice to have plenty of rest and eat balanced diet
 Be alert of drug reaction
 Emphasize the importance of follow-up
REMEMBER
 no longer infectious after two (2) weeks of appropriate and adequate therapy for as
long as treatment compliance
 when to say a patient is CURED (-culture sensitivity test)
 Drug-Susceptible TB cases- culture-negative in the last month of tx
 Drug resistant cases- three or more consecutive cultures take at least thirty (30) days
apart are negative
PREVENTION
 Submit all babies for BCG immunization
 Avoid overcrowding
 Improve nutritional and health status
 Advice persons who have been exposed to infected persons to receive tuberculin test
if necessary CXR chest x-ray and prophylactic isoniazid meds han na exposed ha TB