RE-EMERGING

INFECTIOUS
DISEASES -
TUBERCULOSIS
PBH 101 || SUMMER 2022

DR. SHOMIK MARUF

GLOBAL IMPACT OF TB

 TB occurs in every part of the world.

 In 2017, the largest number of new TB cases

occurred in the South-East Asia and Western Pacific
regions, with 62% of new cases, followed by the
African region, with 25% of new cases.

 In 2017, 87% of new TB cases occurred in the 30

high TB burden countries.
 Eight countries accounted for two thirds of the new
TB cases: India, China, Indonesia, the Philippines,
Pakistan, Nigeria, Bangladesh and South Africa.
 BANGLADESH SITUATION
Bangladesh one of 8 countries
sharing 2/3 of global TB
burden
Have been implementing
Directly Observed
Chemotherapy, Short Course
(or DOTS) since 1993
In 2020, a total of 360,000
new cases were detected and
44,170 deaths (13% case
fatality rate) were attributed to Treatment coverage is 81%
TB. MDR cases reported
1,113. Around 67 XDR-TB
cases were detected.
A treatment success rate of
Challenges: ensuring universal
95% has been achieved
access to TB care, Lack of
among TB cases. MDR-TB
engagement of private health
treatment success rate is also
practitioners and lack of
high at 74% (greater than 55%
awareness
globally)
TUBERCULOSIS
(TB)

 Caused by bacteria
 Usually attack the lungs
 Can also attack any part of the
body- kidney, spine, and brain
 Transmission
 Through the air from one
person to another
 Coughs, sneezes, speaks, or • TB is caused by a bacteria Mycobacterium tuberculosis (MTB) - an acid-fast bacilli (AFB).
sings
• Acid fastness is a physical property that gives a bacterium the ability to resist decolorization by
 Nearby people may breathe acids during staining procedures. This means that once the bacterium is stained, it cannot be
in these bacteria and decolorized using acids routinely used in the process.
become infected • Robert Koch isolated MTB in 1882 which won him the Nobel Prize in 1905. MTB is also called
Koch’s bacillus.
  TB is the most common illness among people living with HIV. Fatal if
CLASSIFICATION undetected/ untreated. TB is the leading cause of death among people with
OF TB HIV. 33% of all HIV death (Earlier)
(SITE SPECIFIC) TB HIV TB.

SDG target for TB

Catastrophic cost was defined as total TB care costs exceeding 20% of annual household income
 Latent TB infection
 People who are infected, but not
sick
 Do not feel sick, do not have any
symptoms, and cannot spread
TB to others
 Some people with latent TB
infection go on to get TB
disease
 TB disease
 Immune system can’t stop TB
bacteria from growing
 The bacteria begin to multiply in
the body and cause TB disease
 The bacteria attack the body
and destroy tissue . If this
occurs in the lungs, the bacteria
can actually create a hole in the
lung LTBI can later progress to active TB. Some can reach blood and grow in other parts
(kidney, spine, and brain)  not communicable
https://www.youtube.com/watch?v=202hkf43HXQ
TB GRANULOMA
LTBI VS ACTIVE TB

along with skin and blood

PULMONARY (PTB) VS EXTRAPULMONARY TB (EPTB)
When
should
you
suspect
to Have Active
Tuberculosis ???
 Risks of LTBI  Active TB

1. Persons infected with HIV;

2. Children younger than 5 years of age;
3. Persons infected with M. tuberculosis in the past 02
years
4. Persons who are receiving immunosuppressive
therapy; e.g., steroid.
5. Persons with diabetes, kidney disease, pre-existing
lung disease
6. People with undernutrition; medically underserved,
low-income population
7. Cigarette smokers, drug abusers, alcoholics
 TB DIAGNOSIS TB TREATMENT
 For Active TB:  VACCINE is Bacillus Calmette-Guérin (BCG) is provided in
primary health care services .
 Sputum for bacteria – microscopy,
GeneXpert  Majority of the active TB cases can be effectively treated
with current drugs available requiring 6-9 months.
 Chest x-ray
 A new line of treatment, known as the Host directed
 For LTBI: therapy (HDT) has been developed for TB. Anti-TB drugs +
 Skin test/Tuberculin skin test HDT can reduce the duration of the treatment.
(TST)/Mantoux test (MT)
 Interferon Gamma Response Assay Directly Observed Treatment Short course (DOTS) method
(IGRA)
1. Meet with a health care worker every day or several times a week
 For Both: 2. Meet at a place you both agree on: TB clinic, your home or work, or
any other convenient location
 Blood based bio-markers
3. Take your medicines at this place while the health care worker
watches
4. May need to take medicines only 2 or 3 times each week instead of
every day
 PREVENTION: PROTECT YOUR FAMILY AND FRIENDS

It generally takes a few weeks of treatment with TB medications before you're not contagious anymore. Follow these
tips to help keep your friends and family from getting sick:
 Stay home. Don't go to work or school or sleep in a room with other people during the first few weeks of
treatment for active tuberculosis.
 Ventilate the room. Tuberculosis germs spread more easily in small closed spaces where air doesn't move. If it's
not too cold outdoors, open the windows and use a fan to blow indoor air outside.
 Cover your mouth. Use a tissue to cover your mouth anytime you laugh, sneeze or cough. Put the dirty tissue in a
bag, seal it and throw it away.
 Wear a mask. Wearing a surgical mask when you're around other people during the first three weeks of treatment
may help lessen the risk of transmission.

 Finish your entire course of medication OR be responsible for MDR & XDR TB
THANK YOU