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Tuberculosis Introduction Tuberculosis (TB) is considered as the worlds deadliest disease and remains as a major public problem in the

Philippines. TB is a highly infectious chronic disease caused by the tubercle bacilli. IT is primarily a respiratory disease but can also affect other organs of the body and is common among malnourished individuals living in crowded areas. It often occurs in children of underdeveloped and developing countries in he form of primary complex especially after a bout of a debilitating childhood disease such as measles. Tuberculosis (TB) is a contagious disease. Like the common cold, it spreads through the air. Only people who are sick with TB in their lungs are infectious. When infectious people cough, sneeze, talk or spit, they propel TB germs, known as bacilli, into the air. A person needs only to inhale a small number of these to be infected. Left untreated, each person with active TB disease will infect on average between 10 and 15 people every year. But people infected with TB bacilli will not necessarily become sick with the disease. The immune system "walls off" the TB bacilli which, protected by a thick waxy coat, can lie dormant for years. When someone's immune system is weakened, the chances of becoming sick are greater. In the Philippines, Tuberculosis ranks sixth in the leading cause of morbidity (2002) and mortality (2002). He estimated incidence rate all TB cases in the Philippines is 243/100,000 population/year (WHO Report 2006). The country ranks ninth among the 22 high burdened countries under the WHO watch list.

The causative or infectious agents of TB are M. Tuberculosis and M. Africanum primarily in humans and M. Bovis primarily from cattle. Other mycobacteria occasionally produce disease clinically indistinguishable from tuberculosis; the etiologic agents ca be identified only by culture of the organisms. Signs and Symptoms Cough of two weeks or more Fever Chest or back pains not referable to any musculo-skeletal disorders Hemoptysis or recurrent blood-streaked sputum Significant weight loss Other signs such as sweating, Fatigue, Body malaise and SOB

Mode of Transmission Airborne droplet method through coughing, singing or sneezing Direct invasion through mucous membranes Bovine tuberculosis results from exposure to tuberculosis cattle, usually by ingestion of unpasteured milk or dairy products. Period of Communicability As long as viable tubercle bacilli are being discharged in the sputum. Some untreated or in adequate treated patients may be sputum- positive intermittently for years. The degree of communicability depends on the ventilation, exposure of the bacilli to sun or UV light and opportunities for their aerosolization by coughing, sneezing, talking or singing. Susceptibility and Resistance The most hazardous period for development of clinical disease is the first 6-12 month after infection. The risk of developing the disease is highest in children under 3 years old, lower in later childhood and high again among adolescents, young adults and the very old. Reactivation of long latent infections account for a large proportion of cases of clinical disease in older person. For those infected, susceptibility to disease is markedly increased in those with HIV infection and other forms of immunosuppression and also increased among underweight and undernourished persons with silicosis, diabetes or gastrectomies and among substance abusers.

Methods of Control Preventive Measures Prompt diagnosis and treatment of infectious cases BCG( Bacillus Calmette- Guerin) vaccination of newborn, infants and grade I/School entrants Educate the public in mode of spread and methods of control and the importance of early diagnosis Improve social conditions, which increase the risk of becoming infected, such as over crowding. Make available medical, laboratory and x-ray facilities for examination of patients, contacts and suspects, and facilities for early treatment of cases and persons at high risk of infection and beds for those needing hospitalization. Provide public health nursing and outreach services for home supervision of patients to supervise therapy directly and to arrange for examination and preventive treatment of contacts

TB Control Program (DOH) What is TB? Tuberculosis is an infectious disease caused by TB bacteria (Mycobacterium tuberculosis) that primarily affects the lungs. This condition is known as pulmonary tuberculosis (PTB). You may also have tuberculosis in the bones, meninges, joints, genito-urinary tract, liver, kidneys, intestines and heart and this is called extra-pulmonary tuberculosis. What are some of the relevant TB statistics? The Philippines is among the 22 high-burdened countries in the world according the WHO. TB is the 6th leading cause of illness and the 6th leading cause of deaths among the Filipinos. Most TB patients belong to the economically productive age-group (15-54 years old) according to the 2nd National Prevalence Survey in 1997. How does one get TB? One gets infected with TB if he inhales the germs released from air droplets when a pulmonary TB patient coughs, sneezes and spits. A PTB patient whose sputum is positive for the TB germs/bacteria, if left untreated, may infect approximately 10-20 persons in tow years. How is TB diagnosed? Pulmonary TB is suspected if a person has symptoms of cough for more than 2 weeks, fever, chest and back pains, poor appetite, loss of weight and hemoptysis. He should seek medical consultation and his sputum should be examined to detect the presence of TB germs/bacteria. How is TB treated? Tuberculosis is a curable disease. Patients are prescribed with appropriate regimen to render them non-infectious and cured, as early as possible. The treatment for TB is a combination of 34 anti-TB drugs. NEVER should we prescribe a SINGLE DRUG for TB treatment! This will worsen the patient's condition. What is DOTS? D.O.T.S stands for Directly-Observed Treatment Short course. It is a comprehensive strategy endorsed by the World Health Organization (WHO) and International Union Against Tuberculosis and Lung Diseases (IUATLD) to detect and cure TB patients. There are five elements of DOTS that need to be fulfilled. These are: a. Political commitment b. quality sputum microscopy for diagnosis c. regular supply of anti-TB drugs

d. standardized recording and reporting of TB data e. supervised treatment by a treatment partner According to the WHO Report on the TB Epidemic, 1997:

DOTS cure TB patients and it can produce cure rates as high as 95% even in the poorest countries. DOTS prevent new infections among children and adults DOTS can stop resistance to anti-TB drugs. DOTS is cost-effective.

How can we avail of DOTS Services? DOTS services are available in the rural health units, city health units, city health centers and government hospitals around the country. Currently, there are also private facilities that are offering DOTS services to their clients. Is TB curable? YES! TB can be cured through DOTS.

How can private physicians learn to use DOTS? The Philippine Coalition Against TB (PhilCAT) had already started to adopt DOTS strategy. They can contact their different medical societies officers and member offices. There are already private DOTS facilities. In the meantime, what should patients and physicians do for the prevention and control of TB? Those who have symptoms of TB should go to the nearest health center to be evaluated for TB. Physicians should assure that patients take their medications regularly and completely. What is the National TB Program of the Government? The National TB Program (NTP) is the Government's commitment to address the TB problem in the country. The NTP is being implemented nationwide in all government health centers and government hospitals. Its objectives are to detect active TB cases (at least 70%) and cure them (at least 85%). Achieving and sustaining targets will eventually result to the decline of the TB problem in the Philippines.

TUBERCULOSIS (Philippines)
Microbiology Lecture
M-F 1:30-3:30

Submitted by: Carlo Nio B. Alcantara Block 2J Submitted to: Mr. Elvinjoy Gopico Clinical Instructor