Tuberculosis.

Epidemiology.
Etiologogy.
 Tuberculosis

• TB
• TBC
• Phthisis
• Tuberculosis
 Tuberculosis
• Stone Age – 5000 B.Ch.
• Egyptien mummies –
2700 B. Ch.
• Manou law – a. 1200
B.Ch. (interdiction of
marriage with women
suffering from TB)
• XVIII – XIX centuries: 30%
of deaths are caused by
TB
Tuberculosis
 History

• 1821 – 1826 – Laennec

• 1865 – Villemin
• 1882 – Robert Koch
• 1890 – R. Koch –
tuberculina
• 1895 – Roentgen
• 1907 – Pirquet
• 1908 – Mantoux
• 1921 – Calmette şi
Guerin
• 1943 - Vaksman
 History
• Hippocrate (island Cos, 460 B.Chr. - Larissa, Tessalia
377 I.C.) described Phtysis - transmissible disease in the
family
• Galen (130-200) transmissible disease
Aristotel (384-322 I.C.) described scrofula in pigs and
the fact that phthisis is contagious
• Avicena described the disease as transmissible type
 History
• Giorolamo Fracatorius (1483-1553) -
First epidemiologist, recognized the
transmissibility of TB
• Franciscus Sylvius (1614-1672),
described at the autopsies "tubercules“=>
TB
• Sanatoriums (Germania - sec 19 Hermann
Brehmer)
 History
• În 1810, Carmichael: TB of the cows is
transmitted through infected milk and meat.
• Rene Laennec,1819 introduced stetoscope
• Jean-Antoine Villemin,1865: transmissible
disease" and demonstrated that TB is a specific
disease determined by inoculable agent
• Forlanini – colapsotherapy - 1880
• Robert Koch identify the bacilli– 1882
• Waksman –streptomycine in 1943
 Sanatoriums
• Before antibiotics,
patients were sent to
sanatoriums.
• Patients were treated
with fresh air,
sunshine and bed
rest.
• Those who could not
afford, often die at
home
 Evolution
• Medicines that can
destroy bacteria – were
discovered in 1940 -1950
• Streptomicina (SM) 1943
• Izoniazida (HIN) and
• Acid P-aminosalicylic
(PAS) were discovered
1943 and 1952
 Evolution
• TB death rate dropped dramatically.

• The annual incidence of TB declined.

• Most nursing homes were closed in the ≈70s

 Regiunea Europeană OMS
53 de țări

18 țări cu cea mai mare povară TB

1. Armenia 10. Lituania
2. Azerbaidjan 11. R. Moldova
3. Belarus 12. România
4. Bulgaria 13. Rusia
5. Estonia 14. Tadjikistan
25 de țări UE 6. Georgia 15. Turcia
7. Kazahstan 16. Turkmenistan
8. Kârgâzstan 17. Ucraina
9. Letonia 18. Uzbekistan
 480,000 TB MDR, 9,7% cu XDR

Biggest rate in URSS

India, China, Rusia, Pakistan and Ukraine

includes 60% from all MDR-TB cases
Incidence and mortality 1990 - 2017 гг.
(абсолютные цифры и 100 000 населения)
Incidence in children/ 100 000 , 2012 - 2017 гг.
Rate of MDR-TB (%), 1995 - 2017 гг.
Rate TB/HIV
 Epidemiological indices
Republica Moldova, 2015
• Global incidence (new case and relapse) –
3599 cases – 88,4 la 100 000 population
• New case– 2854 cases – 70,1 la 100 000
population (HIV-pozitivi – 219 cases – 7,7%)
• Relapse - 745 cases – 18,3 la 100 000
population
• Prevalence – 4278 cases – 105,2 la 100 000
population
• Mortality – 406 cases – 10,0 la 100 000
population (HIV-pozitivi – 84 cases – 20,7%)
 Epidemiological indices
Republica Moldova, 2015
• Tuberculosis children150 new cases
18,8/100 000 population:
0 – 4 ani – 46 cases
5 – 14 ani – 65 cases
15 – 18 ani – 39 cases
MDR-TB + aditional to
Fluoroquinolone and one of
injectabile drug
capreomycin, kanamicin or
amikacin
TB with extended rezistence
XDR - TB
67th World Health Assembly, Geneva, May 2014
• Bacilul Koch
• BK
• Mycobacterium
tuberculosis
• AFB-acid fast
bacilli
• MBT
 Koch Bacillus
• Robert Koch
• 24 march 1882
• 24 march –
• World Day of fight
against
• 1911 Robert Koch
received Nobel
Ziehl-Neelsen staining
Lipid-Rich Cell Wall of Mycobacterium
Mycolic acids

CMN
Group:
Unusual cell
wall lipids
(mycolic
acids,etc.)

(Purified Protein
Derivative)
 The components of the bacterial wall
• "Cord factor" glycolipid surface identified only in
virulent strains, which cause the growth of MBT in
vitro. Injected to mice induces specific granulomas.
• "Sulfatides" - surface glycoproteins containing sulfur,
is presented only in virulent strains, prevents the
phagosome fusion with lysosomes in macrophages
which contain MBT
• LAM heteropolysaccharides (similar structure with
endotoxin of gram negative bacteria) inhibit
macrophage activation due to releasing of IFN-γ, TNF-
α, IL-10 (interleukins causing fever, weight loss, tissue
damage).
 Epidemiological chain

• Source of infection

• Way of transmition

• Mecanism of transmission
 Source of infection
• The main source of infection is patient
with pulmonary ТВ
• Patients with active extrarespiratory
fistulised TB, (urogenital, osteo-
articular, lymphatic)
• Sick animals with TB, spreading
infection through food or during care
 Ways of transmition
• Airborne transmission (90-95%), dropllet
nuclei ≈ 1-5μm issued through cough
(3500 MTB), sneezing (1 mln. MTB),
speaking (5 minutes - 3500 MTB)

• Dropllet nuclei fall 1cm per hour in non

vetilated rooms.
 Increased risk of M. tuberculosis transmition

• Susceptibility of the exposed

individuals to be infected
• Contagiousness is directly linked to
the number of exhaled MBT .
• Environment - environmental factors
that affect the resistance of M.
tuberculosis
 Increased risk of M. tuberculosis transmition

Exposure:
• Proximity, frequency and duration of exposure.
• People with prolonged and close contact with TB patient
have a higher risk to become infected, with an estimated
rate of infection 22% annually.
Virulence of M. tuberculosis:
• Virulence is the ability of the pathogen to penetrate, to
adapt, to multiply and to spread into body.
• Virulence change essentially under the action of
environmental factors.
 Contagiousness

Features Description
Clinical •The presence of cough, lasting more than 3
weeks.
•Pulmonary TB, particularly involving the larynx
(highly contagious)
•The patient doesn’t cover mouth and nose when
is coughing
•Inadequate or inappropriate treatment (drugs,
duration)
Radiologic •Cavity on chest X ray
e și de •AFB and culture positive for M. tuberculosis
laborator
 Factors that increase the transmition
probability of M. tuberculosis

• Space - a small space divided by a person

with a TB patient.
• Insufficient ventilation resulting in lack of
dilution or elimination of infectious droplets
• Air circulation - Recirculation of nuclei
drops
• Handling specimens - improper handling of
specimens generating droplet nuclei
• Positive air pressure in the patient room-
causing the circulating of M. tuberculosis in
other areas.