Tuberculosis

Sudesna Chowdhury
ID: 2025174
DEFINITION
 Tuberculosis (TB) is a potentially fatal contagious disease
that can affect almost any part of the body but is mainly an
infection of the lungs.

Origin:
- Neo Latin Word

Tubercle – ROUND NODULE

Tuberculosis
Osis - CONDITION
HISTORY OF TUBERCULOSIS:

Dr. Robert
Koch
discovered the
bacteria that
Found in the cause TB-
ancient Mycobacteriu
mummies of m
Egypt Tuberculosis

1550–-1080 24 Mar. 1882

EPIDEMIOLOGY
 2019:
- Globally 10 million people were affected with TB.
- 87% of new cases: identified in 30 high TB burden countries.
- A total of 1.4 million people died from TB .
 Eight countries account for 2/3 of the total with India leading the count,
followed by:
- Indonesia
- China
- The Philippines,
- Pakistan
- Nigeria
- Bangladesh &
- South Africa.
 TB incidence is falling at about 2% per year globally between 2015 and
2019.
 An estimated 60 million lives were saved through TB diagnosis and
treatment.
WORLD PERCENTAGE

3
4.3
7.7 Asia

Africa

Eastern Mediterian region

26
59
European Region

America
TUBERCULOSIS IN BANGLADESH
Bangladesh is in It accounts for The incidence Mortality rate is 24
Top 30 - TB 3.6% of the global rate is 221 per per
burden countries. total infection. 100,000. 100,000population.

TB is the number 361,000 estimated people

who developed TB 38,150 people
3 causes of death among them 33,000 were
in Bangladesh. children in 2019.
died due to TB.
 CAUSATIVE ORGANISMS:

Human Animal

Mycobacterium Mycobacterium
Tuberculosis Bovis
 Mycobacterium tuberculosis complex:

M. Tuberculosis
M. Bovis
M. Africanum
M. Microti

OTHER MYCOBACTERIUM ASSOCIATED WITH HUMAN DISEASES:

Atypical Anonymous Nontuberculous

Mycobacteria Mycobacteria Mycobacteria

MOTT
Tuberculoid Opportunist (Mycobacteria other
Mycobacteria Mycobacteria than tubercule
bacilli)
 TUBERCULOSIS IS CAUSED BY-
MYCOBACTERIUM TUBERCULOSIS
Mycobacterium Tuberculosis Characteristics:
-Gram Positive
-Obligate aerobe
-Non-Spore-Forming
-Non-motile rod
- Mesophile
- 0.2 to 0.6 x 2-4 um²
-Slow generation time: 15-20 hours
- Lipid rich cell wall contains mycolic acid- 50% of cell wall dry
weight:
i) Responsible for many of this bacterium’s characteristics
properties
ii) Acid Fast- retains acidic stains
iii) Confers resistance to detergents antibacterial
SPREAD OF TUBERCULOSIS
PATHOGENESIS
Severe Symptoms:
 Shortness of breath
 Urine discoloration
 Cloudy & reddish urine
 Fever with chills.
 Fatigue
Diagnosis:

 1.Bacteriological test:
a. Zeihl-Neelsen stain
b. Auramine stain(fluorescence microscopy)
 2. Sputum culture test:
a. Lowenstein –Jensen(LJ) solid medium: 4-18 weeks
b. Liquid medium : 8-14 days
c. Agar medium : 7 to 14 days
 3.Radiography:
Chest X-Ray(CXR)
 4.Nucleic acid amplification:
i) Species identification ; several hours
ii) Low sensitivity, high cost
iii) Most useful for the rapid confirmation of
tuberculosis in persons with AFB-
positive sputa
iv) AFB-negative pulmonary tuberculosis
v) Extra pulmonary tuberculosis
 5.Tuberculin skin test (PPD)

Injection of fluid into the

skin of the lower arm.

48-72 hours later –

checked for a reaction.

Diagnosis is based on
the size of the wheal.

1 dose = 0.1 ml contains 0.04μg

Tuberculin PPD.
TUBERCULIN TEST INTERPRETATION
 6. Other biological examinations:
i) Cell count(lymphocytes)
ii) Protein(Pandy and Rivalta tests) – Ascites,
pleural effusion and meningitis.
BCG VACCINE:
- BACILLE CALMETTE GUERIN (BCG).
- FIRST USED IN 1921.
- ONLY VACCINE AVAILABLE TODAY FOR PROTECTION AGAINST
TUBERCULOSIS.
- IT IS MOST EFFECTIVE IN PROTECTING CHILDREN FROM THE DISEASE.
- GIVEN 0.1 ML INTRADERMALLY.
- DURATION OF PROTECTION 15 TO 20 YEARS
- EFFICACY 0 TO 80%.
- SHOULD BE GIVEN TO ALL HEALTHY INFANTS AS SOON AS POSSIBLE
AFTER BIRTH
- UNLESS THE CHILD PRESENTED WITH SYMPTOMATIC HIV INFECTION
MANAGEMENT:

FIRST LINE DRUGS: SECOND LINE DRUGS:

- ISONIAZID - CYCLOSERINE
- RIFAMPICIN - ETHIONAMIDE
- ETHAMBUTOL - STREPTOMYCIN
- PYRAZINAMIDE - AMIKACIN
- RIFAPENTINE - CAPREOMYCIN
- RIFABUTIN
DOSAGE REGIMEN:
 INTENSIVE PHASE + CONTINUATION PHASE
 HREZ (2 MONTHS) + HRE (4 MONTHS
TREATMENT REGIMEN ACCORDING TO WHO
ISONIAZID (H) RIFAMPICIN (R) PYRAZINAMIDE (Z)
ETHAMBUTOL (E) STREPTOMYCIN
DOTS - DIRECTLY OBSERVED TREATMENT SHORT COURSE
DOTS means that a trained health care worker or other
designated individual provides the prescribed TB drugs and
watches the patient
swallow every dose.
MULTI-DRUG RESISTANCE TB:

 TB caused by strains of Mycobacterium

tuberculosis that are resistant to at least isoniazid and
rifampicin, the most effective anti- TB drug.
 Globally, 3.6% are estimated to have MDR-TB.

 Almost 50% of MDR-TB cases worldwide are

estimated to occur in China and India
TUBERCULOSIS AND HIV:

 Worldwide the number of people infected with both

HIV and TB is rising.
 The HIV virus damages the body’s immune system and
accelerates the speed at which TB progresses from a
harmless infection to a life threatening condition.
 The estimated 10% activation of dormant TB infection
over the life span of an infected person, is increased to
10% activation in one year, if HIV infection is
superimposed.
 It is the opputunistic infection that most frequently
kills HIV-positive people.
 PREVENTIVE MEASURES:

1) Use Personal Preventive Protective

Device.
2) BCG vaccine
3) Regular medical follow up
4) Isolation of Patient
5) Ventilation
6) Natural sunlight
7) UV germicidal irradiation
THANK YOU ALL