Final Report in TB

8/12/2019 Final Report in TB

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INTRODUCTION

Tuberculosis (TB) is contagious infection caused by

bacteria that usually affect the lungs. It is a disease of

poverty affecting mostly young adults in their most

productive years.TB can be passed on to another person through tiny

droplets spread by coughing and sneezing.

Tuberculosis can affect other organs of the body, such

as the kidneys, spine or brain. Symptoms depend on

the organ affected. TB of the spine causes severe back

pain, while TB of the kidneys can cause bloody urine.


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ETIOLOGIC AGENT

MYCOBACTERIUM TUBERCULOSIS

slender, aerobic, non-sporulating,

non-motile organism.

Cell wall composed of mycolic acid,which makes them acid fast;they

will retain stains even on treatment

with a mixture of acid and alcohol.

Slow grower

Mycobacteria stain weakly positive

with Gram stain.


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1. Agent

(Mycobacterium tuberculosis)

2. Reservoir

(Human/surrounding

environment/cattle)

3. Mode of Escape

coughing, sneezing,

talking

4. Mode of Transmission

(Aerosol droplets, dust particles)

5. Mode of Entry

Inhalation/AspirationIn the respiratory tract,

Ingestion,Skin contact

6. Host

Human

EPIDEMIOLOGIC

CHAIN


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EPIDEMIOLOGY

WHO: Philippines ranks fourth in the world for

the number of cases of tuberculosis and has

the highest number of cases per head in South

East Asia.

The disease kills 68 people daily in a country

1.7 million people died from TB in 2009,

including 380,000 people with HIV, equal to

4700 deaths a day


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EPIDEMIOLOGY

The Philippines is among the 22 high-burdened

countries in the world according the WHO.

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)


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RISK FACTORS


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There are number risk factors for tubercolosisinfection:

1.Silicosis2 HIV

3 Nutrition

4 Crowding

5 Diabetes mellitus6 Other

7 Genetics

8 Weak Immune System9 Native Country

10 Poor Health Care


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Silicosis

Silica particles irritate the respiratory

system, causing immunogenic responses such

as phagocytosis, which results in high

lymphatic vessel deposits. It is probably this

interference and blockage of macrophage

function that increases the risk of

tuberculosis. Persons with chronic renal failureand also on hemodialysis have an increased

risk


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paint

concrete

Portland cement

Masonry

sandstone

rock

paint

also be in soil, mortar, plaster, and shingles.


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HIV

HIV is a major risk factor for tuberculosis.

The risk of developing TB is estimated to be

between 20-37 times greater in people living

with HIV than among those without HIV

infection. TB is a leading cause of morbidity

and mortality among people living with HIV.


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Nutrition

A body mass index (BMI) below 18.5increases the risk by 2 to 3 times. An increasein body weight lowers the risk. Other clinical

conditions that have been associated withactive TB include gastrectomy with attendantweight loss and malabsorption, jejunoilealbypass, renal and cardiac transplantation,

carcinoma of the head or neck, and otherneoplasms (e.g., lung cancer, lymphoma, andleukemia).


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Crowding

Prisoners are particularly vulnerable to infectiousdiseases such as HIV/AIDS and TB. Imprisonmentfacilities provide conditions that allow TB to spreadrapidly due to overcrowding, poor nutrition, and a lack

of health services. Those who live with a friend,relative or roommate infected with tuberculosis aremore susceptible to contracting TB through close andcontinuous exposure to the infection. The same appliesto people who work in overcrowded environments

with inadequate ventilation and/or a population ofpeople at higher risk of having TB, such as animmigration center, nursing home, prison, or health-care facility like a hospital.


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Diabetes mellitus

There is also a very high 3 fold increased

risk of infection with TB for patients who have

diabetes mellitus The correlation between

diabetes mellitus and TB concerns publichealth as it merges communicable and non-

communicable diseases.


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OtherOther conditions that increase risk include the sharing

of needles among IV drug users, recent TB infection or ahistory of inadequately treated TB, chest X-ray suggestiveof previous TB, showing fibrotic lesions and nodules,prolonged corticosteroid therapy and otherimmunosuppressive therapy, compromised immune system(3040% of people with AIDS worldwide also have TB),

hematologic and reticuloendothelial diseases, such asleukemia and Hodgkin's disease, end-stage kidney disease,intestinal bypass, chronic malabsorption syndromes,vitamin D deficiency, and low body weight.

Genetics There is also genetic susceptibility


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Weak Immune System

Anything capable of weakening the

immune system can increase a person's

vulnerability to tuberculosis.


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Native Country

According to the Centers for DiseaseControl and Prevention, the rate of TB amongpeople who lived in the United States in 2006

was more than 9.5 times higher for foreign-born individuals as opposed to those born inthe country. In 2007, 58 percent of all TB casesin the United States were people born in other

countries, with the most frequent birthcountries being China, India, Mexico, thePhilippines and Vietnam


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Poor Healthcare

Individuals who don't have sufficient

access to quality medical care -- such as those

who have a low income or are homeless -- are

at risk for tuberculosis simply becausediagnosing and treating the infection are less

likely.


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MANIFESTATIONS OF TB

Cough: 2 or more weeks with or without the ff

symptoms:

Fever

Chest pain/back pains

Hemoptysis

Weight loss

Sweating

Fatigue

Shortness of Breath


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CLASSIFICATION OF TB

Pulmonary TB Smear Positive

Px with 2 positive sputum specimen w/ or w/o abnormalities

in chest x-ray consistent with TB

1 sputum specimen positive with chest x-ray abnormalitiesconsistent with Active TB

Smear Negative

3 negatIve sputum specimen with Chest x-ray abnormalities

consistent with Active TB

Extra Pulmonary TB

Px with at least 1 mycobacterial smear positive from an

extra-pulmonary site


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TYPES OF TB

NEW A px who has never had treatment for TB or who

has taken anti-TB drugs for


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TYPES OF TB

RETURN AFTER DEFAULT A px who returns to treatment w/ positive

bacteriology (smear/culture) following

interruption of treatment for 2 months or more

TRANSFER-IN

A patient who has been transferred from another

facility adopting NTP policies w/ proper referral

slip to continue treatment

OTHERS

All cases who do not fit into above definitions


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TB PATHOGENESIS


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Pathogenesis


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Pathogenesis


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Pathogenesis


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Pathogenesis


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Pathogenesis


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TB Virulence Genes

KatG encodes for catalase/peroxidase

enzymes that protect against oxidative

stress

rpoV main factor initiating transcription

of several genes

Erp encodes protein required for

multiplication

Beijing/W gene identified in outbreak

conditions; associated with higher

mortality rates and chances of developing


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TREATMENT


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NTP TREATMENT REGIMENS

TB Treatment

Regimen

TB Patients To Be

Given Treatment

DRUGS AND DURATION

Initial Phase Continuation

Phase

I New smear-positve PTB; new smear-

negative PTB with extensive

parenchymal lesions on CXR asassessed by TBDC; extra-pulmonary TB;

severe concomitant HIV disease

2 HRZE 4 HR

II Treatment failure; Relapse; treatment

after interruption; RAD; others

2 HRZES/ 1

HRZE

5 HRE

III New smear-negative PTB with minimal

lesions on CXR as assessed by TBDC

(other than in Category I)

2 HRZE 4 HR

IV Chronic case (still sputum-positive after

supervised re-treatment)

Refer to specialized centers

with access to second line

drugs


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Recommended dosages (mg/kg body

weight):Drugs Daily Thrice-weekly

Isoniazid 10

Rifampicin 10 (8-12) 10 (8-12)

Pyrazinamide 25 (20-30) 35 (30-40)

Ethambutol 15 (15-20) 30 (25-35)

Streptomycin 15 (12-18) 15 (12-18)


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How can TB be prevented?

1. Early diagnosis and treatment: TB should be treated early in order to preventdeterioration of the disease and spread of the infection. Patients with active

pulmonary tuberculosis can attend any government chest clinic for treatment.2. Examination of close contacts: The close contacts of TB patients, usually the

household contacts, should be examined. This includes tuberculin skin testing and/orchest x-ray examination for young children and chest x-ray examination for olderchildren and adults.

3. Leading a healthy life style: The germs attack the lungs when a person's body

resistance is reduced. So try to guard yourself by leading a healthy lifestyle in orderto minimize the chance of contracting the illness. This includes:

- adequate exercise

- enough rest and sleep

- balanced diet

- avoidance of smoking and alcohol

- breathing fresh air and maintaining good indoor ventilation

- good personal hygiene (e.g., avoid coughing and sneezing directlyat other persons)

4. BCG (Bacille Calmette-Guerin) vaccination


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PROGNOSIS

With treatment, most are able to make a full recovery. Inaddition, some may survive without treatment and may even fully

recover from the disease. Without treatment, approximately half ofthose infected with active TB will eventually die within 5 years ofthe infection. This is because TB bacteria multiply quite slowlycompared to most other bacteria, and active TB bacteria can causean illness to worsen overtime, leading to other complications.

Patients infected with drug-resistant TB may have a lowerpossibility of being cured. The percentage recovery is dependent onthe drugs they are resistant to and also, the amount of lung damagethey have before the start of effective treatment.

If tuberculosis is coupled with other diseases such asHIV/AIDS or other serious illness, the resultant outlook is moreinclined to worsen.

Final Report in TB

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