TUBERCULOSIS

Devadharshini
Gayathri
Pavithra
INTRODUCTION

● Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium

tuberculosis.
● It mainly affects the lungs (pulmonary TB) but can also involve other organs
such as the intestines, bones, joints, lymph nodes, skin, and meninges. It
remains an important public health problem worldwide.
Age and sex distribution:
In India (2023):

● 58% of TB cases were men (≥15 years).

● 37% were women (≥15 years).
● 5% were children (0–14 years).
● 0.04% were transgender persons.
EPIDEMIOLOGICAL INDICES(PARAMETERS):

● Incidence: New cases.

● Prevalence: Existing cases.
● Mortality: Deaths due to TB.
● Case Fatality Rate: % of TB cases that die.
● Case Notification Rate: Reported TB cases per population.
● Case Detection Rate: % of estimated cases detected.
● Drug Resistance Prevalence: % of TB cases resistant to anti-TB drugs.
NATURAL HISTORY OF TUBERCULOSIS:
Agent
[Link]
Source of infection:case
Infectious cases:Communicable
Disease

Environment : Host:
Poor quality of life Age
Poor housing Sex
Overcrowding Genetic
Smoking Nutrition
Alcohol...
MODE OF
TRANSMISSION:
● Tuberculosis is transmitted mainly by
airborne droplet nuclei expelled by an
infectious pulmonary TB patient during
coughing, sneezing, speaking, or
singing.

INCUBATION PERIOD:
● The time between infection with
Mycobacterium tuberculosis and the
development of a positive tuberculin
test is 3–6 weeks.
PATHOGENESIS : Inhalation of TB bacilli
↓
Alveoli
↓
Macrophage uptake
↓
Bacilli multiply inside
macrophages
↓
Lymphatic spread
↓
Primary complex
(Ghon focus + lymph node)
↓
Cell-mediated immunity
↓
Granuloma formation
↓
Healing / Latent TB
OR
Progressive TB
OR
Reactivation TB
OR
Miliary TB
CASE FINDING IN PUBLIC SECTOR:
Passive case finding Patient comes to health facility with
symptoms

Intensified finding Screening of high risk groups

Active case finding Health workers search for cases in

the community

Screening strategies:

[Link] screening- recent close contact withTb

and symptoms of tb
[Link] screening -Hospitals and healthcare
institution.
-Congregate-Old-age,homes
COLLECTION OF SPUTUM COLLECTION FOR OUT PATIENT:
SPUTUM: Spot sample: The
Day 1 Sample 1
patient gives the
● A pulmonary first sputum sample
at the health facility
tuberculosis should under supervision.
submit two sample The patient is given
a sputum container
for microscopy. to take home.
● Bacilli present in air
Day 2 Sample 2 The patient then
way overnight brings the morning
sample back to the
● So should collect in
health facility for
morning examination.
False positive and negative results of sputum smear:

False Positive : False Negative :

● Laboratory contamination of slides or ● Poor-quality sputum sample (saliva

reagents. instead of sputum).
● Contaminated sputum collection ● Insufficient number of bacilli in the
containers. specimen.
● Presence of non-tuberculous acid-fast ● Inadequate sputum collection or transport.
bacilli (NTM). ● Improper staining technique.
● Errors in staining or slide reading. ● Inadequate examination of smear by the
● Carry-over of bacilli from a previously technician.
positive specimen. ● Patient already on anti-TB treatment.
● HIV-associated or paucibacillary TB.
Radiological view:
 Tuberculin Test (Mantoux Test)
Definition:A skin test used to detect infection with tuberculosis (TB)

Procedure:Inject 0.1 mL PPD (1 TU) intradermally on the forearm.

Read the test after 48–72 hours

Measure induration (swelling), not redness.

Interpretation:

< 6 mm → Negative ,

6-9 mm → Doubtful and ≥ 10 mm → Positive

Positive Test Criteria
● ≥ 5 mm: HIV-positive persons,
recent contacts of TB cases,
immunosuppressed patients.
● ≥ 10 mm: High-risk groups
(health workers, recent
immigrants from
high-prevalence countries,
children <4 years, etc.).
● ≥ 15 mm: Persons with no
known risk factors.
Two-step testing
● The text describes the procedure for a two-step tuberculin skin
test (Mantoux test), which is used to screen for tuberculosis
infection.
● The first test requires a reading 48-72 hours after the injection
to check for an immune response.
● If the first test is negative, a second test is administered three
weeks later to ensure accuracy.
● Final interpretation depends on the reaction to the second test,
which is also read 48-72 hours after injection.
 DRUGS

First line: Second line:

● Rifampicin ● Fluoroquinolones
● Isoniazid ● Ethionamide
● Pyrazinamide ● Capreomycin
● Ethambutol ● Kanamycin
● Streptomycin ● Cycloserine
PREVENTION AND CONTROL
DIRECTLY OBSERVED TREATMENT SHORT
COURSE(DOTS):
DOTS is the internationally recommended strategy for tuberculosis (TB) control,
adopted by the World Health Organization. It ensures that TB patients take their
medicines regularly under supervision, improving cure rates and preventing drug
resistance.

Objectives of DOTS

● Achieve high cure rates in TB patients.

● Ensure treatment completion.
● Prevent treatment failure and relapse.
● Reduce transmission of TB in the community.
● Prevent development of multidrug-resistant TB (MDR-TB).
DOTS Treatment Phases
Intensive Phase (IP)

● Multiple drugs given under direct observation.

● Rapid reduction of bacterial load.

Continuation Phase (CP)

● Fewer drugs continued for a longer duration.

● Prevents relapse and ensures complete cure.
 Plain text
TB Suspect
↓
Diagnosis
↓
Registration
↓
DOTS Initiation
↓
Directly Observed Treatment
↓
Regular Follow-up
↓
Treatment Completion
↓
Cured / Treatment Success
BCG

● First human vaccination: Intradermal BCG vaccination

was first given in 1927.
● Nature of vaccine: BCG is the only widely used live
bacterial vaccine, prepared from an attenuated bovine
strain of tubercle bacilli.
● India: Since 1967, the BCG Laboratory at Guindy,
Chennai has been using the Danish 1331 strain for
vaccine production.
Types of BCG vaccine:

● Liquid (fresh) vaccine

● Freeze-dried vaccine (more stable and commonly used)

Dose:

● Newborns < 4 weeks: 0.05 mL

● ≥ 4 weeks and older children: 0.1 mL (0.1 mg)
Adult BCG Vaccination Initiative (India)
Eligible adults:
● Previous TB within last 5 years
● Age ≥ 60 years
● BMI < 18 kg/m²
● Close contacts of TB patients
● Smokers
● Diabetics
Not given to:
● Immunocompromised persons
● HIV patients
● Organ transplant candidates
Tuberculosis Preventive Treatment (TPT)
Prevents progression of latent TB infection (TBI) to active
TB.

High-Risk Groups:

● People living with HIV

● Household contacts of
pulmonary TB patients
● Immunosuppressed individuals
● Silicosis patients
● Dialysis patients
● Organ transplant candidates
● Anti-TNF therapy recipients
Recommended TPT Regimens
● Isoniazid daily for 6 months and Weekly Isoniazid + Rifapentine for 3
months.

Tests for TB Infection Contraindications:

● Tuberculin Skin ● Active TB disease

Test (TST) ● Acute/chronic hepatitis
● Interferon Gamma ● Concurrent hepatotoxic drugs
Release Assay ● Heavy alcohol consumption
(IGRA) ● Peripheral neuropathy
● Drug allergy
Rehabilitation in TB:
● Helps chronic TB patients regain physical and
mental function.
● Needed especially after severe disease or lung
surgery.
Surveillance:
● Monitors TB burden and effectiveness of control
measures.
● Evaluates trends in infection rates and
vaccination programs.