TB is one of the leading cause of death in India after HIV/AIDS.

2.  A specific disease caused by infection with
Mycobacterium tuberculosis, the tubercle bacillus,
which can affect almost any tissue or organ of the
body, the most common site of the disease being the
lungs.
 The bacteria that cause tuberculosis are spread from
one person to another through tiny droplets released
into the air via coughs and sneezes.

3. Class Type Description
0 No TB
exposure
Not infected
No history of exposure
Negative reaction to tuberculin skin test
1 TB exposure
No evidence of
infection
History of exposure
Negative reaction to tuberculin skin test
2 TB infection
No disease
Positive reaction to tuberculin skin test
No clinical, bacteriologic, or radiographic evidence of TB
3 TB, clinically
active
M. tuberculosis cultured (if done)
Clinical, bacteriologic, or radiographic evidence of current
disease
4 TB
Not clinically
active
History of episode(s) of TB
Positive reaction to the tuberculin skin test.
No clinical or radiographic evidence of current disease.
5 TB suspect Diagnosis pending
TB disease should be ruled in or out within 3 months

4.  There are two types of TB Based on symptoms:
latent and active.
 ACTIVE TB:
 Active TB is an illness in which the TB bacteria are rapidly
multiplying and invading different organs of the body. The
typical symptoms of active TB variably include cough,
phlegm, chest pain, weakness, weight loss, fever, chills
and sweating at night.
 LATENT TB:
 Many of those who are infected with TB do not develop
overt disease. They have no symptoms and their chest x-
ray may be normal. The only manifestation of this
encounter may be reaction to the tuberculin skin test (TST)
or interferon-gamma release assay (IGRA).

5.  There are two types of tuberculosis: the “open” or
pulmonary-positive or pulmonary tuberculosis and
“closed” or pulmonary-negative tuberculosis also called
as extra pulmonary tuberculosis.
 In the case of pulmonary tuberculosis an inflammation
developed inside the lungs that the immune system is not
able to isolate, i.e., bring under control. This enables TB
bacteria to be released through the respiratory tract (e.g.,
through coughing) and means that this type of
tuberculosis infection is contagious.
 In case of extra pulmonary tuberculosis organs that are
affected by the bacteria – most commonly the lymph
nodes, but also the bones and joints, spine, intestines,
kidneys or brain .As with the closed tuberculosis, EP
tuberculosis is not contagious.

6.  India is the country with the highest burden of TB.
The World Health Organisation (WHO) TB statistics
for India for 2016 give an estimated incidence figure
of 2.79 million cases of TB for India.
 In India, each year, approx. 2,20,000 deaths are
reported due to Tuberculosis between 2006 and
2014. This public health problem is the world's
largest tuberculosis epidemic.
 Tuberculosis is the second-most common cause of
death from infectious disease (after those due to
HIV/AIDS).

7.  Mycobacterium tuberculosis, the causative agent of
tuberculosis, is an oblong, bacillus-type bacterium
that grows and multiplies within cells which belongs
to the family Mycobacteriaceae.
 It is acid-fast strain . Acid fast stains such as Ziehl-
Neelsen, or fluorescent stains such as auramine are
used instead to identify M. tuberculosis with a
microscope. The physiology of M. tuberculosis is
highly aerobic and requires high levels of oxygen.
 Mycobacterium tuberculosis is slow-growing and
typically requires up to six weeks to form visible
colonies in laboratory cultures.

8. ZIEHL NEELSEN METHOD
AURAMIN
METHOD

9.  Over half of the cell wall of
Mycobacterium tuberculosis is
lipid, creating a protective
water-resistant shell around the bacteria.
 Mycobacterium tuberculosis
enters hosts via inhalation from the air.
After inhalation the bacteria enter
a type of white blood cell
known as a macrophage.
 Macrophages normally locate and
destroy pathogens in the body, but
Mycobacterium tuberculosis is able to live and multiply inside the
cells without being destroyed.
 The incubation period may vary from about 2 to 12 weeks.

10.  Tuberculosis is caused by bacteria that spread from
person to person through microscopic droplets
released into the air.

11.  Factors that increase the risk of the disease.
 Weakened immune system :
 A number of diseases, conditions and medications can weaken immune
system, includes:
 HIV/AIDS
 Diabetes
 Severe kidney disease
 Travelling or living in certain areas:
 The risk of contracting tuberculosis is higher for people who live in or
travel to areas that have high rates of tuberculosis and drug-resistant
tuberculosis.
 Lack of medical care.
 Substance use: Use of IV drugs or excessive alcohol weakens your
immune system and makes more vulnerable to tuberculosis.
 Tobacco use: Using tobacco greatly increases the risk of getting TB and
dying of it.

13.  A bad cough that lasts 3
weeks or longer
 Pain in the chest
 Coughing up blood or sputum
 Weakness or fatigue
 Weight loss
 No appetite
 Chills
 Fever
 Sweating at night

14.  Spinal pain
 Joint damage
 Swelling of the membranes that cover
your brain (meningitis).
 Liver or kidney problems.

15.  BLOOD TESTS:
 Blood tests may be used to confirm
or rule out latent or active tuberculosis.
 SPUTUM TESTS:
 The samples are tested
for TB bacteria.
 Sputum samples can also
be used to test for drug-resistant strains of TB
 M. tuberculosis (stained red) in sputum
 CULTURE TESTS:
 Mycobacterium tuberculosis are
called acid-fast bacilli (AFB) because
after an acid wash the bacteria retain
the colour of the stain. They can then
be seen under the microscope

16.  chest X-ray: if the germ has attacked and
caused inflammation in the lungs, an
abnormal shadow may be visible on the
chest X-rays.
 CT scan: an imaging
test to check lungs
for signs of an infection

17.  A tuberculin skin test, also known as a Mantoux test
or PPD (purified protein derivative), is
done by injecting a solution
containing a protein made from
tuberculosis bacteria just under
the top layer of skin on the
fore arm.
If the skin at the injection site
develops a raised red bump, it
indicates that the person may be infected with TB.

18.  Most common TB drugs
 Isoniazid
 Rifampin (Rifadin, Rimactane)
 Ethambutol (Myambutol)
 Pyrazinamide
 Bedaquiline (Sirturo)
 Linezolid (Zyvox)
 Active TB disease is best treated with combinations of
several antibiotics to reduce the risk of the bacteria
developing antibiotic resistance.
 First-line drugs used to treat active TB are isoniazid,
Rifadin, ethambutol ( Myambutol), and pyrazinamide.

19. Latent TB Infection Treatment Regimens
Drugs Duration Interval Minimum Doses
Isoniazid 9 months
Daily or
Twice weekly
270
76
Isoniazid 6 months
Daily or
Twice weekly
180
52
Isoniazid and
Rifapentine
3 months Once weekly 12
Rifampin 4 months Daily 120

20.  TREATMENT FOR PULMONARY TB:
 isoniazid, rifampicin, pyrazinamide, ethambutol,
and streptomycin - are recommended for the
initial 3 to 4 months.
 TREATMENT FOR EXTRA PULMONARY TB:
 Same combination of antibiotics are used .
 In case of brain TB corticosteroids such as
prednisolone for several weeks along with
antibiotics is prescribed to reduce swelling in
affected areas.

21.  The only available vaccine as of 2011 is Bacillus
Calmette-Guérin (BCG). In children it decreases
the risk of getting the infection by 20% and the
risk of infection turning into active disease by
nearly 60%.
 It is the most widely used vaccine worldwide,
with more than 90% of all children being
vaccinated. The immunity it induces decreases
after about ten years.

22.  Stay home.
 Ventilate the room.
 Cover your mouth.
 Wear a mask
 Finish your entire course of medication
 Vaccinations

23.  www.medicinenet.com
 www.wedmd.com
 www.nationaljewish.org
 www.ncbi.nlm.nih.gov
 www.sciencedirect.com
 www.mayoclinic.com
 Ananthanarayana textbook page no: 351-
363