TB is a most deadliest disease from ancient time to till now.

1. Presenter: Dr.Darshna Sarvaiya
1st year resident
Community Medicine
Tuesday, June 21, 2022
TB- An Overview
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2.  To enumerate the important milestones in the history of Tuberculosis
 To state the burden of Tuberculosis in India & globally
 To explain the Natural History of Disease
 To explain the different Epidemiological Indices
 To describe the interventions to control Tuberculosis (Up to Diagnosis)
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3. Chronic granulomatous disease
Causative agent : 1) Human : mycobacterium tuberculosis
2) Animal : mycobacterium bovis
Pulmonary Tuberculosis ( 85 % )
Extra – pulmonary Tuberculosis ( 15 % )
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5. Hippocrates( 460 B.C. )
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6. ARISTOTLE( 384 B.C.)
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8. Robert Koch – march 24,1882
Discovery of causative agent
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9. Von pirquet – 1907
Discovery of tuberculin test
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10. BCG vaccine – ( 1906 – 1921 )
Invention of BCG vaccine
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11.  Consumption
 Phthisis pulmonaries
 Scrofula
 King’s evil
 king’s disease
 Rajayakshma
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14. Amitabh Bachchan.
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15. René Laennec
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16. Kamala Nehru
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17. Adolf Hitler
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18. Muhammad Ali Jinnah
the founder of Pakistan
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19. Kahlil Gibran
World famous Lebanese -American
artist and poet
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20. Desmond Tutu
human and social rights activist
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21.  World wide public health problem  top 10 causes of death worldwide
 10.0 million cases – diagnose with TB
 6.7million case - notified
 5.8 million men , 3.2 million women , 1 million child
 Only 6% of global cases were in the WHO European Region (3%) and WHO Region of the Americas
(3%)
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24.  5,58,000  MDR –TB cases
 1,39,114  enrolled for treatment
 Three countries accounted for almost half of the world’s case MDR/RR-TB:
India , china , Russian federation
 The severity of national epidemics varies widely among countries.
In 2017 – fewer than 10 new cases per lac population in high income country
150 – 400 cases per lac population in most of 30 high TB burden
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25.  Treatment outcome :
 82% TB , 77 % HIV associated TB , 55 % MDR /RR-TB , 34 % XDR –TB
 The actual burden of paediatric TB is not known due to diagnostic difficulties
 Assumed that about 10 % of total TB load found in children
 Globally , 1 million cases of paediatric TB cases every year  > 1,00,000
deaths
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26.  India is the highest TB burden country in the world in
terms of absolute number of incident cases that occur
each year .
 Accounts for 1/4th of the estimated global incident TB
cases in 2017.
 Each year approx. 2,2o,ooo deaths
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27.  TB kills more women in reproductive age group
 Create more orphans than any other infectious disease
 children of the TB patient either leave the school or take up employment to
support their families
 Vast majority -> loss of life rather than morbidity
 Poor living condition , malnutrition , small housing , overcrowding
 HIV  increase susceptibility
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28. Natural history of disease
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29.  Mycobacterium Tuberculosis , mycobacterium bovis
 M. Tuberculosis complex : - M. africanum
- M. bovis
- M . Canetti
- M . microti
 Atypical Mycobacteria :
1) photo chromogens : M. kansasii
2) non- scotochromogen : M. intercellulare
3) scotochromogen : M. sacrofulaceum
4) rapid growers : M. fortuitum

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30.  Two sources : 1) human & 2) bovine
 1) Human source :
- Most common source of infection
- TB cases whose sputum is +ve for tubercle bacilli , who has not received treatment or not Treated fully
 2) Bovine source :
- Infected milk
- Not much problem in the country  boiling of the milk before consumption
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31.  Pts. are infective as long as they remain untreated
 Effective antimicrobial treatment reduces infectivity by 90% within 48 hours
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32.  Age : affect all the age group ( 2 % in 0- 14 years , 20 % in 15-24 years )
 Sex : more prevalent in male
 Hereditary : No
 Nutrition : malnutrition predispose to TB
 Immunity : no inherited
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33.  Poor socioeconomic status : -
- Over crowding
- Decrease hygiene & sanitary conditions
- Nutrition deficiency
- Poor quality of life
 Exposure to the silica : silicosis
 Hormonal factor : D.M.
corticosteroid
 HIV / AIDS
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34.  Reservoirs :
- human patients
- infected cattle
 Mode of spread :
1) Man to man : I) Micro-droplet ( airborne )
( coughing , spitting , sneezing , talking etc. .. )
II ) Dried sputum ( may survive dried sputum for months
without sun exposure )
2) Cattle to man : I ) drinking infected raw milk
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35.  Ranges from 3 to 6 weeks
 Depend upon closeness of contact
 Extent of disease
 Sputum positivity of the source case
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37.  Incidence :
- No. of new cases and recurrent ( relapse ) episodes of TB occurring in a given year
 Prevalence :
- No. of TB cases ( all forms) at a given point in time
 Mortality :
- No. of deaths caused by TB in HIV-negative people
 Case-fatality rate :
- Risk of death from TB among people with active TB disease
 Case notification rate :
- New or recurrent episodes of TB notified to WHO for a given year ,expressed per 1 lac population
 Case detection rate :
- No. of notification of new and relapse cases in a year divided by the estimated incidence of such
cases in a same year
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38.  Prevalence of drug resistant cases :
- prevalence of patient excreting tubercle bacilli resistant to anti – TB drug
 Prevalence of infection :
- percentage of individual who shows a positive reaction to the standard
tuberculin test
 Incidence of infection : ( annual infection rate ) :
% of population under study who will be newly infected by M. TB among
the non-infected of the preceding survey during the course of one year.
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39. A) Case definition :
a) Bacteriologically confirmed TB case
b) Clinically diagnosed TB case
Classify according to :
1) Anatomical site : pulmonary & extra pulmonary
2) History of previous treatment :
- Previously treated pt.- 1 or more month of Tx
- Relapse : person who returns smear +ve having previously treated and declare cure
- Tx after failure patients : person with smear +ve treated and again become +ve at end of their Tx
- Tx after loss to follow up : previously Tx for TB & declare loss to follow up at the end of Tx
- Patient with unknown previous TB treatment : do not fit into any of the category
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40. 3) Based on drug resistance :
- Mono resistance : resistance to one first –line anti –TB drugs only
- Poly drug resistance : > 1 first line anti TB drug
- Multi drug resistance: both isoniazid & rifampicin
- Extensive drug resistance : any fluoroquinolones & one of three second line inj. drugs
- Rifampicin resistance : without resistance to any other drug
- Total drug resistance : resistance to the all the first & second line anti-TB drug
4) Based on HIV status :
- HIV negative TB patient
- HIV status unknown by TB patient
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41. B) Treatment outcome
- Cured : bacteriologically confirmed TB  smear or culture –ve
- Tx completed : completed Tx without evidence of failure
- Tx failed : smear or culture +ve at 5 month or later during Tx
- Died : dies for any reason before or during TB treatment
- lost to follow –up : did not start treatment
- Not evaluated : no Tx outcome are assigned
- Treatment success cohort : cured & Tx completed
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42.  TB control means reduction in the prevalence and incidence of the disease in the community
 The WHO define that tuberculosis “ control” is said to be achieved when the prevalence of
natural infection in the age group 0-14 year is of the order of 1% . This is about 40 % in India .
 Control measure consist of :
1) Curative component
2) Preventive component
 Most powerful tool in containing the disease in Case finding & treatment
 Case finding : early detection of sputum +ve cases
 Case definition : WHO define – a pt. whose sputum is +ve for TB bacilli Tuesday, June 21, 2022
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43.  Live attenuated , freeze dried powder
 Common strain used – Danish 1331 produced at guindy , tamilnadu , India
 Reconstituted with sterile water
 Induced cell mediated immunity
 Primary infection is not prevented
 Duration of protection – 15 to 20 years
 Administration at birth provides – early protection
ensure compliance
convenient to implement
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44. Papule at site of injection
Increase size with diameter of 4-8 mm ( 5-6 weeks )
Breaks into shallow ulcer with crust
Healing occurs ( 6- 12 weeks )
Permanent tiny round 4-8 mm diameter
Phenomenon after vaccination
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45.  Ipsilateral axillary or cervical lymphadenopathy
 Disseminated infection
 Osteomyelitis
 Sacrofuloderma
 Immunodeficiency ( HIV , leukaemia , lymphoma )
 Generalized eczema
 Infective dermatosis
 Hypogammaglobulinemia
 Contraindication
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