Tuberculosis Tuberculosis is a serious chronic pulmonary and systemic disease caused most often by M. tuberculosis. The source of transmission is humans with active tuberculosis who release mycobacteria present in sputum. Oropharyngeal and intestinal tuberculosis contracted by drinking milk contaminated with M. bovis is rare in countries where milk is routinely pasteurized, but it is still seen in countries that have tuberculous dairy cows and unpasteurized milk. Epidemiology According to the World Health Organization (WHO), tuberculosis is estimated to affect more than a billion individuals worldwide, with 8.7 million new cases and 1.4 million deaths each year. But there is significant progress toward WHO targets for reduction in cases of tuberculosis. Globally, between 2010 and 2011, new cases of tuberculosis fell at a rate of 2.2%, and mortality has decreased by 41% since 1990. Infection with HIV makes people susceptible to rapidly progressive tuberculosis; 13% of the people who developed tuberculosis in 2011 were HIV-positive. In 2011 there were 10,528 new cases of tuberculosis in the United States, 62% of which occurred in foreign-born people. Tuberculosis flourishes wherever there is poverty, crowding, and chronic debilitating illness. In the United States, tuberculosis is mainly a disease of older adults, immigrants from high-burden countries, racial and ethnic minorities, and people with AIDS. Certain disease states also increase the risk: diabetes mellitus, Hodgkin lymphoma, chronic lung disease (particularly silicosis), chronic renal failure, malnutrition, alcoholism, and immunosuppression. It is important that infection with M. tuberculosis be differentiated from active disease. Most infections are acquired by person-to-person transmission of airborne organisms from an active case to a susceptible host. In most healthy people primary tuberculosis is asymptomatic, although it may cause fever and pleural effusion. Generally, the only evidence of infection, if any remains, is a tiny, fibrocalcific pulmonary nodule at the site of the infection. Viable organisms may remain dormant in such lesions for decades. If immune defenses are lowered, the infection may be reactivated, producing communicable and potentially life-threatening disease. Causative Organism Tubercle bacillus or Koch’s bacillus (named after discovery of the organism by Robert Koch in 1882) called Mycobacterium tuberculosis causes tuberculosis in the lungs and other tissues of the human body. The organism is a strict aerobe and thrives best in tissues with high oxygen tension such as in the apex of the lung. Out of various pathogenic strains for human disease included in Mycobacterium tuberculosis complex, currently most common is M. tuberculosis hominis (human strain), while M. tuberculosis bovis (bovine strain) used to be common pathogen to human beings during the era of consumption of unpasteurised milk but presently constitutes a small number of human cases.

1. Introduction to
Tuberculosis
(TB) Gopal Khodve
Ph.D. Research Scholar
Pharmacology & Toxicology
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2. This Slide Deck Covers the
Following Topics about
Tuberculosis (TB):
1. What is Tuberculosis (TB)?
2. How TB spreads
3. Latent TB Infection and TB Disease
4. Risk Factors
5. TB Testing
6. Treatment
7. TB Elimination
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3. What is Tuberculosis
(TB)?

4. Tuberculosis (TB)
• TB is spread from person to person through the air.
• TB is a disease caused by bacteria called Mycobacterium
tuberculosis. The bacteria, or TB germs, usually attack the
lungs. However, TB germs can attack any part of the body such
as the kidney, spine, or brain.
• Pulmonary TB is TB in the lungs.
• Extrapulmonary TB is TB in places other than the lungs, such as the
kidney, spine, or brain.
• Not everyone infected with TB germs becomes sick.
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5. Causative Organism
• Tubercle bacillus or Koch’s bacillus (discovery of the organism by Robert
Koch in 1882) called Mycobacterium tuberculosis causes tuberculosis in the
lungs and other tissues of the human body.
• various pathogenic strains for human disease included in Mycobacterium
tuberculosis complex, currently most common is M. tuberculosis hominis
(human strain), while M. tuberculosis bovis used to be common pathogen to
human
• Other less common strains included in the complex are M. africanum, M.
microti, M. pinnipedii and M. canettii. A non-pathogenic strain, M.
smegmatis, is found in the smegma and as contaminant in the urine of both
men and women.
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6. TB is the World’s Top Cause of
Death due to Infectious Disease
• TB is not a disease of the past.
• Too many people in the United States still suffer from TB.
• In 2019, there were 8,976 cases of TB disease in the United
States, which is the lowest number on record.
• TB is a serious disease that can cause a person to become
very sick if not treated with medicine.
• Treatments are available to prevent and cure TB.
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7. ATYPICAL MYCOBACTERIA (NON-TUBERCULOUS MYCOBACTERIA).
• The term atypical mycobacteria or non-tuberculous mycobacteria is used
for mycobacterial species other than M. tuberculosis complex and M.
leprae.
• Non-tuberculous mycobacteria are widely distributed in the environment
and are, therefore, also called as environmental mycobacteria. They too
are acid fast.
• Occasionally, human tuberculosis may be caused by atypical mycobacteria
which are non-pathogenic to guinea pigs and resistant to usual anti-
tubercular drug.
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8. How TB Spreads

9. MODE OF TRANSMISSION
• Inhalation
• Ingestion
• Inoculation
• Transplacental route
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10. TUBERCLULOSIS 10
How actual transmission happen
of micro bacterium tuberculosis ?

11. TB Spreads
Through the Air
TB spreads from person
to person when someone
with contagious TB
coughs, speaks, or sings.
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12. TYPES OF TUBERCULOSIS
• A. Primary tuberculosis
• B. Secondary tuberculosis
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13. Primary Tuberculosis
• The first contact of the Mycobacterium organism with a host leads to
manifestations known as primary tuberculosis.
• This primary TB is usually localized to the middle portion of the
lungs, and this is known as the Ghon focus of primary TB.
• In most infected individuals, the Ghon focus enters a state of latency.
This state is known as latent tuberculosis.
• The infection of an individual who has not been previously infected or
immunised is called primary tuberculosis or Ghon’s complex or childhood
tuberculosis.
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14. Secondary tuberculosis
• Secondary tuberculosis usually occurs because of reactivation of
latent tuberculosis infection.
• The lesions of secondary tuberculosis are in the lung apices. A
smaller proportion of people who develop secondary tuberculosis do
so after getting infected a second time (re-infection).
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15. TUBERCLULOSIS 15
ATYPICAL MYCOBACTERIA (NON-TUBERCULOUS MYCOBACTERIA).
• The term atypical mycobacteria or non-tuberculous mycobacteria is used
for mycobacterial species other than M. tuberculosis complex and M.
leprae.
• Non-tuberculous mycobacteria are widely distributed in the environment
and are, therefore, also called as environmental mycobacteria. They too
are acid fast.
• Occasionally, human tuberculosis may be caused by atypical mycobacteria
which are non-pathogenic to guinea pigs and resistant to usual anti-
tubercular drug.

16. TB is NOT Spread by
Sharing
toothbrushes
From Saliva
Shaking
someone’s hand
Touching bed
linens or toilets
Sharing food,
drink, or utensils
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69. Latent TB Infection
and TB Disease

70. Two TB-Related Conditions
Latent TB Infection (LTBI)
• People with latent TB infection
• Do not feel sick, do not have symptoms, and cannot spread
TB germs to others.
• Can have latent TB infection for years.
• Have a small amount of TB germs in their bodies that are
alive but inactive.
• Latent TB infection can develop into TB disease.
TB Disease
• If TB germs become active and multiply, latent TB infection can
turn into TB disease.
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71. Not Everyone Who Is Infected with TB Becomes Sick
Person with
Latent TB Infection
Person with
TB Disease
Has a small amount of TB germs in
his/her body that are alive but inactive
Has a large amount of active TB
germs in his/her body
Cannot spread TB germs to others May spread TB germs to others
Does not feel sick, but may become sick if
the germs become active in his/her body
May feel sick and may have symptoms
such as a cough, fever, and/or weight loss
Usually has a positive TB skin test or TB
blood test result indicating TB infection
Usually has a positive TB skin test or TB
blood test result indicating TB infection
Should consider treatment for latent TB
infection to prevent TB disease
Needs treatment for TB disease
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72. Untreated Latent TB Infection
Can Lead to TB Disease
• If the immune system can’t stop TB germs from growing,
they become active (multiplying in your body); this is called
TB disease.
• Latent TB infection treatment is 90% effective in preventing
the development of TB disease.
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73. Tuberculosis (TB) Disease: Only the Tip
of the Iceburg
There are two types of TB conditions: latent TB infection and TB disease.
People with TB disease are sick from active TB germs. They usually have
symptoms and may spread TB germs to others.
People with latent TB infection do not feel sick, do not have symptoms, and cannot
spread TB germs to others.
But, if their TB germs become active, they can develop TB disease.
Millions of people in the U.S. have latent TB infection Without treatment, they are
at risk for developing TB disease.
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74. Possible TB Disease Symptoms
Night Sweats Fever Chills
Weakness
or fatigue
Weight loss No appetite
Cough lasting
longer than
3 weeks
Pain in
the chest
Coughing up
blood or sputum
(phlegm from inside
the lungs)
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75. People with TB Disease Are Sick
and Can Spread TB Germs
• TB disease is a serious condition and can lead to death if
not treated.
• TB disease can almost always be treated and cured with medicine.
• A person with TB disease typically requires the following:
X-rays 180 days of medicine
Lab tests Follow up and testing of close contacts
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76. Public Health Workers are
Responsible for Finding TB Contacts
• A TB contact is persons exposed to someone with contagious
TB disease
• Contacts can include family members, roommates or
housemates, close friends, coworkers, classmates, and others
• People with TB disease can spread TB germs to those around
them
• The local health department will conduct a contact
investigation by following up and testing those who have been
close to someone with TB
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77. Risk Factors

78. Who Is at Higher Risk For Becoming
Infected with TB Germs?
Anyone can get TB
Some people have a higher risk of getting infected
with TB:
• People who have contact with someone who has infectious TB disease
• People who were born in or who frequently travel to countries where TB
disease is common, including Mexico, the Philippines, Vietnam, India,
China, Haiti, Guatemala, and other countries with high rates of TB
• Health care workers and others who work or live in places at high risk for
TB transmission, such as homeless shelters, jails, and nursing homes
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79. Reported TB Cases by Race/Ethnicity,*
* All races are non-Hispanic; multiple race indicates two or more races reported for a person but does not include persons of Hispanic/Latino origin.
† Excludes unknown/missing values 79
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80. Who Is at Risk for Developing TB Disease?
People at high risk for developing TB disease generally fall into two categories:
• Those who have been recently infected with TB germs
• Those with medical conditions that weaken the immune system, such as:
HIV infection Substance abuse Specialized treatment for rheumatoid
arthritis or Crohn’s disease
Organ transplants Severe kidney
disease
Head or neck cancer Diabetes Medical treatments such
as corticosteroids
Silicosis Low body weight
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81. TB Testing

82. Two Types of Tests Can Be Used
to Diagnose TB Infection
• TB blood test or
• TB skin test
OR
If either test is positive,
further tests are done to
confirm a diagnosis of
TB disease:
• Medical examination
• Chest x-ray
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83. TB Blood Test
Blood is drawn and sent to a lab for analysis.
• Positive blood test: A person likely has been infected with
TB germs. Additional tests are needed to determine if the
person has latent TB infection or TB disease.
• Negative blood test: A person’s blood did not react to the test
and latent TB infection or TB disease is not likely.
The TB blood test is also known as an Interferon-Gamma Release
Assay (IGRA).
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84. TB Skin Test
The TB skin test, also called the Mantoux tuberculin skin test
(TST), requires two visits with a healthcare provider.
On the first visit, a test is placed. On the second visit, the test is read.
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85. People Vaccinated with BCG
Can Still Get TB Disease
Bacille Calmette-Guérin (BCG)
• Is a vaccine for TB disease.
• Is often given to infants and small children in countries
where TB is more common.
• Protects against severe forms of TB in children.
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86. TB Blood Tests Are Preferred for People
Who have Received the TB Vaccine (BCG)
• The TB vaccine (BCG) may make a TB skin test hard
to interpret.
• The TB vaccine does not affect TB blood tests results.
• TB blood tests give more accurate results in people
who have received the TB vaccine.
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87. Treatment

88. Treatment for Latent TB Infection Can
Prevent the Development of TB Disease
• TB germs in the body of someone with latent TB infection
are inactive, so they will not feel sick.
• As long as TB germs remain in the body, they can become active,
multiply, and make someone sick with TB disease.
• People with latent TB infection
• Should take medicine to prevent the development of TB disease,
even though they don’t feel sick.
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89. Treatment for Latent TB Infection
Compared to treatment for TB disease, latent TB infection treatment
Is shorter.
Is less costly.
Has fewer side effects.
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90. Treating TB Disease Protects Your
Health and the Health of Others
• People with TB disease can pass TB germs to their family,
friends, and others around them if they don’t take TB
medicine the right way.
• People with TB disease need to take several medicines when
they start treatment.
• After taking TB medicine for several weeks, a doctor will be
able to tell TB patients when they are no longer able to
spread TB germs to others.
• Most people take TB medicine for at least 6 months to
be cured.
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91. TB Elimination

92. goal,
targets,
mileston
es
92
Vision:
A world free of TB
Zero TB deaths,
Zero TB disease, and Zero
TB suffering
Goal:
End the Global TB
epidemic
Vision, goal, targets, milestones

93. Health Care Providers and
Communities Need to “Think TB!”
Protect the health and well-being of community members
at higher risk for TB:
• Know who is most at risk for TB
• Recognize the signs and symptoms of TB
• Test and treat patients who are at high risk for TB
• Be aware of latest TB research and shortest treatment
options
• Encourage conversations about TB and how it affects the
community to reduce stigma
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94. Key
Partners
in TB
Elimination
• Health care workers in doctors’
offices and hospitals, community
health centers, and academic
institutions
• State and local health
departments
• Communities at higher risk for TB
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95. Resources
CDC TB website:
www.cdc.gov/tb/
State & Local TB Control Offices:
www.cdc.gov/tb/links/tboffices.htm
Find TB Resources:
https://findtbresources.cdc.gov
Facebook:
www.facebook.com/CDCTB/
Twitter:
www.twitter.com/cdc_tb
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. 95
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