2. PREVALENCE:
• According to WHO, there are at least 8 million TB cases
worldwide and 3 million deaths annually
• Biggest killer in the world as a single pathogen afflicting
mostly children and adults in their productive years
• In 2002, 6th among the 10 leading causes of mortality in
the Philippines and one of the 10 leading causes of
morbidity.
• About 75 filipinos die of TB everyday
• WHO classified the Philippines as one of the top 22 high
burden countries
• TB cases were about 3x more common among males
than females
• Common among 30-59 age bracket
3. Pathology/transmission:• Disease produced by infection with Mycobacterium tuberculosis
• Infection is almost always acquired by inhalation of infectious
droplets containing viable tubercle bacilli
• In areas where bovine TB is prevalent, infection can also be
acquired through ingestion of contaminated milk
• In rare instances, TB infection can be though direct inoculation
usually through the skin of the hand
• Infectious droplets can be produced by coughing, sneezing,
talking and singing
• Infectious droplets are produced mainly by patients with
pulmonary TB especially those who are positive by sputum
microscopy
• Majority of TB cases (80% to 85%) manifest the pulmonary type of
disease (PTB)
4. Diagnostic methods:
1. Tuberculin skin testing
• Method of demonstrating infection with M. Tuberculosis at sometime in
the past, whether recent or remote especially in children
• As screening test to identify children who will benefit from INH
preventive therapy.
• Mantoux test is the standard and recommended method of doing test
• The test is based on a delayed hypersensitivity reaction to
intracutaneously injected antigens or tubercle bacilli composed of
tuberculoproteins (old tuberculin and PPD)
• Administered by injecting 0.1 ml. Of biological on the inner surface of
the forearm approx. 3-4 inches below the elbow joint.
• Positive test is defined as an area of skin induration measuring 10mm
or more.
• Reading shall be done between 48-72 hrs after injection.
5. Diagnostic methods:
2. Chest x-ray- not used for TB diagnosis alone
• A negative chest x-ray does not rule out the presence of primary TB
• No diagnostic x-ray changes in primary TB as hilar node enlargement
may not be easily differentiated from blood vessel and bronchial
markings.
3. Bacteriological examination
• A. Sputum smear culture
• B. Sputum smear microscopy
• Primary diagnostic tool
• Demonstration of acid fast bacilli under the microscope and they
appear pinkish to red in color, rod-shape, slender, straight, curved,
beaded at times, arranged singly, in pairs or in clumps.
• Essential criterion in the definite diagnosis of active tuberculosis.
6. Diagnostic methods:
• 4. Gene expert (Xpert MTB/RIF)
• -Molecular test for TB by detecting the presence of TB bacteria, as well as
testing for the drug resistance for Rifampicin
• - Chemical test to look for Mycobacterium in a sample of sputum
• - The sputum sample is fed into a machine and the machine looks for the
DNA specific for TB bacterium and automatically multiply it (polymerase
chain reaction technique)
• - Machine also looks for the structure of the genes to detect if the bacterium
develop resistance to rifampicin
• - Usually takes 2 hours
• -Tells us whether or not a person has TB and whether that person can be
treated with rifampicin
• - 98% more sensitive than other tests
• -more expensive
7. Infectiousness of tb cases:
• Sputum smear- positive PTB cases have higher
bacillary load and are able to release a bigger
number of organisms in the air
• Smear (+ ) cases are the most potent sources of
new infections in other people (about 65%)
• Patients with negative sputum smears can also
transmit infection (about 17% to 20%) more
common among children, elderly and HIV(+).
However, this has low risk mortality.
9. Prevention:
• BCG vaccination – introduction of 0.1 ml. Suspension of
live attenuated bovine tubercle bacilli which is capable
of producing immunity against TB in an individual
• Plays a major role in preventing morbidity and mortality
among developing countries
• Given as soon as possible after birth
• Protects infants from serious complications of TB
• Overall protective effect at 50%, 64% against TB
meningitis and 78% protection against disseminated TB.
10. Symptoms of tb:
• Cough for two or more weeks with or without
• - Fever
• - Chest and/or back pain not referable to any muskulo-
• Skeletal disorders
• -Hemoptysis or recurrent blood-streaked sputum
• -Significant weight loss
• -Other symptoms, such as sweating, fatigue, body
• Malaise, shortness of breath
11. Strategies in tb control:
A. 1987 – short-course chemotherapy (SCC) was adopted nationwide
• Highlighted the use of Rifampicin, 2HRZ/4HR. A fourth drug-
Streptomycin or Ethambutol-was also being used for the intensive
phase.
• To ensure treatment compliance, the various drugs were packaged in
blister packs.
B. DOT (Directly Observed Treatment)
• Method developed to ensure treatment compliance by providing
treatment constant and motivational supervision to TB patients. It
works by having a responsible person, referred to as treatment
partner, watch TB patient take medicines everyday during the whole
course of treatment.
• C. TB Diagnostic Committee
• -Review sputum negatives with chest x-ray findings suggestive of PTB,
evaluates and make appropriate recommendations
12. Strategies in tb control:
D. PPMD (Public-Private mix DOTS)
• Synchronize the management of TB in public and private sectors
E. Fixed-dose combination
• Two or more first line Anti-tb drugs are combined in one tablet.
• Simplifies treatment, prevents development of drug resistance
F. DOT-Ch ( DOT in children)
• Implemented in 2006 to reach out to children 0-14 years old infected
with TB.
13. RECOMMENDED CATEGORY OF
TREATMENT REGIMEN:
Category Type of TB Patient Intensive Phase Continuation Phase
I New smear-positive PTB, new
smear-negative PTB with
extensive parenchymal lesions
on CXR as assessed by the
TBDC and severe concomitant
HIV disease
2HRZE 4HR
II Treatment failure, Relapse, RAD 2HRZES/HRZE 5HRE
III New smear-negative PTB with
minimal parenchymal lesions on
CXR as assessed by the TBDC 2HRZE 4HR
IV Chronic(still-smear positive after
supervised re treatment)
Refer to
specialized
facility
