3. What is TB??
Definition: An airborne infectious disease caused predominantly by
Mycobacterium tuberculosis species.
First discovered in 1882 by Robert Koch.
Typically attacks the lungs but can also affect other parts of the
body.
Persons become infected when they inhale droplet nuclei that
contain tubercle bacilli and the bacilli begin to multiply in the
lungs.
It can also spread to other parts of the body via the blood stream,
the lymphatic system or through direct extension to other organs.
It is slowly spreading chronic granulomatous bacterial infection
characterized by gradual weight loss.
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5.
6. Presumptive TB
Refers to a patient who presents with symptoms or signs suggestive of TB.
Tuberculosis Case Definitions: Necessary for
Correct patient registration and reporting.
Correct choice of appropriate standard regimen.
Patient follow-up.
Cohort analysis including determining trends in the proportions of different
types of patients.
7. Classification of TB
TB cases (bacteriologically confirmed or clinically diagnosed) are classified
according to the:
Anatomical site of disease
History of previous treatment
Drug resistance
HIV status
8. Classification based on
Anatomical site of the disease
Pulmonary TB (PTB):
Any bacteriologically confirmed or clinically diagnosed case of TB involving the
lung parenchyma or the tracheobronchial tree.
Miliary TB is classified as PTB because there are lesions in the lungs.
Tuberculous intra-thoracic lymphadenopathy (mediastinal and/or hilar) or
tuberculous pleural effusion, without radiographic abnormalities in the lungs,
constitutes a case of extra-pulmonary TB.
A patient with both pulmonary and extra- pulmonary TB should be classified as a
case of PTB.
9. Extra-pulmonary TB (EP TB)
Any bacteriologically confirmed or clinically diagnosed case of TB involving
organs other than the lungs such as pleura, lymph nodes (mediastinal, hilar,
cervical etc.), larynx, meninges, abdomen, genitourinary tract, spine, bones
and joints, skin etc.
10. Classification based on previous
History
Relapse
Treatment after failure
Treatment after loss to follow up
Other previously treated
11. Classification based on Resistance
Mono-resistance
Poly-resistance
Multi-drug resistance TB (MDR)
Extensively drug resistance TB (XDR)
Rifampicin resistance (RR)
12. Classification based on HIV
status
HIV-positive TB patient
HIV-negative TB patient
HIV status unknown TB patient
14. Tools for diagnosis of TB
Sputum smear examination
Radiological tests (Chest X-ray)
Tuberculin test
Culture of TB Bacilli
Rapid molecular diagnostic test (RMDT)
FNAC, biopsy, H/P for EP TB
15.
16. Diagnosis of EP TB
CB-NAAT (GeneXpert) and Liquid Culture are the preferred diagnostic technologies
Supporting tests:
Histopathological or cytopathological examination-
Imaging studies using X-Rays, CT Scan, Ultra Sonography, of the involved region
or organ
Biochemical test, e.g. exudate.
Cytological examination of effusions, ascites, CSF fluid, etc.
Tuberculin skin test (Mantoux Test)
Interferon Gamma Release Assays (IGRA)
21. Basic principles of TB management
Prescribing an appropriate combination of drugs.
Administering the drugs for the required duration (several months).
Ensuring correct dosage to achieve the optimum therapeutic effect.
27. Rx of EP TB
TB lymph node:
If there is no noticeable improvement after 6 months of treatment then, based
on clinical judgement of the the continuation phase may be extended upto 10
months
TB meningitis:
Treatment duration is 12 months
Adjunctive steroid; prednisolone or dexamethasone tapering over 6-8 months
28. Rx of EP TB cont.
Pott’s disease:
Duration of treatment: 12 months
Indications of surgery: patients with neurological deficit, an unstable spine lesion,
and/or when they are not responding to therapy.
31. Treatment outcomes
Cured
Treatment completed
Treatment failure
Died
Lost to follow up
Transferred out
Not evaluated
Treatment success
