3rd year BAMS syllabus topic

1. TUBERCULOSIS
Dr. Jasminkumar Viramgami
Reader & H.O.D.,
Dept. of Swasthavritta,
Govt. Akhandanand Ayurved College, Ahmedabad, Gujarat

2. Introduction
• An infectious disease
• caused by M. tuberculosis.
• primarily affects lungs and causes pulmonary
tuberculosis.
• chronic with varying clinical manifestations.
• also affects animals, known as "bovine
tuberculosis", sometimes communicated to
man.

3. Problem statement
• TB is one of the top 10 causes of death
worldwide.
• 1/3 of the global population asymptomatically
infected with TB, of whom 5-10 % will develop
clinical disease during their life.
• India is the highest TB burden country (Nearly
20% of global) in the world.
• 2 out of every 5 Indians infected.
• infectious pulmonary TB patient can infect 10-
15 persons in a year.

6. Agent factor
Agent: M. Tuberculosis is a intra-cellular parasite.
• Strains = human and bovine.
• The human strain responsible for majority of cases
• bovine strain affects mainly cattle and animals.
• It grows slowly. can’t tolerate heat. can live in
humid or dry or cold surroundings.
Communicability : patients infective as long as
untreated.

7. Source of infection
two sources -human and bovine.
human source- most common.
• human case whose sputum is positive and who
has either received no treatment or has not
been treated fully.
• Such sources can discharge the bacilli in their
sputum for years.
bovine source- usually infected milk.
• It is no problem in India because of the practice
of boiling milk.

8. Host factors
Age : affects all ages.
• in India more in adults than in children.
• It affects adults in the most productive age
group (15-54 years). More than 80 %
Sex : more in males.
Nutrition: malnutrition influence to TB
Immunity : no inherited immunity against TB.
• acquired as a result of natural infection or BCG
vaccination.

9. Social factors
include many non-medical factors such as
• poor quality of life,
• poor housing, and overcrowding,
• population explosion,
• under nutrition,
• lack of education,
• large families,
• early marriages,
• lack of awareness of causes of illness etc.
these factors are interrelated and contribute to the
occurrence and spread of TB.

10. Mode of transmission
transmitted mainly by-
• droplet infection and droplet nuclei
generated by sputum positive patients with
pulmonary tuberculosis.
• It is not transmitted by fomites, such as
dishes and other articles used by the patients.

11. Incubation period
• from receipt of infection to the development of
a positive tuberculin test
• ranges from 3 to 6 weeks
• the IP may be weeks, months or years.
• development of disease depends upon various
factors

12. Common Symptoms of TB Disease
• Productive Cough
(2-3 weeks or more)
• Hemoptysis
• Chest pains
• Fever- evening
• Night sweats
• Feeling weak and tired
• Losing weight
• Decreased or no appetite
• Tachycardia
 If you have TB outside the
lungs, you may have other
symptoms

14. Types
• Pulmonary
• Extra-pulmonary

16. Milliary Tuberculosis
acute milliary tuberculosis

18. The control of tuberculosis
The control measures consist of a
• curative component - case finding and
treatment;
• preventive component - BCG vaccination.
first step is early detection of sputum positive
cases.

20. Prevention
Finding patients earlier
Treatment and management of patients
Prevention with medicines
The systemic organization of prevention

21. Case-finding tools
Target group:
• majority of pulmonary TB patients have one or
more symptoms referable to chest,
• such as persistent cough and fever.
• The chest symptoms develop early.
• This is the most fertile group for case finding.

22. Investigations
sputum examination- sputum AFB smear by direct
microscopy.
• 3 sputum specimens, collected early in the
morning
Sputum culture- second in a case-finding.
• necessary for sensitivity tests and monitoring
drug treatment.
Chest x-ray- necessary as additional criteria
• for the diagnosis of pulmonary TB when only
one sputum smear is positive out of three

23. Anti TB drugs
There are now 12 or 13 drugs active against TB,
of which, 6 are considered to be essential.
Classified into two groups bactericidal and
bacteriostatic.
• bactericidal = kill the bacilli drugs
• bacteriostatic = inhibit the multiplication of
the bacilli and lead to their destruction by the
immune mechanism of the host.

24. • Bactericidal drugs: rifampicin (rmp), inh,
streptomycin, pyrazinamide
• Bacteriostatic drugs: ethambutol,
thioacetazone
• The second line drugs: fluoroquinolones
(ciprofloxacin, ofloxacin, levofloxacin,
moxifloxacin and gatifloxacin),
• ethionamide, capreomycin, kanamycin and
amikacin. Cycloserine, macrolides

25. BCG vaccination
• It induces a benign, artificial infection
• which stimulate an acquired resistance
• and thus reduce morbidity and mortality from
primary TB.
• BCG is the widely used live bacterial vaccine.
• live bacteria derived from attenuated bovine
strain.

27. • Dose is 0.1 mg in 0.1 ml
volume.
• given very early in infancy
either at birth or at 6 wk
age.
• injected Intra-dermally
using tuberculin syringe
just above the insertion of
deltoid muscle.
• A satisfactory injection
should produce a wheal of
5mm.

28. Role of hospitals
some patients will be needing hospitalization.
The main indications for hospitalization are -
• emergencies such as massive haemoptysis and
spontaneous pneurnothorex
• surgical treatment
• management of serious types of tuberculosis
such as meningeal tuberculosis
• certain social indications, such as when there
is no one to look after the patient at home.

29. Rehabilitation
Aim: Treating patients without interfering with
their normal work and life.
Who needs Rehabilitation?
• who are chronically ill and are still excreting
tubercle bacilli.
• who had lung resection
• to suit their physical and mental abilities.

30. • In 1882 Dr. Robert Koch discovered the cause
of TB, the TB bacillus on March 24.

31. World TB Day, 24 March 2018 Theme
• All can be leaders of effort to end TB in their
own work or terrain

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THANK YOU
Dr. J M Viramgami, HOD Swasthavritta,
GAAC