This document summarizes tuberculosis (TB), including its cause, affected organs, history, epidemiology, diagnosis, treatment, and prevention. Key points include: - TB is caused by the bacterium Mycobacterium tuberculosis, which most commonly affects the lungs. - TB has been documented as far back as 5000 BC in ancient Egypt and China. Major advances in understanding and treating TB came in the late 19th/early 20th centuries. - India has the highest global TB burden, with over 2 million new cases annually. Diagnosis involves sputum microscopy and culture, while treatment requires a multi-drug regimen over 6-24 months. - Prevention involves the BCG vaccine and identifying latent

1. TUBERCULOSIS
Dr. Sushrit A. Neelopant
Assistant Professor,
Department of Community Medicine
RIMS, Raichur

2. • Cause- M. Tuberculosis
• Organs-
– Lungs
– Intestine, meninges, bones, joints, LN, skin
– Humans, Cattle

3. • 5000BC : Evidence of TB
• Neolithic age : Evidence of TB
• Egyptian mummys : Bones & Joints TB
• Ancient Chinese Med. Lit. : TB called – Lao-ping
• Rigveda (2000BC) : Kshaya or Yakshma
• Susruta : Describes disease
- Difficult to cure
• Hippocrates (460-377BC) : Attention to TB Case
- Waste of time
TB Patients – Burden to nation

4. • In England (11th to 12th centuries):
 TB known as – King’s Evil
 Trt. for TB : King Edward – Feet touching,
– Blessings
: Queen Anne
• Franciscus sylvius (1614–1672 AD):
 Word used – Tubercle
 Tubercles Seen – Lungs of patients

5. • Gaspard Laurent Bayle (1774 – 1816 AD):
Word first time used : Tuberculosis
• Robert Koch (1882 ) : Discovery of TB bacilli
• Roentgen (1895) : X-ray
• Calmette & Guerin (1924) : BCG Vaccine

6. • Jesus Christ
• Theodore Laennaec
• Ramanujan
• Kamala Nehru
• Kumar Gandharva
• Jinna
• Nelson Mandela etc.

7. • 1/3- affected
• 5-10% - will develop TB
• New cases % deaths- developing countries
• 2013- 9M- 6.1M reported to WHO
• Treatment success rate- 86%
• 2014-
– Incidence- 176/L
– Prevalence- 227/L
– Mortality- 21/L

8. • 39% of global burden- SEAR
• 24% - India
• 3.4M- India, Bangladesh, Indonesia, Myanmar, Thailand
• Ped. TB- 10%

9. • Highest TB burden
• 2015-
– Prev- 195/ L
– Incidence- 167/ L
– Mortality- 17/ L

10. • Incidence
• Prevalence
• Mortality from TB
• Case fatality rate
• Case notification rate
• Case detection rate
• Prevalence of DR cases
• Prevalence of infection
• Incidence of infection

11. • Bacteriologically confirmed TB
• Clinically diagnosed TB

12. • Anatomical site- Pulm., extra pulm.
• History of prev. Rx-
– New pt.,
– prev. Rx pt- Relapse, Ta Failure, Ta Loss to Follow up,
other prev. Rx, Pt.s with unknown prev. TB Rx
• Drug resistance
– Mono
– Poly – other than I, R
– Multi – both I, R
– Extensive – MDR + FQ + Inj- C, K, A
– Rif. Res.

13. • Cured –
• Treatment completed-
• Treatment failed –
• Died-
• Lost to follow-up-
• Not evaluated -
• Treatment success -

14. Natural history
1. Agent factors
• Agent: Mycobacterium tubercle bacilli
• Commonly known as- Koch’s Bacillus or tubercle bacillus
or acid fast bacillus.
• Discovered by Dr. Robert Koch on 24th March in 1882.
(World TB day)
• Wells in 1934 demonstrated a plausible mechanism of
airborne spread.

15. • Facultative intracellular parasite
• Gram positive, acid fast bacilli
• Straight or slightly curved, Thick cell wall
• Measures 0.5μm by 3μm
• Culture characteristics- grows slowly: 14 -15hrs
• Optimum pH required is 6.4 – 7.0

16. • Media for TB bacilli
• Among all strains, of importance to man are
• Human strain- man
• Bovine strain- cattle
Solid media Liquid media
L. J. medium Dubos medium
Dorset Middle brooks
Petragnini Sula’s
Loeffer Sautan’s
Tarshis Proskauer & Becks

17. Source of infection :
• Human source
• Most common is a human case with sputum-positive for
TB bacilli, & who has either received no treatment or has
not been treated fully.

18. Mode of spread:
• Through droplet nuclei- aerosolized by coughing,
sneezing & speaking.
• 3000 infectious nuclei per cough
• Tiny droplets dry rapidly
• The smallest (<5 to 10 μm in diameter) may remain
suspended in the air for several hours & gain direct
access to the terminal alveoli when inhaled.

19. • An estimated annual average of 10-15 persons contract the
infection from one case of infectious pulmonary TB.
• Bovine source: infected milk
Communicability:
• Patients are infective as long as they remain untreated.
Effective anti- TB treatment reduces infectivity by 90% within
48hours.

20. 2. Host factors
• Age – affects all, mainly 15-54years productive age
group
• In India from an average 2% in 0-14yrs to almost 20% at
15-20 years of age.
• Sex – more common in males.

21. • Nutrition – malnutrition widely predisposes TB.
• Immunity – no inherited immunity against TB
• Acquired as a result of natural infection or BCG
vaccination.
• Low immunity makes person susceptible to TB as seen
in HIV infection.

22. 3. Socio-economic factors
• Social disease with medical aspects.
• Barometer of social welfare.
• Social factors – overcrowding, poor quality of life, poor
housing, under nutrition, lack of education, large families,
lack of awareness of causes of illness, etc.
• Tobacco, smoking, alcoholism & corticosteroids therapy
also reduce resistance against infection.

23. -- Host – Parasite Relationship
-- Host - Immunity, DTH
-- Parasite – No., Virulence
Lung – commonest involvement
a) Constitutional Symptoms
Fever, Night sweats, Psychoneurosis,
Digestive disturbances, Weight loss
Anorexia, Malaise

24. b) Pulmonary Symptoms
Cough – 90%
Expectoration – 85%
Haemoptysis – 42%
Dyspnea – 35%
Chest Pain – 20%
c) Extra-pulmonary Symptoms
Lymphadenopathy

25. 1. Curative component
1. Case finding
2. Treatment
2. Preventive component
1. BCG Vaccination

26. 1. Sputum examination- microscopy
A. Collection
a. Day 1- sample 1- on the spot sample
b. Day 2- sample 2- early morning sample
OR
c. Pt. From far – 2 samples 1 hr apart
B. ZN
C. Slide reporting No. Of AFB Result
Nil/ 100 OIF 0
1-9/ 100 OIF Scanty
10-99/ 100 OIF +
1-10/ 1 OIF ++
> 10/ 1 OIF +++

27. 2. Fluorescence microscopy
A. Industrialized countries
B. Auramine stain
C. Speed- 1-2 min
D. Field of view – 5-10 times
3. LED microscopy
A. Superior to conventional microscopy
B. Recommended- phased manner

28. • CXR
• Smear –Ve PTB & Children
• Pleural, pericardial effusion
• Miliary TB
• Exclude bronchiectasis, aspergiloma

29. Solid media Liquid media
L. J. medium Dubos medium
Dorset Middle brooks 7H10/ 7H11
Petragnini Kircher’s/ Middle brook 7H9
Loeffer Sula’s
Tarshis Sautan’s
Proskauer & Becks

30. • Micro colony detection on solid media
– Middle brook 7H11 incubate- Examine alternate day
– MTB- detection in <7 days
• Radiometric BACTEC 460 TB method
– C labelled palmitic acid in 7H12,
– Detection- metab.
– GI value
• MGIT 960
• MB/ BACT system
– Non-radiometric continuous monitoring system
– Colorimetric detection – CO2

31. • Genotypic
– PCR
– TMA and NAA
– Cartridge based NAAT
– GeneXpert MTB/ RIF
• Phenotypic
– FAST Plaque TB

32. • MycoDot
• Detect- TB (ELISA)
• Pathozyme Myco (ELISA)
• Antigen A60 (ELISA)

33. • Von Pirquet- 1907
• Estimate- prev.
• Tuberculin-
– PPD-S (5 TU, 0.1µg/ 0.1ml) &
– PPD-RT 23 with Tween 80 (1 TU)
• Montoux test-
– 1 TU, ID, forearm, pale wheal- 6-10mm
– Result- 48-96 hrs, ideal- 72hrs
• Erythma, Induration-
– >10mm- +ve, 6-9mm- doubtful, <5mm- more risk

36. • Bactericidal
– Rifampicin- 450mg
– INH- 600mg
– Streptomycin- 750mg
– Pyrazinamide- 1500mg
• Bacteriostatic
– Ethambutol- 1200mg

37. • Fluoroquinolones
• Ethionamide
• Capreomycin
• Kanamycin, Amikacin
• Cycloserine
• Thioacetazone
• Macrolides

38. • Category I- Red box-
– New sputum +ve
– New sputum smear –ve
– New extra-pulmonary
– New others
• Category II- Blue box
– Sputum smear +ve Relapse
– Sputum smear +ve Failure
– Sputum smear +ve treatment after default

39. • MDR-TB
– 6 (9)- Km Lvx Eto Cs Z E H
– 18- Lvx Eto Cs E H
– Reserve/ substitute- PAS, Mfx, Cm
• XDR-TB
– 6-12- Cm, PAS, Mfx, High dose- H, Cfz, Lzd, Amx/Clv
– 18- PAS, Mfx, High dose-H, Cfz, Lzd, Amx/Clv
– Reserve/ substitute- Clarithromycin, Thiacetazone

40. • Thioacetazone- Severe rash, agranulocytosis
• Streptomycin- Hearing loss / disturbed balance
• Ethambutol- Visual disturbance
• Rifampicin- Renal failure, shock, thrombocytopaenia
• Pyrazinamide- Hepatitis

41. • Danish 1331
• Dose
• Administration
• Age
• Phenomena after vaccination
• Complications- ulcer, supp. Lymphadenitis, dissem. TB
• Protective value