Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis. It primarily affects the lungs but can affect other parts of the body. While TB can be cured with proper treatment, it is important to complete the full treatment regimen to avoid developing drug-resistant strains. Transmission in healthcare settings is a concern, so facilities implement TB infection control plans including airborne precautions, prompt detection and treatment of infectious patients, and respiratory protection for healthcare workers.

1. DMD4C
Group 5
Aquino, Anna Patricia
Gharehdaghi,Vahid
Medina, Alyssa Fe
Khosravani, Mehrdad
Navarro, Lou Phyllis
Nocete, Kristel Faye
Palaca, Bea Marie
Tan, Helen Grace
Villanueva,Viel Katrine
Viloria,Viviene Mae

3.  Tuberculosis is an infectious disease caused by
Mycobacterium tuberculosis
 It is a serious condition, but can be cured with
proper treatment.
 TB mainly affects the lungs.
 However, it can affect any part of the body
 When you haveTB disease of the lungs, you can
spread it to other people

4. Anyone can catchTB, but people particularly at risk
include those:
 who live in, come from, or have spent time in a
country or area with high levels ofTB
 in prolonged close contact with someone who is
infected
 living in crowded conditions
 with a condition that weakens their immune system
 having treatments that weaken the immune system
 who are very young or very old
 in poor health or with a poor diet because of
lifestyle and other problems

6.  TB germs are passed through the air
 The condition is spread when a person with an activeTB
infection in their lungs coughs or sneezes;
someone else inhales the expelled droplets
 Although it is spread in a similar way to a cold or the flu,
TB is not as contagious.
 WHY?You would usually have to spend prolonged periods in
close contact with an infected person to catch the infection
yourself.

7.  In most cases, your body is able to fight off the
germs
 Latent or activeTB
However, in some cases the bacteria infect the
body but don't cause any symptoms (latentTB),
or the infection begins to cause symptoms
within weeks or months (activeTB).
 Up to 10% of people with latentTB eventually
develop activeTB years after the initial
infection.

8.  Through quick, casual contact, like passing
someone on the street
 By sharing utensils or food
 By sharing cigarettes or drinking containers
 By exchanging saliva or other body fluids
 By shaking hands
 Using public telephones

9.  TB infection:TB germs stay in your lungs, but
they do not multiply or make you sick
 You cannot passTB germs to others
 TB disease:TB germs stay in your lungs or move
to other parts of your body, multiply, and make
you sick
 You can pass theTB germs to other people

10. A Person with Latent TB Infection A Person withTB Disease
•Does not feel sick Has symptoms that may include
-a bad cough that lasts 3 weeks or longer
-pain in the chest
-coughing up blood or sputum
-weakness or fatigue
-weight loss
-no appetite
-chills
-fever
-sweating at night
•Does not feel sick •Usually feels sick
•Cannot spread TB bacteria to others •May spread TB bacteria to others
•Usually has a skin test or blood test result
indicating TB infection
•Usually has a skin test or blood test result
indicating TB infection
•Has a normal chest x-ray and a negative
sputum smear
•May have an abnormal chest x-ray, or
positive sputum smear or culture
•Needs treatment for latent TB infection to
prevent TB disease
•Needs treatment to treat TB disease

11.  Many people who have latentTB infection never developTB disease. But
some people who have latentTB infection are more likely to developTB
disease than others.
 Those at high risk for developingTB disease include:
-People with HIV infection
-People who became infected withTB bacteria in the last 2 years
-Babies and young children
-People who inject illegal drugs
-People who are sick with other diseases that weaken the immune system
-Elderly people
-People who were not treated correctly forTB in the past
 If you have latentTB infection and you are in one of these high-risk
groups, you should take medicine to keep from developingTB disease.
 There are several treatment options for latentTB infection.You and your
health care provider must decide which treatment is best for you. If you
take your medicine as instructed, it can keep you from developingTB
disease.
 A person withTB disease has a large amount ofTB bacteria in the body.
Several drugs are needed to treatTB disease.

12.  Cough (2-3 weeks or more)
 Coughing up blood
 Chest pains
 Fever
 Night sweats
 Feeling weak and tired
 Losing weight without trying
 Decreased or no appetite
 If you haveTB outside the lungs, you may have
other symptoms

13. Certain people should be tested forTB infection because they are at higher
risk for being infected withTB bacteria, including:
 People who have spent time with someone who hasTB disease
 People from a country whereTB disease is common (most countries in
LatinAmerica, the Caribbean,Africa, Asia, Eastern Europe, and Russia)
 People who live or work in high-risk settings (for example: correctional
facilities, long-term care facilities or nursing homes, and homeless
shelters)
 Health-care workers who care for patients at increased risk forTB disease
 Infants, children and adolescents exposed to adults who are at increased
risk for latent tuberculosis infection orTB disease

14. Testing
There are two kinds of tests that are used to detectTB bacteria in the
body:
 theTB skin test (TST)
 TB blood tests.
A positiveTB skin test orTB blood test only tells that a person has
been infected withTB bacteria.
It does not tell whether the person has latentTB infection (LTBI) or
has progressed toTB disease.
Other tests, such as a chest x-ray and a sample of sputum, are
needed to see whether the person hasTB disease.
Diagnosis
 If a person is found to be infected withTB bacteria, other tests are
needed to see if the person has latentTB infection orTB disease.

15. • There are two types of tests forTB infection:
theTB skin test and theTB blood test.
• A person’s health care provider should choose
whichTB test to use.
• Factors:
-reason for testing
-test availability
-cost.
• Generally, it is not recommended to test a
person with both aTB skin test and aTB blood
test.

16.  TheTB skin test is also called the Mantoux tuberculin skin test (TST).
ATB skin test requires two visits with a health care provider.
On the first visit the test is placed;
on the second visit the health care provider reads the test.
 TheTB skin test is performed by injecting a small amount of fluid (called
tuberculin) into the skin on the lower part of the arm.
 A person given the tuberculin skin test must return within 48 to 72 hours
to have a trained health care worker look for a reaction on the arm.
 The result depends on the size of the raised, hard area or swelling.
 Positive skin test:This means the person’s body was infected withTB
bacteria. Reading the result of aTB skin test
 Additional tests are needed to determine if the person has latentTB infection
orTB disease.
 Negative skin test:This means the person’s body did not react to the test,
and that latentTB infection orTB disease is not likely.
 There is no problem in repeating aTB skin test. If repeated, the
additional test should be placed in a different location on the body (e.g.,
other arm).
 TheTB skin test is the preferredTB test for children under the age of five.

17.  TB blood tests are also called interferon-gamma release assays or
IGRAs.
 A health care provider will draw a patient’s blood and send it to a
laboratory for analysis and results.
PositiveTB blood test:This means that the person has been infected with
TB bacteria. Additional tests are needed to determine if the person has
latentTB infection orTB disease.
NegativeTB blood test:This means that the person’s blood did not react to
the test and that latentTB infection orTB disease is not likely.
 TB blood tests are the preferredTB test for:
People who have received theTB vaccine bacille Calmette–Guérin (BCG).
People who have a difficult time returning for a second appointment to look
for a reaction to theTST.

18.  People who were previously vaccinated with BCG may
receive aTB skin test to test forTB infection.
Vaccination with BCG may cause a false positive
reaction to aTB skin test.A positive reaction to aTB
skin test may be due to the BCG vaccine itself or due
to infection withTB bacteria.
 TB blood tests (IGRAs), unlike theTB skin test, are not
affected by prior BCG vaccination and are not
expected to give a false-positive result in people who
have received BCG.TB blood tests are the preferred
method ofTB testing for people who have received
the BCG vaccine.

19.  Tuberculosis (TB) transmission has been documented
in health care settings where workers and patients
come in contact with people who haveTB disease.
 Periodic testing of health care workers is
recommended
 TB testing programs should include anyone working
or volunteering in health-care settings.
 There are two types of testing forTB in health care
workers.
Initial baseline testing upon hire:Two-step testing with a
TB skin test or aTB blood test
Annual or serial screening: determined by state
regulations or risk assessment outcomes.

20.  There is a greater risk to a pregnant woman
and her baby ifTB disease is not diagnosed
and treated.
 TB skin testing is considered both valid and
safe throughout pregnancy.
 TB blood tests also are safe to use during
pregnancy.

21. Diagnosis of LatentTB Infection
 A diagnosis of latentTB infection is made if a person
has a positiveTB test result and a medical evaluation
does not indicateTB disease.
 The decision about treatment for latentTB infection
will be based on a person’s chances of developingTB
disease by considering their risk factors.
Diagnosis ofTB Disease
 TB disease is diagnosed by medical history, physical
examination, chest x-ray, and other laboratory tests.
 TB disease is treated by taking several drugs as
recommended by a health care provider.

22. People suspected of havingTB disease should be referred for a
complete medical evaluation, which will include the following:
1. Medical History
Clinicians should ask about the patient’s history ofTB exposure,
infection, or disease. It is also important to consider demographic
factors that may increase the patient’s risk for exposure toTB or to
drug-resistantTB.Also, clinicians should determine whether the
patient has medical conditions, such as HIV infection or diabetes,
that increase the risk of latentTB infection progressing toTB
disease.
2. Physical Examination
A physical exam can provide valuable information about the patient’s
overall condition and other factors that may affect howTB is
treated, such as HIV infection or other illnesses.
3.Test forTB Infection
The Mantoux tuberculin skin test (TST) or theTB blood test can be
used to test for M. tuberculosis infection. Additional tests are
required to confirmTB disease.

23. 4. Chest Radiograph
A posterior-anterior chest radiograph is used to detect chest abnormalities.
Lesions may appear anywhere in the lungs and may differ in size, shape,
density, and cavitation.These abnormalities may suggestTB, but cannot be
used to definitively diagnoseTB..
5. Diagnostic Microbiology
Acid-fast microscopy is easy and quick, but it does not confirm a diagnosis of
TB because some acid-fast-bacilli are not M. tuberculosis.Therefore,
a culture is done on all initial samples to confirm the diagnosis.

24. 6. Drug Resistance
For all patients, the initial M.
tuberculosis isolate should be tested for drug
resistance. It is crucial to identify drug
resistance as early as possible to ensure
effective treatment. Drug susceptibility
patterns should be repeated for patients who
do not respond adequately to treatment or
who have positive culture results despite 3
months of therapy.

25. AIMS:
 to cure the patient ofTB and restore their
quality of life and productivity
 to prevent relapse ofTB
 to reduce the transmission ofTB to others
 to prevent the development and
transmission of drug resistantTB

26.  WhenTB bacteria become active (multiplying in the body)
and the immune system can’t stop the bacteria from
growing, this is calledTB disease.TB disease will make a
person sick. People withTB disease may spread the
bacteria to people with whom they spend many hours.
 It is very important that people who haveTB disease are
treated, finish the medicine, and take the drugs exactly as
prescribed.
 If they stop taking the drugs too soon, they can become
sick again;
 if they do not take the drugs correctly, theTB bacteria that
are still alive may become resistant to those drugs.
 TB that is resistant to drugs is harder and more expensive
to treat.

27.  TB disease can be treated by taking several
drugs for 6 to 9 months. There are 10 drugs
currently approved by the U.S. Food and Drug
Administration (FDA) for treatingTB. Of the
approved drugs, the first-line anti-TB agents
that form the core of treatment regimens are:
 isoniazid (INH)
 rifampin (RIF)
 ethambutol (EMB)
 pyrazinamide (PZA)

28.  Isoniazid
 Rifampicin
 Pyrazinamide
 Ethambutol
 and Streptomycin
 are thoseTB drugs that generally have the
greatest bactericidal activity when used for
TB treatment.The amount of drug that aTB
patient needs to take depends on the
patient’s weight.

30.  Untreated tuberculosis in pregnancy poses a significant
threat to the mother, fetus and family.
 Adherence to treatment is especially difficult in pregnancy
because of the general fear of any medication and
pregnancy-related nausea.
 Supervised treatment is especially helpful in encouraging
adherence.
 All 4 first line drugs [isoniazid, rifampicin
(rifampin), ethambutol and pyrazinamide]
have an excellent safety record in pregnancy
and are not associated with human fetal
malformations.

31.  Streptomycin should not be used in pregnancy, as perhaps 1
in 6 babies will have problems with hearing and/or balance.
 Ciprofloxacin has the best safety profile of second line
drugs in the treatment of drug-resistant tuberculosis.
 Preventive treatment with isoniazid can be undertaken
safely during pregnancy.
 Pyridoxine (vitamin B6) should be added to the drug
treatment of tuberculosis in all pregnant women taking
isoniazid.
 Neither tuberculin nor the Bacille Calmette Guérin (BCG)
vaccine are treatments for tuberculosis, but they play an
important role in the management of the disease.
 Tuberculin testing is safe, but BCG vaccination should be
avoided in pregnancy and instead given earlier in life.

32. • Stopping treatment too soon or skipping
doses can allow the bacteria that are still alive
to become resistant to those drugs, leading to
TB that is much more dangerous and difficult
to treat.

36.  Tuberculosis (TB) transmission has been documented in
health care settings where health care workers and
patients come in contact with people who haveTB
disease.
 People who work or receive care in health care settings are
at higher risk for becoming infected withTB
 Therefore, it is necessary to have aTB infection control
plan as part of a general infection control program
designed to ensure the following:
prompt detection of infectious patients,
airborne precautions,
treatment of people who have suspected or confirmedTB
disease.

37.  Use of respiratory protection equipment can further
reduce risk for exposure of health care workers to
infectious droplet nuclei that have been expelled into the
air from a patient with infectiousTB disease.
 The following measures can be taken to reduce the risk for
exposure:
 Implementing a respiratory protection program;
 Training health care workers on respiratory protection;
and
 Educating patients on respiratory hygiene and the
importance of cough etiquette procedures.