The document provides an overview of tuberculosis (TB) including:
- Causative agent, symptoms, and modes of transmission
- Disease burden globally and in India
- Diagnostic methods under India's National Tuberculosis Elimination Programme (NTEP) including sputum smear microscopy, culture-based tests, and molecular tests
- Evolution of TB control in India from early programs to NTEP, which aims to eliminate TB in India by 2025
Pulmonary tuberculosis is caused by inhaling Mycobacterium tuberculosis and can affect the lungs or other organs. While many infected people do not develop active TB, risk factors like diabetes, smoking, HIV, and malnutrition can increase the risk. In 2020, an estimated 10 million people worldwide fell ill with TB, including 5.6 million men and 3.3 million women. India has a high burden of both TB and diabetes, putting many at increased risk of active TB. Diagnosis involves tests like smear microscopy, culture, and molecular tests. The goals of treatment are cure and preventing transmission and drug resistance. The new guidelines shift to a daily drug regimen for both intensive and continuation phases for new TB cases. Treatment outcomes
this presentation is based on national health program in india in relation to tuberculosis and malaria as these are mostly occuring disease in india so national program are organised to irradicate the spread of vector borne disease by various methods like controlling the vector (mosquitos) from spreading
role of community pharmacist in educating and monitoring of patients for infection and counselling and educating them regarding the control of malaria and tb.
- TB cases in the US decreased from 1953 to 1984 but increased 20% from 1985 to 1992, with 25,313 cases reported in 1993. Since then, cases have declined steadily.
- Factors contributing to the increase included the HIV epidemic, increased immigration from high-prevalence countries, transmission in congregate settings like prisons and nursing homes, and deterioration of public health infrastructure.
- TB is caused by Mycobacterium tuberculosis bacteria and is spread through airborne particles inhaled by an uninfected person during prolonged contact with an active case.
The document summarizes guidelines for the treatment of tuberculosis in India. It outlines that pulmonary TB is caused by inhaling Mycobacterium tuberculosis bacteria, and that while many get infected, not all develop active TB disease. The RNTCP program was launched in 1997 using the WHO-recommended DOTS strategy to improve TB control. The program aims to achieve universal access to TB diagnosis and treatment through free government services. It describes diagnostic tools, classifications of TB cases, treatment goals, and categories of new and previously treated cases.
This document provides information on tuberculosis (TB) in the United States, including key facts about the disease:
- Reported TB cases decreased from 1953 to 1984 but then increased 20% from 1985 to 1992 before declining again.
- Factors contributing to the increase included the HIV epidemic, immigration from high-prevalence countries, and transmission in congregate settings.
- TB is caused by Mycobacterium tuberculosis bacteria and usually affects the lungs. It is transmitted through airborne particles expelled from the lungs of infected individuals.
The document discusses tuberculosis (TB) in the United States. It notes that reported TB cases decreased from 1953 to 1984 but then increased 20% from 1985 to 1992 before declining again since 1993. Factors contributing to the rise in cases included the HIV epidemic, increased immigration from high-prevalence countries, and transmission in congregate settings. TB is caused by Mycobacterium tuberculosis and transmitted through airborne particles. While 10% of infected persons will develop active TB, targeted testing focuses on those at highest risk like close contacts and those with conditions increasing risk of progression. Diagnosis involves medical history, physical exam, tuberculin skin test, chest x-ray, and bacteriological examination. Treatment includes antibiotics and directly observed
Pulmonary tuberculosis is caused by inhaling Mycobacterium tuberculosis and can affect the lungs or other organs. While many infected people do not develop active TB, risk factors like diabetes, smoking, HIV, and malnutrition can increase the risk. In 2020, an estimated 10 million people worldwide fell ill with TB, including 5.6 million men and 3.3 million women. India has a high burden of both TB and diabetes, putting many at increased risk of active TB. Diagnosis involves tests like smear microscopy, culture, and molecular tests. The goals of treatment are cure and preventing transmission and drug resistance. The new guidelines shift to a daily drug regimen for both intensive and continuation phases for new TB cases. Treatment outcomes
this presentation is based on national health program in india in relation to tuberculosis and malaria as these are mostly occuring disease in india so national program are organised to irradicate the spread of vector borne disease by various methods like controlling the vector (mosquitos) from spreading
role of community pharmacist in educating and monitoring of patients for infection and counselling and educating them regarding the control of malaria and tb.
- TB cases in the US decreased from 1953 to 1984 but increased 20% from 1985 to 1992, with 25,313 cases reported in 1993. Since then, cases have declined steadily.
- Factors contributing to the increase included the HIV epidemic, increased immigration from high-prevalence countries, transmission in congregate settings like prisons and nursing homes, and deterioration of public health infrastructure.
- TB is caused by Mycobacterium tuberculosis bacteria and is spread through airborne particles inhaled by an uninfected person during prolonged contact with an active case.
The document summarizes guidelines for the treatment of tuberculosis in India. It outlines that pulmonary TB is caused by inhaling Mycobacterium tuberculosis bacteria, and that while many get infected, not all develop active TB disease. The RNTCP program was launched in 1997 using the WHO-recommended DOTS strategy to improve TB control. The program aims to achieve universal access to TB diagnosis and treatment through free government services. It describes diagnostic tools, classifications of TB cases, treatment goals, and categories of new and previously treated cases.
This document provides information on tuberculosis (TB) in the United States, including key facts about the disease:
- Reported TB cases decreased from 1953 to 1984 but then increased 20% from 1985 to 1992 before declining again.
- Factors contributing to the increase included the HIV epidemic, immigration from high-prevalence countries, and transmission in congregate settings.
- TB is caused by Mycobacterium tuberculosis bacteria and usually affects the lungs. It is transmitted through airborne particles expelled from the lungs of infected individuals.
The document discusses tuberculosis (TB) in the United States. It notes that reported TB cases decreased from 1953 to 1984 but then increased 20% from 1985 to 1992 before declining again since 1993. Factors contributing to the rise in cases included the HIV epidemic, increased immigration from high-prevalence countries, and transmission in congregate settings. TB is caused by Mycobacterium tuberculosis and transmitted through airborne particles. While 10% of infected persons will develop active TB, targeted testing focuses on those at highest risk like close contacts and those with conditions increasing risk of progression. Diagnosis involves medical history, physical exam, tuberculin skin test, chest x-ray, and bacteriological examination. Treatment includes antibiotics and directly observed
The document provides information on tuberculosis (TB) in the United States, including key points:
- Reported TB cases decreased from 1953 to 1984 but then increased 20% from 1985 to 1992, peaking at 25,313 cases in 1993 before declining again.
- Factors contributing to the rise in cases include the HIV epidemic, increased immigration from high-prevalence countries, and transmission in congregate settings such as prisons.
- TB is caused by the bacterium Mycobacterium tuberculosis and is spread through airborne particles inhaled by an uninfected person during prolonged contact with an active case.
- Testing and treatment strategies aim to identify latent TB infections and ensure completion of treatment to prevent active
This document discusses screening and treatment for latent tuberculosis infection (LTBI). It defines LTBI as the presence of M. tuberculosis bacteria without symptoms or disease. The Mantoux tuberculin skin test (TST) is used to detect LTBI. Persons at high risk for developing active TB from LTBI include recent contacts of infectious TB cases, HIV+ persons, and those with conditions like diabetes. Treatment with 9 months of isoniazid or 4 months of rifampin can prevent latent infections from progressing to active TB disease. Close monitoring is needed during treatment to watch for adverse reactions like hepatitis.
This document discusses screening and treatment for latent tuberculosis infection (LTBI). It defines LTBI as the presence of M. tuberculosis bacteria without symptoms or disease. The Mantoux tuberculin skin test (TST) is used to detect LTBI. Persons at high risk for developing active TB from LTBI include recent contacts of infectious TB cases, HIV+ persons, and those with conditions like diabetes. Treatment with 9 months of isoniazid or 4 months of rifampin can prevent latent infections from progressing to active TB disease. Close monitoring is needed during treatment to watch for adverse reactions like hepatitis.
Tuberculosis is an infectious disease caused by the bacterium Mycobacterium tuberculosis that primarily affects the lungs. It is transmitted from person to person through droplets from the throat and lungs of people with active TB disease. TB has affected humans for thousands of years and was responsible for the deaths of millions of people in the 19th century. Today it remains a major global health problem, with 10 million new cases and 1.3 million deaths in 2016. India has the highest burden of TB cases globally. The WHO End TB Strategy aims to end the global TB epidemic with targets of reducing TB deaths by 95% and cutting new cases by 90% between 2015 and 2035.
1. Tuberculosis is caused by Mycobacterium tuberculosis and primarily affects the lungs. It can spread through airborne transmission. India has a high burden of TB with an estimated incidence of 211 cases per 100,000 population in 2016.
2. The Revised National Tuberculosis Control Programme was launched in India to decrease TB mortality and morbidity. It aims to achieve 90% cure rates for new smear-positive cases and detect 85% of expected new smear-positive cases.
3. Diagnosis involves smear microscopy, radiography, tuberculin skin test, culture, and rapid molecular tests. Treatment regimens include daily and intermittent options depending on if the patient has new or previously
This document discusses tuberculosis (TB), including its risk factors, pathogenesis, clinical manifestations, diagnosis, treatment, and prevention. It notes that TB is transmitted via airborne droplets and its major risk factors include close contact with active TB cases, immunosuppression, poverty, and smoking. Diagnosis involves sputum microscopy, culture, nucleic acid tests, chest imaging, and the tuberculin skin test. Treatment follows the DOTS (Directly Observed Treatment, Short Course) strategy to cure TB and prevent drug resistance.
This document discusses the epidemiology of tuberculosis (TB). It defines epidemiology and TB, describes how TB spreads from person to person through airborne droplets. It discusses factors that influence transmission risk and stopping transmission. It also outlines the incubation period, history of TB discoveries, common epidemiological indices used to measure the TB problem, definitions of different TB cases, the natural history of TB including agent and host factors, and the global and national burden of TB, particularly in India which accounts for over 1/5 of global TB incidence.
Tuberculosis is a major global health problem caused by the bacterium Mycobacterium tuberculosis. India has a large burden of TB, accounting for over 1.5 million new cases annually. TB is transmitted through the air when people who are sick with pulmonary or laryngeal TB expel bacteria by coughing, sneezing, speaking, or singing. Standard epidemiological indices are used to measure the TB problem in communities and allow international comparisons. These include prevalence and incidence rates of both infection and active disease. Controlling the spread of TB requires prompt diagnosis and effective treatment of infected individuals.
Robert Koch discovered the tuberculosis bacterium Mycobacterium tuberculosis in 1882. TB remains a major global health problem, infecting one third of the world's population and causing millions of deaths each year, primarily in developing countries. Diagnosis involves medical history, physical exam, tuberculin skin test, chest x-ray, and bacteriological confirmation through sputum smear and culture. Treatment requires long courses of multiple antibiotics to cure TB disease and prevent drug resistance, with directly observed therapy essential to ensure patient adherence and cure.
This document provides objectives and information about tuberculosis (TB) for students. It defines TB and identifies risk factors. It explains how TB is transmitted and defines latent TB and drug-resistant TB. It describes the history of TB, scientific discoveries about it, and breakthroughs in treatment. It outlines the pathophysiology, symptoms, diagnostic tools, treatment regimens, and patient monitoring for TB.
Revised definitions of tb cases and management as per ntepDrSmritiMadhusikta
The document provides revised definitions and management guidelines for tuberculosis (TB) cases according to India's National Tuberculosis Elimination Program (NTEP). Key changes include:
- Updated case definitions for presumptive TB, DR-TB, pediatric TB, and EPTB.
- Classification based on history of treatment and drug resistance is revised.
- Diagnostic algorithms and tools are introduced, including new molecular tests.
- Treatment is shifted to daily fixed-dose combinations administered according to weight bands, with an 8-week intensive phase and 16-week continuation phase.
- Guidelines for managing DR-TB, hospitalized patients, EPTB and special groups are provided.
This document provides information about tuberculosis (TB), including its introduction, epidemiology, definition, modes of transmission, clinical presentation, treatment, prevention, and management. Some key points include:
- TB is caused by the bacterium Mycobacterium tuberculosis and can spread through the air from one person to another. It affects millions of people worldwide each year.
- Symptoms may include cough, fatigue, weight loss, fever, and breathing difficulties. Diagnosis involves tests like the Mantoux skin test, chest x-ray, and sputum microscopy.
- Treatment involves standardized short course chemotherapy over 6-8 months using combinations of front-line antibiotic drugs. Prevention strategies focus on BCG vaccination, screening of contacts
Epidemiology & Control measures for Tuberculosis. AB Rajar
n this Lecture I tried my best to include all essential features about the TB disease. I hope that this will help to undergraduate Medical students for better understanding the Disease.
TB 2013_Diagnosis and clinical presentationRamadan Arafa
This document discusses the clinical presentation and diagnosis of tuberculosis (TB). It presents 3 case studies and discusses the typical symptoms, risk factors, and diagnostic approach for TB. Key points include: 1) TB most commonly presents with nonspecific symptoms like fever, night sweats, and weight loss; 2) diagnostic approach involves sputum smear, culture, chest x-ray and consideration of risk factors; 3) delay in diagnosis can increase transmission and disease severity.
This document provides an overview of tuberculosis (TB) presented by several individuals from NIPER Kolkata. It discusses the history, biology, pathogenesis, stages of infection, virulent mechanisms, prevalence, current scenario, WHO recommendations for diagnosis and treatment, and preventive measures for TB. The WHO aims to reduce global TB incidence rate by 2035 through its End TB Strategy which focuses on early detection, accurate diagnosis, effective treatment, and monitoring & evaluation of programs.
This document provides an overview of tuberculosis (TB) presented by several individuals from NIPER Kolkata. It discusses the history, biology, pathogenesis, stages of infection, virulent mechanisms, prevalence, current scenario, WHO recommendations for diagnosis and treatment, and preventive measures for TB. The WHO aims to reduce global TB incidence rate by 2035 through its End TB Strategy which focuses on early detection, accurate diagnosis, effective treatment, and monitoring programs.
This document summarizes a review study on tuberculosis conducted by Bashar M. Khazaal. It defines tuberculosis as an infectious disease caused by mycobacterium tuberculosis, which usually involves the lungs but can spread to other parts of the body. Risk factors, pathophysiology, clinical manifestations, diagnostic methods, complications, management, and drug-resistant forms like MDR-TB and XDR-TB are described. Diagnostic tests discussed include tuberculin skin test, chest X-ray, bacteriological examination, drug susceptibility testing using phenotypic and molecular methods, Quantiferon-TB, T-Spot TB, and PCR. Treatment involves a multi-drug regimen over several months and directly observed therapy to prevent drug resistance
Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs. Tuberculosis is curable and preventable.
TB is spread from person to person through the air. When people with lung TB cough, sneeze or spit, they propel the TB germs into the air. A person needs to inhale only a few of these germs to become infected.
The causative agent is Mycobacterium tuberculosis (also known as the tubercle bacillus).
Tuberculosis (TB) is an infectious disease that primarily affects the lung parenchyma. The primary infection usually involves the middle or lower lung area.
It is also may be transmitted to other parts of the body, including the Meninges, kidneys, bone, joints, pericardium, GI tract and lymph nodes And this condition known as Extra pulmonary TB.
The disease also can affects animals such as cattle, this is known as “bovine tuberculosis” which may sometimes be transmitted to man.The primary infectious agent, “ M.Tuberculosis”, is an acid – fast aerobic (AFB) rod that grows slowly and is sensitive to heat and ultraviolet light.
Case finding and diagnosis Workshop for Medical College Task Force memberRivu Basu
1. Case finding and diagnosis of TB involves classifying TB based on anatomical site, identifying presumptive TB patients, and using appropriate diagnostic tools.
2. Strategies to enhance case finding include passive case finding based on symptoms, intensified case finding through bidirectional screening of high-risk groups, and active case finding through systematic screening of vulnerable populations using sensitive diagnostic tests.
3. The vision is to achieve universal access to early and accurate TB diagnosis and improve efficiency through early identification of presumptive TB patients, screening high-risk groups, using free sensitive diagnostic tests and algorithms, and engaging private providers.
India accounts for over one-fifth of the global tuberculosis burden with 2.2 million cases annually, the highest of any country. The Revised National Tuberculosis Control Programme (RNTCP) was established to address this large burden. The key components of RNTCP are based on the WHO-recommended DOTS strategy of using short course chemotherapy regimens administered under direct observation to ensure treatment adherence. Diagnosis involves microscopic examination of sputum samples and treatment regimens differ based on whether a patient is newly diagnosed or was previously treated. Regular follow-up during and after treatment is important to monitor symptoms, treatment response, and detect any recurrence of active TB.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
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The document provides information on tuberculosis (TB) in the United States, including key points:
- Reported TB cases decreased from 1953 to 1984 but then increased 20% from 1985 to 1992, peaking at 25,313 cases in 1993 before declining again.
- Factors contributing to the rise in cases include the HIV epidemic, increased immigration from high-prevalence countries, and transmission in congregate settings such as prisons.
- TB is caused by the bacterium Mycobacterium tuberculosis and is spread through airborne particles inhaled by an uninfected person during prolonged contact with an active case.
- Testing and treatment strategies aim to identify latent TB infections and ensure completion of treatment to prevent active
This document discusses screening and treatment for latent tuberculosis infection (LTBI). It defines LTBI as the presence of M. tuberculosis bacteria without symptoms or disease. The Mantoux tuberculin skin test (TST) is used to detect LTBI. Persons at high risk for developing active TB from LTBI include recent contacts of infectious TB cases, HIV+ persons, and those with conditions like diabetes. Treatment with 9 months of isoniazid or 4 months of rifampin can prevent latent infections from progressing to active TB disease. Close monitoring is needed during treatment to watch for adverse reactions like hepatitis.
This document discusses screening and treatment for latent tuberculosis infection (LTBI). It defines LTBI as the presence of M. tuberculosis bacteria without symptoms or disease. The Mantoux tuberculin skin test (TST) is used to detect LTBI. Persons at high risk for developing active TB from LTBI include recent contacts of infectious TB cases, HIV+ persons, and those with conditions like diabetes. Treatment with 9 months of isoniazid or 4 months of rifampin can prevent latent infections from progressing to active TB disease. Close monitoring is needed during treatment to watch for adverse reactions like hepatitis.
Tuberculosis is an infectious disease caused by the bacterium Mycobacterium tuberculosis that primarily affects the lungs. It is transmitted from person to person through droplets from the throat and lungs of people with active TB disease. TB has affected humans for thousands of years and was responsible for the deaths of millions of people in the 19th century. Today it remains a major global health problem, with 10 million new cases and 1.3 million deaths in 2016. India has the highest burden of TB cases globally. The WHO End TB Strategy aims to end the global TB epidemic with targets of reducing TB deaths by 95% and cutting new cases by 90% between 2015 and 2035.
1. Tuberculosis is caused by Mycobacterium tuberculosis and primarily affects the lungs. It can spread through airborne transmission. India has a high burden of TB with an estimated incidence of 211 cases per 100,000 population in 2016.
2. The Revised National Tuberculosis Control Programme was launched in India to decrease TB mortality and morbidity. It aims to achieve 90% cure rates for new smear-positive cases and detect 85% of expected new smear-positive cases.
3. Diagnosis involves smear microscopy, radiography, tuberculin skin test, culture, and rapid molecular tests. Treatment regimens include daily and intermittent options depending on if the patient has new or previously
This document discusses tuberculosis (TB), including its risk factors, pathogenesis, clinical manifestations, diagnosis, treatment, and prevention. It notes that TB is transmitted via airborne droplets and its major risk factors include close contact with active TB cases, immunosuppression, poverty, and smoking. Diagnosis involves sputum microscopy, culture, nucleic acid tests, chest imaging, and the tuberculin skin test. Treatment follows the DOTS (Directly Observed Treatment, Short Course) strategy to cure TB and prevent drug resistance.
This document discusses the epidemiology of tuberculosis (TB). It defines epidemiology and TB, describes how TB spreads from person to person through airborne droplets. It discusses factors that influence transmission risk and stopping transmission. It also outlines the incubation period, history of TB discoveries, common epidemiological indices used to measure the TB problem, definitions of different TB cases, the natural history of TB including agent and host factors, and the global and national burden of TB, particularly in India which accounts for over 1/5 of global TB incidence.
Tuberculosis is a major global health problem caused by the bacterium Mycobacterium tuberculosis. India has a large burden of TB, accounting for over 1.5 million new cases annually. TB is transmitted through the air when people who are sick with pulmonary or laryngeal TB expel bacteria by coughing, sneezing, speaking, or singing. Standard epidemiological indices are used to measure the TB problem in communities and allow international comparisons. These include prevalence and incidence rates of both infection and active disease. Controlling the spread of TB requires prompt diagnosis and effective treatment of infected individuals.
Robert Koch discovered the tuberculosis bacterium Mycobacterium tuberculosis in 1882. TB remains a major global health problem, infecting one third of the world's population and causing millions of deaths each year, primarily in developing countries. Diagnosis involves medical history, physical exam, tuberculin skin test, chest x-ray, and bacteriological confirmation through sputum smear and culture. Treatment requires long courses of multiple antibiotics to cure TB disease and prevent drug resistance, with directly observed therapy essential to ensure patient adherence and cure.
This document provides objectives and information about tuberculosis (TB) for students. It defines TB and identifies risk factors. It explains how TB is transmitted and defines latent TB and drug-resistant TB. It describes the history of TB, scientific discoveries about it, and breakthroughs in treatment. It outlines the pathophysiology, symptoms, diagnostic tools, treatment regimens, and patient monitoring for TB.
Revised definitions of tb cases and management as per ntepDrSmritiMadhusikta
The document provides revised definitions and management guidelines for tuberculosis (TB) cases according to India's National Tuberculosis Elimination Program (NTEP). Key changes include:
- Updated case definitions for presumptive TB, DR-TB, pediatric TB, and EPTB.
- Classification based on history of treatment and drug resistance is revised.
- Diagnostic algorithms and tools are introduced, including new molecular tests.
- Treatment is shifted to daily fixed-dose combinations administered according to weight bands, with an 8-week intensive phase and 16-week continuation phase.
- Guidelines for managing DR-TB, hospitalized patients, EPTB and special groups are provided.
This document provides information about tuberculosis (TB), including its introduction, epidemiology, definition, modes of transmission, clinical presentation, treatment, prevention, and management. Some key points include:
- TB is caused by the bacterium Mycobacterium tuberculosis and can spread through the air from one person to another. It affects millions of people worldwide each year.
- Symptoms may include cough, fatigue, weight loss, fever, and breathing difficulties. Diagnosis involves tests like the Mantoux skin test, chest x-ray, and sputum microscopy.
- Treatment involves standardized short course chemotherapy over 6-8 months using combinations of front-line antibiotic drugs. Prevention strategies focus on BCG vaccination, screening of contacts
Epidemiology & Control measures for Tuberculosis. AB Rajar
n this Lecture I tried my best to include all essential features about the TB disease. I hope that this will help to undergraduate Medical students for better understanding the Disease.
TB 2013_Diagnosis and clinical presentationRamadan Arafa
This document discusses the clinical presentation and diagnosis of tuberculosis (TB). It presents 3 case studies and discusses the typical symptoms, risk factors, and diagnostic approach for TB. Key points include: 1) TB most commonly presents with nonspecific symptoms like fever, night sweats, and weight loss; 2) diagnostic approach involves sputum smear, culture, chest x-ray and consideration of risk factors; 3) delay in diagnosis can increase transmission and disease severity.
This document provides an overview of tuberculosis (TB) presented by several individuals from NIPER Kolkata. It discusses the history, biology, pathogenesis, stages of infection, virulent mechanisms, prevalence, current scenario, WHO recommendations for diagnosis and treatment, and preventive measures for TB. The WHO aims to reduce global TB incidence rate by 2035 through its End TB Strategy which focuses on early detection, accurate diagnosis, effective treatment, and monitoring & evaluation of programs.
This document provides an overview of tuberculosis (TB) presented by several individuals from NIPER Kolkata. It discusses the history, biology, pathogenesis, stages of infection, virulent mechanisms, prevalence, current scenario, WHO recommendations for diagnosis and treatment, and preventive measures for TB. The WHO aims to reduce global TB incidence rate by 2035 through its End TB Strategy which focuses on early detection, accurate diagnosis, effective treatment, and monitoring programs.
This document summarizes a review study on tuberculosis conducted by Bashar M. Khazaal. It defines tuberculosis as an infectious disease caused by mycobacterium tuberculosis, which usually involves the lungs but can spread to other parts of the body. Risk factors, pathophysiology, clinical manifestations, diagnostic methods, complications, management, and drug-resistant forms like MDR-TB and XDR-TB are described. Diagnostic tests discussed include tuberculin skin test, chest X-ray, bacteriological examination, drug susceptibility testing using phenotypic and molecular methods, Quantiferon-TB, T-Spot TB, and PCR. Treatment involves a multi-drug regimen over several months and directly observed therapy to prevent drug resistance
Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs. Tuberculosis is curable and preventable.
TB is spread from person to person through the air. When people with lung TB cough, sneeze or spit, they propel the TB germs into the air. A person needs to inhale only a few of these germs to become infected.
The causative agent is Mycobacterium tuberculosis (also known as the tubercle bacillus).
Tuberculosis (TB) is an infectious disease that primarily affects the lung parenchyma. The primary infection usually involves the middle or lower lung area.
It is also may be transmitted to other parts of the body, including the Meninges, kidneys, bone, joints, pericardium, GI tract and lymph nodes And this condition known as Extra pulmonary TB.
The disease also can affects animals such as cattle, this is known as “bovine tuberculosis” which may sometimes be transmitted to man.The primary infectious agent, “ M.Tuberculosis”, is an acid – fast aerobic (AFB) rod that grows slowly and is sensitive to heat and ultraviolet light.
Case finding and diagnosis Workshop for Medical College Task Force memberRivu Basu
1. Case finding and diagnosis of TB involves classifying TB based on anatomical site, identifying presumptive TB patients, and using appropriate diagnostic tools.
2. Strategies to enhance case finding include passive case finding based on symptoms, intensified case finding through bidirectional screening of high-risk groups, and active case finding through systematic screening of vulnerable populations using sensitive diagnostic tests.
3. The vision is to achieve universal access to early and accurate TB diagnosis and improve efficiency through early identification of presumptive TB patients, screening high-risk groups, using free sensitive diagnostic tests and algorithms, and engaging private providers.
India accounts for over one-fifth of the global tuberculosis burden with 2.2 million cases annually, the highest of any country. The Revised National Tuberculosis Control Programme (RNTCP) was established to address this large burden. The key components of RNTCP are based on the WHO-recommended DOTS strategy of using short course chemotherapy regimens administered under direct observation to ensure treatment adherence. Diagnosis involves microscopic examination of sputum samples and treatment regimens differ based on whether a patient is newly diagnosed or was previously treated. Regular follow-up during and after treatment is important to monitor symptoms, treatment response, and detect any recurrence of active TB.
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it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
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3. Tuberculosis
• Chronic ??? infectious disease caused by
Mycobacterium tuberculosis
• Primarily affects lungs: Pulmonary Tuberculosis
• Can also affect intestine , meninges, bones and
joints ,lymph nodes, skin and other tissues
4. HISTORY OF TB
• Can be traced back to 9,000 years
• Earliest mention in India- 3,300 years ago
• Phthisis , White Plaque, Kshaya
• Term Tuberculosis: Johann Schonlein (1834)
5. *Robert Koch discovered that TB is caused by a bacteria
Mycobacterium tuberculosis on 24 March 1882
World TB day : 24th March
* Theme (2022) : “ Invest to end TB, save lives”
9. AGENT FACTORS
• M. Tuberculosis: facultative intracellular parasite
• Two strains – Human and bovine
Human strain is responsible for majority of cases
• Bovine – affects mainly animals .
10. • SOURCE OF INFECTION
• Two sources of infection – human and bovine.
• Human source – whose sputum is positive for tubercle
bacilli and who has either received no treatment or has not
treated fully.
* Annually 10 -15 persons contract infection from one case of
infectious pulmonary TB.
• * Bovine source – Infected milk.
• Effective anti – microbial treatment reduces infectivity by
90 percent within 48 hours .
11. HOST FACTORS
A .AGE
• Affects all ages
• In India the infection rate is 2 per cent in 0 to 14 years age
group and 20 percent in 15 to 24 years .
B.SEX
More prevalent in males than females.
12. • C .NUTRITION
• Malnutrition is a predisposing factor of TB.
• D .IMMUNITY
• Acquired by natural infection or BCG vaccination.
13. SOCIAL FACTORS
It includes:
:Poor quality of life
:Poor housing
: Overcrowding
: Population explosion
: Undernutrition
: Smoking
: Alcohol abuse
:Large families
:Lack of awareness of causes of illness.
14. MODE OF TRANSMISSION
• Droplet transmission (1-5 micron)
• Not transmitted by fomites such as dishes and other articles.
15. INCUBATION PERIOD
-Weeks to years.
-The time between the infection and the development of
positive tuberculin skin test – 3 to 6 weeks.
-Disease development depends upon-
1.Closeness of contact.
2.Extent of disease.
3.Sputum positivity of source case.
16. SYMPTOMS
• Persistent cough
• Fever
• Coughing up blood
• Fatigue
• Loss of appetite
• Unintentional weight loss
• Night sweats
• Chest pain.
17. DISEASE BURDEN OF TB
• 13th leading cause of death worldwide
• 2nd leading cause of death of infectious diseases after covid in 2020
• 1/3rd of the global population: infected asymptomatically
• 10 billion people fall ill every year
• 1.5 million people die due to TB every year
18. • India contributes largest to the TB cases amoung all countries.
• The total no. Of incidence TB patients notified During 2021
was 19,33,381 which was 19% higher than that of 2020
(16,28,161).
• Rate of 188 per 1,00,000 population.
• In India Uttar Pradesh has the maximum number of TB cases.
20. • Causitive agent-Mycobacterium tuberculosis.
• Host-usually human beings which harbors the disease.
• Environment-Tobacco smoke,indoor air pollution,overcrowding
living condition.
• The mission of an epidemiologist is to break at least one of side
of the triangle,disrupting the connection between the
environment the host and the agent and stopping the
continuation of the disease.
21. Epidemiological indices
• Need : to measure the problem in community as well as
planning and for evaluation
1. Incidence : No. of new and recurrent (relapsed) episodes of TB
occurring in a given year
22. 2.Prevalance: no of TB cases (all forms) present at a given
point of time or period of time.
Later being period prevalence and former being point
prevalance.
3.Mortality:no of deaths purely from TB (HIV – people)
4.Case fatality rate : risk of death from TB among people
with active disease.
23.
24. 5. Case Notification Rate: New and recurrent episodes of
TB for a given year expressed per 1 lakh population.
Important in estimation of TB incidence.
6. Case Detection Rate: No. Of notification of new and
relapse cases in year divided by estimated incidence of such
cases.
25. Prevalence of drug resistant cases
It is prevalence of patient excreting bacilli resisted to anti TB
drugs.
A. Prevalence of infection. : %of individuals showing positive
reaction to tuberculin test .
Problems : BCG vaccination and cross senstivity.
B. Incidence of infection :% of population under study who will
be newly infected by TB.
26. • Newer definetions :(2014)
Presumptive case:(TB suspect) presents with symptoms and
signs.
A. CASE DEFINETIONS
1.Bacteriologically confirmed case:
one from whom biological specimen is positive by microscopy
, culture or rapid tests.
2.Clinically diagnosed case: one who is not
bacteriologically confirmed but diagnosed by clinician.
27. • These cases include diagnosis on basis of x ray
abnormalities or histology.
CASES ARE FURTHER CLASSIFIED ON :
1.Anatomical site of disease.
2.History of previous treatment.
3. Drug resistance.
4. HIV status.
28. 1. ANATOMICAL SITE OF DISEASE
PULMONARY TB
• Confirmed case of lung
parenchyma &
tracheobronchial tree.
• Miliary ,hilar ,mediastinal are
not included.
EXTRAPULMONARY TB
• Any confirmed case of TB
involving organs other than
TB .
• Eg :lung, lymph node,bones
e.t.c
29. • Based on history of previous treatment
NEW PATIENTS: Patients who have never been treated for TB
or have taken anti TB drugs for less than 1 month
PREVIOUSLY TREATED PAT. : Received 1 month or more anti
TB drugs.
30. • They are further classified as:
A. Relapse patients : Previously treated , cured, completed
treatment and are diagnosed now with recurrent episode of
TB
B.Treatment after failure patients:
Previously treated but treatment failed at end of most
recent treatment course
31. 3.Treatment after loss to follow up patients: Previously been
treated for TB , declared lost to follow up at end of their recent
treatment.
4.Other previously treated patients:
Previously treated but outcome unknown or undocumented
32. Based on drug resistance-
A. Mono resistance: Resistant to 1 first line anti TB drugs
B. Poly drug resistance :Resistant to more than 1 first line anti TB
drugs (except H&R)
33. c. Multidrug resistance: Resistance to at least both rifampicin
or isoniazid known as MDR TB.
D. Extensive drug resistance: In addition to MDR resistance to
FQs or at least one of three 2nd line injectable drug
34. 4. Based on HIV status:
HIV + TB PATIENT : Confirmed case of TB which have + result from HIV
TEST conducted
HIV – TB PATIENT: Confirmed case of TB who has – result from HIV
test conducted
35. Treatment outcome definitions:
They make clear distinctions b/w
1.Patient treated for drug susceptible TB
2.Patient treated for drug resistant TB .
36. TREATMENT OUTCOMES FOR TB PATIENTS (EXCLUDING MDR
&RR TB)
CURED : Pulmonary TB patient, bacteriologically confirmed at the
beginning of treatment who was smear negative in last month of
treatment.
TREATMENT COMPLETED: Patient who completed treatment without
failure but with no record to show that.
37. Smear results in last month of treatment and on at least one
previous occasions were negative.
TREATMENT FAILED:
TB patient whose smear is + at month five or later during
treatment.
38. Died: Patient who dies before or during course of treatment.
Lost to follow up: Patient who did not start treatment or
whose treatment was interrupted for 2 consecutive months or
more.
Not evaluated: Patient for whom no treatment outcome is
assigned.
39. Treatment success: Sum of cured and treatment
completed.
COHORT: Patients in whom TB has been diagnosed and
registered for treatment for a specific period .
40. OUTCOMES FOR RR TB/ XDR TB :
CURED: Treatment completed without evidence of failure
AND 3 or more + cultures taken at least 30 days apart are – after the
intensive phase .
41. TREATMENT COMPLETED: Without evidence of failure but no
record that 3 or more consecutive cultures taken 30 days
apart are – after intensive phase .
TREATMENT FAILED :Treatment terminated or need for permanent
regimen change of at least 2 anti TB drugs
42. DIED: Patient died during treatment
LOST TO FOLLOW UP: A patient whose treatment was interrupted
for 2 consecutive months or more .
NOT EVALUATED : No treatment outcome is assigned.
43. Cohort : a group of patients where RR TB has been
diagnosed & who were started 2nd line MDR TB drug
regimen during a specified time period .
44. EVOLUTION OF TB CONTROL IN INDIA
• 1950-60 - Important TB reasearch at TRC and NTI
• 1962 - National TB Programme
• 1992-Programme review.
• 1997-RNTCP.
• 2006-Stop TB Strategy.
• 2014-End TB Strategy.
• 2020- renamed as NTEP
46. Components of DOTS
• 1.Accountability.
• 2.Good quality sputum microscopy.
• 3.Political commitment.
• 4.Uninterrupted supply of good quality drugs.
• 5.Direct observation therapy
47. NTEP
• Adopted on janurary2020.
• Comprises of 5 levels.
- National level.
-State level.
-District level.
-Sub District level.(Tuberculosis unit level).
- Peripheral Health institutions.
48. Central TB Division
State TB Office
District TB Centre
Tuberculosis Unit
Designated Microscopy Centre
DOT Centre
State TB Officer
DTO, MO-DTC, LT, Driver
MO-TC
STS,STLS
MO, LT
DOT, Provider-MPW, NGO,
PP,Com Vol
State TB Training
and
Demonstration
Centre
• IRL :
Intermediate Ref
Lab
• State Drug Store
49. NTEP
• Goals NTEP ---
• Eliminate TB by 2025 in place of 2030
• Targets NTEP –
• --Decrease incidence by 80%
• --Decrease mortality by 90%
50. • National Level-
-Central TB division (CTB) manages NTEP programme in india.
- supported by NTI( national TB institute), NRL (national
reference laboratories)
• STATE LEVEL –
- comes under NHM of the state.
-resided by state tuberculosis officer(STO), state TB cell (STC)
-supported by STDC (TRAINING , SUPERVISION, MONITORING)
Intermediate refrence labortary (IRL)
IRL lab in himachal -- dharampur
51. • DISTRICT LEVEL -
-Managed by CMO
-Has DTC and resided by full time district TB officer (DTO).and
assisted by other technical and secretarial staff.
• SUB DISTRICT LEVEL(Tuberculosis unit level)-
-Intergrates TB contol Programme with health system.
-Tuberculosis unit (TU) are nodal point for TB control in sub
district with aim of optimum resource utilisation and monitoring
at block levelfo
-Managed by MO(usually BMO),Senior treatment
supervisor,Senior laboratory supervisor
52. - CMO undertake supervisory visits for 7 days in a month
- TU has also 1 microscopy centre.
-
• PERIPHERAL HEALTH INSTITUTIONS(PHI)-
-at least headed by MO
-PHCs, CHCs,FRUs.TB hospitals , Private and NGOs facilities fall
under this level.
-emphasis on case finding and treatment.
- There is 1 TBHV per 1lakh population.
53. Diagnostic test under NTEP
• Sputum smear microscopy –(a) ZN staining
-- (b) LED FM
• Culture medium ---(a) LJ medium
---(b)ALC
• Drug senstivity test
• Molecular diagnostic test –(a) LPA
--(b) NAAT
54. • CHEST X – ray
• Tuberculin skin test (TST)
• TB in HIV – (a) LF-LAM
• Skin test for TB (a) C -TB
59. 99 DOTS
• Low cost mobile phone based technology enabling monitoring
of daily intake of treatment.
• Calls are made on toll free number after taking specified dose
and drug taken is recorded.
60. TB notification
• For proper diagnosis, management and reducing transmission.
• Includes notifying every TB case to CMO via Health Care
Providers.
Ban on TB serology
• Serological tests are highly variable and may reflect remote
infection rather than active disease.
• Poor sensitivity and specificity
61. Direct Benefit Transfer Schemes
• Nikshay Poshan Yojana: Financial Incentive of Rs 500 per
month for each notified TB Patient
• Incentive of complete duration of treatment by linking patients
to Nikshay with AADHAR and PEMS via direct benefit transfer
63. 2 Types of Tools in Diagnosis
• Tools for microbiological confirmation of TB
• Supportive tools for clinical diagnosis of TB
64. Tools for Microbiological Conformation of TB
These include:
• Sputum smear microscopy
A) Zeihl-Neelsen staining
B)Fluorescence staining
• Culture:
A)Solid- Lowenstein Jensen medium
B)Automated liquid culture systems –BACTEC MGIT 960, BacT
Alert or Versatrek etc.
65. • Drug Sensitivity Testing
A)Modified proportionate sensitivity testing (PST) for MGIT 960
system
B)Economic variant of PST using LJ medium
• Rapid Molecular Diagnostic Tests
A)Line probe assay (LPA)
B)Nucleic acid amplification test (NAAT) including CBNAAT and
Truenat
66. Supportive Tools for Clinical Diagnosis of TB
• Radiological test like chest X-ray
• Tuberculin Skin Test (TST)
• Interferon Gamma Release Assay (IGRA)
• Histopathologic tests
67. Sputum Microscopy
• Most commonly used test.
• Number one case finding method all over the world.
• Advantage: It is rapid and economical.
• Disadvantage: It has limited sensitivity in children and PLHIV.
• It is of 2 types further:
Zeihl-Neelsen staining Fluoresent microscopy
68. Collection of Sputum Samples
• The patients should submit 2 sputum samples for microscopy
as the chances of finding TB bacilli are greater with two
samples than with one.
• In practice, the patient provides sputum sample as follows:
DAY 1 sample 1: On the spot sample.
DAY 2 sample 2: Morning sample.
69. • But if patient is,
A) coming from a long distance
B) having likelihood of defaulting to give a second sample
Then 2 spot specimens are collected with a gap of one hour.
72. Slide Reporting
No. Of Bacilli Bacilli Per Slide Result Reported
NO AFB present per 100
slides
0
1-9 AFB present per 100
slides
Scanty/ Number of AFB
seen
10-99 AFB present per 100
slides
+ (+1)
1-10 AFB present per slide ++ (+2)
>10 AFB present per slide +++ (+3)
73. Some Important Points
• Lab technician should observe both slides.
• Smear examined by one microbiologist should not exceed
20/day as visual fatigue leads to deterioration of reading
quality.
• Sputum smear microscopy is positive when there are at least
10,000 organisms present per ml of sputum.
74. False Results in Sputum Microscopy
1) False Negative results may be due to:
A)Collecting Errors
• Inappropriate sputum container
• Inadequate sample
• Sample stored too long
B)Processing Errors
• Faulty sampling of sputum for smear
• Faulty smear preparation and staining
75. C)Interpreting Sputum Smears
• Inadequate time spent examining smear
• Inadequate attention to smear examination
D)Administrative Errors
• Misidentification of patient
• Incorrect labelling of sample
• Mistakes in documentation
76. 2) False Positive results may be due to:
• Red stain retained by scratches on the slide.
• Accidental transfer of AFBs from a positive slide to a negative
slide.
• Contamination of smear or slide by environmental
mycobacteria.
• Presence of various acid fast particles like food particles,
precipitates, other microorganisms.
77. Fluorescence Microscopy
• It is mainly used in developed countries.
• It is performed with auramine stain.
Now, Why is Fluorescent microscopy preferred over ZN staining?
• Field of view is 5-10 times bigger
• Higher speed of examination as scanning of one length
requires only 1-2 minutes.
78.
79. Culturing Methods
• Culturing for isolation of mycobacterium continues to be very
useful in developing countries.
• It requires only 10-100 bacilli/ml of sputum.
• It is done in:
A) Solid media (LJ Media)
B) Automated liquid culture systems (BACTEC MGIT 960, BacT
Alert, Versatrek)
81. Advantages of Culturing
• Useful in HIV infected patients with TB who are severely
immuno-compromised.
• Useful in patients presenting with respiratory symptoms and X-
rays suggestive ,but smear negative.
• Even few bacilli can be grown in spite of smear negativity.
• They can identify treatment failures.
82. Reasons for Fall of Culturing
• Specificity is lost due to contamination.
• Can yield false positive results in 1-4% of the cases.
• Even cultures may be negative in spite of X-rays being
suggestive of TB.
83. Emerging Methods of Culturing
• MGIT- Mycobacterium growth incubator tube method.
• BacT Alert is an automated microbial detection method based
on colorimetric detection of CO2 produced by growing
mycobacteria.
• Versatrek monitors bacterial growth by detecting pressure
changes in headspace of blood culture bottle.
84. Rapid Diagnostic Tools
• These include:
LPA NAAT
Both of these work on PCR in which:
a)TB bacilli are concentrated from sputum sample.
b)Genomic material is isolated from the sample and
subsequently amplified.
85. Line Probe Assay (LPA)
• These detect DNA sequences specific for TB complex as well as
mutations conferring drug resistance.
• Procedure:
a) Sputum samples are decontaminated.
b) Subjected to smear microscopy.
c) DNA is extracted from all smear positive samples.
d) Extracted DNA is subjected to PCR.
86. e) PCR amplified products are reverse hybridized on
nitrocellulose strips containing probes specific for detection of
MTB and mutations associated with drug resistance.
Resistances detected are:
A) First Line
•Rifampicin (rpoB)
•Isoniazid (katG,inhA)
A) Second Line
•Fluoroquinolone class resistance (gyrA, gyrB)
•Second line injectable class resistance (rrs, eis)
87. NAAT
• It also works on the principle of PCR.
• Provides accurate and rapid diagnosis of Mycobacterium
tuberculosis and Rifampicin (Rif) resistance.
• TB bacilli are detected in pulmonary as well as extra-pulmonary
sites.
• Under NTEP, its use is recommended for:
a) DR-TB
b) Children
c) PLHIV
d) Extra Pulmonary TB
e) Smear Negative TB
88. Advantages of NAAT
• Large number of samples can be processed at the same time.
• Results are obtained from unprocessed sputum samples in just
90 minutes.
• Drug resistance can be detected along with determining the
changed drug regimen’s effect on the patient.
Currently, CB-NAAT is the most widely employed method of TB
diagnosis in India.
89. Radiography
• Useful for diagnosis of smear negative pulmonary TB and TB in
children.
• Not routinely indicated in smear positive cases.
• These are valuable tools for the diagnosis of pleural and
pericardial effusion in early stages when clinical signs are
minimal.
• Essential in diagnosis of miliary tuberclosis.
90.
91.
92. Paeditric tuberculosis
• TB in children represent between 6-8% of all TB in age group of
under 15 years .
• SOURCE : Usually an adult often a family member with sputum
smear positive tuberculosis.
• FREQUENCY in a population depends upon-
1. Number of infectious cases
2. Closeness of contact with an infectious case
3. Age of child when exposed to TB
93. TUBERCULIN TEST
• Discovered by Von Pirquet in 1907
• POSITIVE REACTION : evidence of
past or present infection by
M. tuberculosis
• Only means of estimating
prevalence of infection in a
population
94. MANTOUX TEST
• 1 TU of PPD
• 0.1ml - intradermally
•
• On flexor surface of left forearm
(midway between elbow and wrist)
• Injection made with tuberculin
syringe (with needle bevel facing
upwards)
95. .
Mantoux test
Result read after 48- 96 hrs;
72 hrs (3rd day) ideal
>10 mm
POSITIVE
6-9mm
DOUBTFUL
<6mm
NEGATIVE
ERYTHEMA
AND
INDURATION
NO INDURATION – TEST
REGARDED AS ZERO
97. TB Interferon gamma release assays(IGRA)
• Blood tests that measure a
person’s immune response to
bacteria that cause TB .
• Work by detecting cytokine
called interferon gamma
cytokine.
98. .
• ADVANTAGES:
1. Only requires a single patient visit to carry out the TB test.
2. Results can be available within 24 hrs
3. Prior BCG vaccination does not cause false positive result.
• DISADVANTAGE:
1. Blood sample must be processed quickly
2. Test only for latent TB
101. .
.
CBNAAT
MTB detected
MTB not detected
/result unavailable
Consider
alternate
diagnosis
and refer
to
specialist
Clinically
diagnosed
TB
Alternate
diagnosis
Rif
sensitive
Rif
indeterminate
Rif resistant
Refer to
mgt of Rif
resistance
Repeat
CBNAAT on
2nd sample
Microbiologically
confirmed TB
Indeterminate on 2nd sample ,
collect fresh sample for liquid
culture
102. Pediatric tuberculosis
• TB in children represent between 6-8% of all TB in age group of under
15 years .
• SOURCE : Usually an adult often a family member with sputum smear
positive tuberculosis.
• FREQUENCY in a population depends upon-
1. Number of infectious cases
2. Closeness of contact with an infectious case
3. Age of child when exposed to TB
103. .
TB diagnosis is based upon:
• Clinical features
• Smear examination of sputum
• Positive family history
• Tuberculin skin testing
• Chest radiography
• Histopathological examination
105. .
.
• Persistent fever >2 weeks , without a known cause and /or
• Unremitting cough for >2 weeks and /or
• Wt loss of 5% in 3 months or no wt gain in past 3 months
CBNAAT/ Smear ,if CBNAAT
not available
MTB detected
MTB not
detected
/sputum not
available
X-ray and TST
Microbiologically
confirmed TB case
106. .
.
X –ray and tuberculin skin
test
CXR highly
suggestive
CXR NS shadows
TST –VE
CXR Normal
TST +VE
CXR normal
TST -VE
Gastric
aspirate/induced
sputum for CBNAAT
+VE -VE
Microbiologically
confirmed TB
No other diagnosis ~clinically
diagnosed TB
Evaluate for EPTB.
Refer to expert
Look for
alternate cause
107. CXR NS shadows
TST –VE
Give course of
antibiotics
Persistent shadow
and symptoms
Gastric
aspirate/induced
sputum for CBNAAT
-VE
+VE
Refer to
expert for
workup of
persistent
pneumonia
Microbiologically
confirmed TB