Short Lecture about Tuberculosis in the Philippines intended for the lay people.

1. TUBERCULOSIS:
Challenges in Diagnosis,
Treatment & Prevention in
the New Normal
Dr. Nino JN Doydora, MD, FPCP, FPCCP
Speaker – Internist/Pulmonologist

2. SPEAKER
• BS Biology (UP Los Banos)
• Medicine (Cebu Institute of Medicine)
• Internal Medicine (Visayas Community Medical Center
• Pulmonary Medicine (University of Perpetual Help
DALTA Medical Center)
• Member, Council on Tuberculosis & Sleep Medicine
(Philippine College of Chest Physicians)
• Member, European Respirology Society
• Visiting Internist/Pulmonologist – OSPA, Ormoc Doctors’
and Gatchalian Hospitals

3. OBJECTIVES
• Discuss Tuberculosis in the Philippines
• Differentiate TB infection vs disease
• Types of TB infection and disease
• Examples of Extra-pulmonary tuberculosis
• TB diagnosis
• TB treatment
• How to monitor treatment response
• Source: 2020 National TB Program MOP 6th ed

4. TUBERCULOSIS
• #1 infectious disease killer in the
world

5. TUBERCULOSIS
• #1 infectious disease killer in the
world

6. TB GLOBAL
PREVALENCE RATE
• One million Filipinos are infected with TB
• Philippines- 3rd highest in the World (TB prevalence)
• South Africa
• Lesotho
• Philippines
• 70 Filipinos die DAILY needlessly due to TB (& its
complications)

9. CASE #1
• 47 yr old male was rushed to the ER
due to coughing out of blood.
• cough>2 months. W/occasional SOB
• (+) weight loss ~10kg in 3 months,
• (+) loss of appetite
• Chest x-ray is Extensive Cavitary TB
• Diagnosis: Pulmonary Tuberculosis

11. CASE #2
• 13 yr old girl w/ neck lymph nodes
>2 weeks. W/occasional cough
• (+) weight loss, (+) loss of appetite
• Chest x-ray is normal
• Lymph node biopsy:
“caseous necrosis”

12. CASE #2
• Lymph node biopsy: Caseous necrosis

13. CASE #3
• 32 years old female noted to having back
deformity for the past 6-8 months
• No cough
• (+) weight loss, (+) loss of appetite
• (+) history of exposure to PTB patient
(Tatay)
• Chest x-ray : Pott’s Disease

14. CASE #3

17. TB Disease VS Infection
•TB Infection – presence of TB Bacteria
inside the body w/ NO SYMPTOMS
•TB Disease - presence of TB Bacteria
inside the body but with SYMPTOMS

18. Tests for TB Disease &
Infection
• TB Infection – presence of TB Bacteria inside the body w/
NO SYMPTOMS
• PPD Skin Testing, Line Probe Assays, IGRA,
Quantiferon
• TB Disease - presence of TB Bacteria inside the body but
with SYMPTOMS
• Sputum exams: (1) AFB Microscopy (P500) [~56% Sensitive]
• (2) Gene Expert MTB Rif (P8,000)
[~90%]
• (3) TB Culture (P16,000) [~90%]

19. Tests for TB Disease
•(1) bacteriologically confirmed OR
•(2) clinically diagnosed

20. TB Screening & Tests
• Screening
• Chest X Ray and / or
• AFB Microscopy (Sputum, CSF, wound smear, etc)
• PPD Skin Testing (usually for children)
• Other tests
• Sputum Gene Expert (DNA Detection)
• TB Quantiferon or line probe Assays (Blood)
• Gold Standard
• TB Culture (usually Sputum)

21. TB Diagnosis
• Tuberculosis – bacteriologically diagnosed, based on
Clinical signs and symptoms plus either:
• (+) AFB Microscopy (Sputum, CSF, wound smear, etc)
• (+) Sputum Gene Expert (DNA Detection)
• (+) TB Culture (usually Sputum, CSF, etc)
• Tuberculosis – Clinically diagnosed, based on
• Clinical signs and symptoms plus (+) TB in
• Chest Xray or CT scan or Quantiferon

22. Sputum Collection

26. 2Mos 4Drugs+4Mos 2Drugs
2Mos
4Drugs+10Mos2Drugs
Six months
12 months

27. TB Screening & Diagnosis

28. TB Treatment & FF-up

29. TB Prevention
• BCG – is the only vaccine available for TB
• It is however only 56% effective in preventing TB
infection/disease
• It is recommended in countries with high TB burden like
the Philippines but NOT routinely given in countries with
almost NO TB cases like :
• USA
• Canada
• Australia
• European countries

30. SUMMARY
• TB remains a primary health problem
• 3rd in the world – Philippines
• TB ranks 6th among the most common cause of death
• WHO: 70 Filipinos die daily d/t TB & its complications
• We have to step up in our efforts to seek active cases

31. THANK YOU!