Tuberculosis is a global health problem, infecting one third of the world's population and causing millions of deaths annually. It is the 6th highest cause of disease in Pakistan, where the incidence of active TB cases is over 80 per 100,000 people each year. TB is caused by the bacterium Mycobacterium tuberculosis, which is transmitted through the air when people with active TB cough or sneeze. It most often affects the lungs but can damage other organs. While the immune system usually keeps the infection under control, active disease can develop if the bacteria overpowers immunity.

1. TUBERCULOSIS

2. EPIDEMIOLOGY
• WHO declared TB a global emergency in 1993.
• Worldwide, one person in three is infected with TB.
• About 8 million people develop disease every year
• It kills more than 3 million people annually. Yet it is completely
curable and (relatively) inexpensive to cure.

3. EPIDEMIOLOGY IN PAKISTAN
• Pakistan ranks 6th amongst the countries with a highest
burden of TB in the world.
• TB is responsible for 5.1 percent of the total national disease
burden in Pakistan.
• Pakistan contributes about 44% of tuberculosis burden in the
Eastern Mediterranean Region.
• According to WHO, the incidence of sputum positive TB cases
in Pakistan is 80/100,000 per year and for all types it is
177/100,000.

4. ETIOLOGY
• TB is caused by an organism called Mycobacterium
tuberculosis that is spread from person to person through the
air. M. tuberculosis organisms are sometimes called tubercle
bacilli.
Some characteristics Of M. tuberculosis:
• Slightly curved rod shaped bacilli
• Thick lipid cell wall
• Can remain dormant for years
• Aerobic
• Non-motile
• Multiplies slowly (18-24 hrs)

5. HOW IS TB TRANSMITTED?
• When a person with infectious TB disease coughs or
sneezes, droplet nuclei containing tubercle bacilli may be expelled
into the air. Other people may inhale the air containing these
droplet nuclei and become infected.
• Less frequently, TB can be transmitted by:
Ingestion of Mycobacterium bovis found in unpasteurized
milk products.
Laboratory accident.

6. • Millions of tubercle bacilli in lungs (mainly in cavities)
• Coughing projects droplet nuclei into the air that contain
tubercle bacilli
• One cough can release 3,000 droplet nuclei
• One sneeze can release tens of thousands of droplet nuclei

7. PATHOGENESIS
• As the TB tries to spread to other parts of the body, it is often
interrupted by the body's immune system. The immune system
forms scar tissue or fibrosis around the TB bacteria, and this helps
fight the infection and prevents the disease from spreading
throughout the body and to other people.

8. ACTIVE TB INFECTION
Germs:
• Awake and multiplying
• Cause damage to the lungs
Person:
• Most often feels sick
• Contagious (before pills started)
• Usually have a positive tuberculin skin test
• Chest X-ray is often abnormal (with pulmonary TB)

9. LATENT TB INFECTION
• If the body's immune system is unable to fight TB or if the bacteria
breaks through the scar tissue, the disease returns to an active state
with pneumonia and damage to kidneys, bones, and the meninges
that line the spinal cord and brain.
Person:
• Not ill
• Not contagious
• Normal chest x-ray
• Usually the tuberculin skin test is +ve
Germs:
• Sleeping but still alive
• Surrounded (walled off) by body’s immune system

10. WHO GETS TUBERCULOSIS?
Although anyone can become infected with TB, some people are
at a higher risk, such as:
• Those who live with others who have active TB infections
• Overcrowded habitations
• Poor or homeless people
• Foreign-born people who come from countries with endemic TB
• Older people, nursing home residents, and prison inmates
• Alcoholics and intravenous drug users
• Those who suffer from malnutrition
• Diabetics, cancer patients, and those with HIV/AIDS or other
immune system problems
• Health-care workers
• Workers in refugee camps or shelters