T.B, Pulmonary Disease, Tuberculosis, cell wall structure of Mycobacterium tuberculosis.Symptoms of T.B, BCG vaccine uptake vs disease trend, mode of transmission, Prevention, Isoniazid, Rifampicin, Ethumbutol,Pyrazinamide, Streptomycin,those of antitubercular drug, first line drug, second line drug.

2.  Introduction:
Dis-easiness,
Opposite of health,
Deviation of physical & mental body function.
‘WHO’, ---
Disease is defined as the condition of the body or any parts of
the body or any organ of the body in which the function is deviated or
impaired.
 Tuberculosis is a ‘communicable disease’.
 It is caused by Mycobacterium tuberculosis .
 This bacteria infects lung, that’s why it’s also known as Pulmonary
Tuberculosis .

3.  Description:
Cell wall of Mycobacterium is made up with Peptidoglycan, Lipoprotein,
Arabinoglycan .
Only due to the presence of Arabinoglycan in the cell wall of
Mycobacterium, antibiotic can’t cross this layer. That’s why antibiotics
can’t destroy this bacteria.
So, we use different dosage to cure Tuberculosis(T.B.).

4. Symptoms:
Tuberculosis is usually asymptomatic. But following features are
happened during Tuberculosis.
 Weight loss.
 Malaise develop insidiously.
 Night sweats are common.
 Chronic coughing with or without blood in the sputum.
M. tuberculosis

6.  Mode of Transmission:
 Droplet Infection:
Droplet is a form of aerosol in which virus or bacteria is surrounded
by the bubble.
Droplet Infection depends upon----
I. Rate & intensity of talking & coughing determine the transmission.
II. Size of droplet is an important parameter to carry viable bacteria.
III. Status of ventilation.
 Indirect Contact:
Use of contaminated items or dust particles
contaminated by infected sputum.

7.  Prevention:
 Control:
I. Personal Hygiene.
II. Social Hygiene.
III. Self-consciousness & health education.
IV. Isolate the patient with proper care.
 Treatments:
 WHO in 1995 recommended “DOTS” (Directly Observed
Treatment Short-course).
 “MDT” (Multi-Drug-Therapy).
There are some drugs combination for treatment of Tuberculosis known
as First Line Drugs.
These drugs are------
I. Isoniazid (H)
II. Rifampicin (R)

8. III. Ethambutol (E)
IV. Pyrazinamide (Z)
There are some other drugs used for the treatment of T.B. are known
as Second Line Drugs……
Ethionamide, Prothionamide, Rifabutin, Ofloxacin, Levofloxacin,
Ciprofloxacin, Kanamycin.
 This treatment is continued for 8 months.
 All 4-drugs are used combine for 2 months.
 Then only Isoniazid & Rifampicin are used combine for last 6
months.
Ethumbutol

9. Dose combinations of Anti tuberculosis drug

11. Gamma Interferon test:

12.  This disease can curable by the help of DOTS.
 But in between this 8 months course, any dose should not be
missed by a T.B. patient.
 If any one dose is missed by the T.B. patient, then the course is
again restarted from the first dose.
 So a T.B. patient must be careful to take all the dose self.
 These doses are given to the patient at free of cost from any
Government Hospital.
 About 3% of all people who develop T.B.

13.  References:
 Arthur C. Guyton, M.D., John E. Hall, Ph.D., Textbook of
Medical Physiology, 11th Ed., Elsevier Saunders, Respiration,
Tuberculosis, Page no- 530.
 Anne Waugh, Allison Grant, Ross and Wilson Anatomy and
Physiology in Health and Illness, 9th Ed., Churchill Livingstone,
The Respiratory System, Tuberculosis, Page no- 264-265.
 Dr. John Everett Park, Park’s Text Book Of Preventive & Social
Medicine, 17th Ed., M/s Banarsidas Bhanot Publishers,
Epidemiology of Communicable Disease, Respiratory infections,
Tuberculosis, Page no-138-152.
 KD Tripathi M.D., Essentials of Medical Pharmacology, 7th Ed.,
Jaypee Brothers Medical Publishers (P) Ltd., Antitubercular
Drug, Tuberculosis, Page no- 765- 779.