Outline of TB diagnosis and Management in Bangladesh

1. Presented By
Dr. Amirul Huda Bhuiyan

2. Tuberculosis
• An infectious disease caused by bacilli called
Mycobacterium tuberculosis

3. Mode of spread
One person with TB disease can infect 10
person in his lifetime

4. TB Bacilli in Human body
TB Infection(immunity is not Compromised)
• Bacilli remain inactive (Latent)
• Sign/Symptom do not appear
• Cannot spread TB bacilli
• Not a Case of TB
• Do not need treatment
• Tuberculin test may (+ve)
TB Disease (immunity Compromised)
• Bacilli remain active
• Sign/Symptoms appear
• Can spread TB Bacilli
• A case of TB
• Need treatment
 90% of TB infected
people do not progress to
TB Disease
 50% people infected with
TB bacilli in Bangladesh.
 1/3rd of world population
has latent TB
 Around 10% of TB infected
People may progress to TB
Disease.

5. Diagnosis of Tuberculosis (pulmonary)
Persistent cough for three weeks or more,
with or without production of sputum.
Presumptive TB

6. Presumptive TB patient must be
tested for TB

7. Tools for Diagnosis of TB
• Sputum microscopy should always be
requested for a patient who cough for 3
weeks or more, even in absence of any other
symptom
• Chest X-Ray – For smear –ve TB should
always be supported by clinical feature
• Mantoux test – For supporting TB diagnosis
in children and EP case.

8. Tools for Diagnosis of TB
• Culture of TB Bacilli- More sensitive but not
accessible to all patients
• Gene X-pert- MTB & Rifampicin resistance.

9. Sputum Specimen

10. Flow chart-1
Cough for 3 weeks or more
Sputum smear microscopy
1 or 2 Smear +Ve for TB
RetreatmentNew case
Start CAT I Send sputum for Xpert
MTB/RIF
And start Cat II
MTB detected, Rifampicin
sensitive
MTB detected, Rifampicin
resistant
Continue Cat II Treat as MDR TB, refer to PMDT

11. Flow chart-2
Cough for 3 weeks or more
Sputum smear microscopy
2 smear negative
1.Do CXR
2. Do Xpert MTB/RIF if highly suggestive of TB
CXR Positive Xpert MTB/ RIF positive
Start treatment as per as Xpert MTB
Both negative
Antibiotic for 1to2 weeks
If symptom persist repeat sputum
microscopy, Xpert MTB
Positive
Start treatment as per as Xpert MTB
Negative
Non TB Case, Follow UP
Follow flow chart
from previous
slides, from
new/retreatment

12. Flow chart-3
Cough for 3 weeks or more
Sputum smear microscopy
2 smear negative
If not highly suggestive of TB
Antibiotic for 1to2 weeks
If symptom persist repeat sputum microscopy, Xpert MTB
Negative Positive
Non TB Case, Follow UP Start treatment as per as Xpert MTB

14. Treatment Regimen
Category TB Patients TB treatment regimens
Initial phase(daily) Continuation Phase
I New smear Positive
New smear negative
EPTB
2(HRZE) 4(HR)
II Previously treated sputum
smear positive TB
Relapse
Treatment after interruption
Treatment failure
2(HRZE)S/1(HRZE) 5(HR)E

15. Category I
Pretreatment weight Intensive phase daily 4FDC Continuation phase, daily 2FDC
30-37 2 2
38-54 3 3
55-70 4 4
>70 5 5

16. Follow up
• Clinical
• Laboratory (Through sputum examination)

17. Follow up-Through sputum
examination CAT I
Routine sputum exam. At the end of
2nd, 5th and 6th months
If sputum results are negative at the
end of 6th month and any one of the
previous occasions
Declared as CURED
Do Gene Xpert, if RIF sensitive start
continuation phase. If RIF resistant-
start MDR Rx
Do sputum at the end of 5th month
if patient is on continuation phase.
Declared as Failure & do Gene Xpert
if RIF sensitive then start Cat Ii if
resistant start MDR Rx.
If remain +Ve at the end
of 2nd month
If remain +Ve at the end
of 5th month

18. Follow up-Through sputum
examination CAT II
Routine sputum exam. At the end of
3rd , 5th and 8th months
If sputum results are negative at the
end of 8th month and any one of the
previous occasions
Declared as CURED
Do Gene Xpert, if RIF sensitive start
continuation phase. If RIF resistant-
start MDR Rx
Do sputum at the end of 5th month
if patient is on continuation phase.
Suspect MDR, advice for Gene
Xpert/CS
Declare as chronic and refer to
specialized center
If remain +Ve at the end
of 2nd month
If remain +Ve at the end
of 5th month
If remain +Ve at the end
of 5th month

19. Follow up-Through sputum examination
Smear negative patient
Routine sputum exam. At the end of
2nd months
Continue and complete treatment
Declare as treatment completed
Declare as failure case and start Cat
II
If remain +Ve at the end
of 2nd month
If result –ve at the end of 2nd month
Extra pulmonary patient
No sputum smear examination
is necessary and patient should
be assessed clinically.

21. Thank YOU………….