The document is a comprehensive overview of tuberculosis (TB), a contagious disease primarily affecting the lungs, with significant global health implications, such as causing 1.6 million deaths annually. It outlines the causes, types, risk factors, diagnosis, and treatment options for TB, highlighting the challenges posed by multidrug-resistant strains. It also emphasizes the importance of careful management, especially for patients with coexisting HIV infections.

1. Presented by- Mrs. Khushnasib
Associate Professor
Subject – Adult health nursing

2. Tuberculosi
s
Presented by – Mrs. Khushnasib
Associate Professor

3. Contents
Introduction
Risk Factors
Types - Causes
Diagnosis(C/P – Investigation)
Treatment

4. INTRODUCTION

5. Definition
 Tuberculosis (TB) is a potentially fatal contagious
disease that can affect almost any part of the body
but is mainly an infection of the lungs.
 Neo-latin word :
o Tubercle = Round nodule/Swelling
o Osis = Condition

6. Global Status of TB
 Tuberculosis (TB) kills 1.6 million people a year
o 0.2 million people infected with HIV
o 98% of these deaths occur in the developing world.
 Close to 9 million new cases develop every year and about one
third of the world’s population is infected with Mycobacterium
tuberculosis.
 TB is a major cause of death among people with
HIV/AIDS and infection is the most potent risk factor for the
conversion of latent TBinfection to active
TB.

7. Global Status of TB
 Multidrug-resistant TB (MDR-TB) has emerged
in nearly every country of the world. Extensively
drug- resistant TB (XDR-TB) has been
identified in 17 countries and in all
geographical regions.

8. Causes of TB

9. Human
Animals
Causative Organisms
 Mycobacterium tuberculosis
 Mycobacterium Bovis
 Others:
o Mycobacterium africanum
o Mycobacterium microti

10. Mycobacterium tuberculosis-Characteristics
 Gram positive
 Obligate aerobe
 Slow generation time: 15-20 hours
 Lipid rich cell wall contains mycolic
acid:
o Responsible for many of
bacterium
characteristics.
o Acid fast.
o Causes resistance to antibacterials.

11. Types of TB

12. Classification
I. Pulmonary TB
 Primary Disease
 Secondary Disease
II. Extra pulmonary
 Lymph node TB
 Pleural TB
 TB of upper airways
 Skeletal TB
 Genitourinary TB
 Miliary TB
 Pericardial TB
 Gastrointestinal TB
 Tuberculous Meningitis

13. TYPES
I. Pulmonary TB
 Primary Tuberculosis :-
 The infection of an individual who has not
been previously infected or immunised
 Lesions forming after infection is peripheral
and accompanied by hilar which may not
be detectable on chestradiography.

14. TYPES
 Secondary Tuberculosis :
 The infection that individual who has been
previously infected or sensitized is
called secondary or postprimary or
reinfection or chronic tuberculosis.

15. TYPES
II. Extra-pulmonary TB
i. Lymph node TB ( tuberculuous lymphadenitis)
 Seen frequently in HIV infected patients.
 Symptoms :- Painless swelling of lymph nodes most commonly
at cervical and Supraclavical (Scrofula)
 Systemic systems are limited to HIV infected patients.
ii. Pleural TB
 Involvement of pleura is common in Primary TB
 and results from penetration of tubercle bacilli into pleural space.

16. TYPES
iii. TB of Upper airways
 Involvement of larynx, pharynx and epiglottis.
 Symptoms :- Dysphagia, chronic productive cough
iv. Genitourinary TB
• 15% of all Extra pulmonary cases.
• Any part of the genitourinary tract get infected.
• Symptoms :- Urinary frequency, Dysuria, Hematuria.

17. TYPES
v. Skeletal TB
 Involvement of weight bearing parts like spine, hip,
knee.
 Symptoms :- Pain in hip joints n knees, swelling of knees,
trauma.
vi. Gastrointestinal TB
 Involvement of any part of GI Tract.
 Symptoms :- Abdominal pain, diarrhea, weight loss

18. TYPES
vii. TB meningitis
 Results from Hematogenous spead of primary & secondary
TB.
viii.TB Pericarditis
 1- 8% of All Extra pulmonary TB cases.
 Spreads mainly in mediastinal or hilar nodes or from lungs.

19. TYPES
ix. Miliary or disseminated TB
 Results from Hematogenous spread of Tubercle Bacilli.
 Spread is due to entry of infection into pulmonary vein producing
lesions in different extra pulmonary sites.
x. Less common Extra Pulmonary TB
 uveitis, panophthalmitis, painful Hypersensitivity
related phlyctenular conjuctivis.

20. Risk Factors

21. Risk factors
 Elderly
 Infants
 Low socioeconomic status
 Crowded living conditions
 Disease that weakens immune system like HIV
 Alcoholism
 Recent Tubercular infection (within last 2 years)
and ect.

22. Diagnosis

23. Medical History
 HIV status
 Symptoms of disease
 History of TB exposure, infection, or disease
 Past TB treatment
 Demographic risk factors for TB
 Other medical conditions that increase risk for
TB disease (e.g., diabetes)

24. Systemic Symptoms
 Fever
 Chills
 Night sweats
 Appetite loss
 Weight loss
 Fatigue

25. Symptoms of Pulmonary TB
 Productive, prolonged cough (duration of
2-3 weeks)
 Chest pain
 Hemoptysis (bloody sputum)
 Symptoms may vary based on HIV status

27. Investigation

28. LAB
 Bacteriological test
 Obtain 3 sputum specimens for
smear examination and
culture
 3 respiratory specimens will
detect 90% of smear-
positive cases
 Look forAFB smear-

29. Acid fast smear showing TB bacilli

30.  PTB+ (Pulmonary TB smear-positive)
 One AFB-positive smear; i.e. any patient with at least
one positive smear result (irrespective of
quantity of AFBs seen on microscopy)
 PTB- (smear-negative)
iii.
i. Patients with three negative smear results and
radiological findings and doctor’s decision to treat for TB
ii. Patients with negative smear results and a positive
culture result for M. tuberculosis
Patients who are unable to produce sputum and with
highly suspicious radiological and clinical findings
and doctor's decision to treat for TB

31. LAB
 Sputum culture test
Culture is indicated for
i. New and retreatment PTB
cases still smear- positive at
end of intensive phase
ii. Symptomatic contacts of
known MDR
cases

32. Radiography
 Chest X-Ray(CXR)
 Cannot confirm diagnosis of TB
 May have unusual
appearance in HIV-positive
persons
 CXR is helpful in HIV+,
smear- negative patients

33. Tuberculin skin test (PPD)
 Injection of fluid into the skin of the lower
arm.
 48-72 hours later -checked for a reaction.
 Diagnosis is based on the size of the wheal:
o <6mm negative
o 6mm-15mm Hypersensitive to
tuberculin protein(Previous TB infection or BCG
– atypical mycobacteria)
o >15mm strongly Hypersensitive
to tuberculin protein(suggestive of TB
infection)

35. Other biological examinations
 Cell count(lymphocytes)
 Protein(Pandy and Rivalta tests) – Ascites,
pleural effusionand meningitis.

36. Treatment

37. Aims of TB Treatment
 Cure the patient of TB
 Prevent mortality from active TB or its latent
effects
 Prevent relapse of TB
 Decrease transmission of TB to others
 Prevent the development of acquired
resistance

38. Preventive measures
 Mask
 BCG vaccine
 Regular medical follow
up
 Isolation of Patient
 Ventilation
 Natural sunlight

39. BCG vaccine
 Only vaccine available today for protection
against tuberculosis.
 effective in protecting children from the disease.
 Given 0.1 ml intradermally.
 Duration of Protection 15 to 20 years
 Should be given to all healthy infants as soon as
possible after birth unless the child presented
with symptomatic HIV infection.

40. Basic Principles of Treatment
 Determine the patient’s HIV status- this could
save their
life!
 Provide safest, most effective therapy in shortest
time
 Multiple drugs to which the organisms
are susceptible
 Never add single drug to failing
regimen

41. DOTS
 Directly observed treatment, short-course
 DOT means that a trained health care worker or other
designated individual provides the prescribed TB
drugs and watches the patient swallow every dose.
 DOT for all patients on all regimens (NO exceptions)

42. FIRST LINE ANTI-TUBERCULOUS
DRUGS
 Isoniazide
 Rifampicin (Rifampin)
 Ethambutol
 Pyrazinamide
 Streptomycin

43. SECOND LINE ANTI-TUBERCULOUS
DRUGS
 Para aminosalicylic acid
 Ethionamide
 Cycloserine
 Fluoroquinolones
 Capreomycin

44. REGIMEN OF TB THERAPY
Patients with active TB:
 Initial phase (first 2-4 months): 4 drugs are used
(RIPE): (Rifampin + INH + Pyrazinamide +
Ethmabutol).
 Continuation phase (next 4-6 months): at least 2 drugs
are used (INH + rifampin).

45. REGIMEN OF TB THERAPY
Patients with latent TB:
 Latent TB (i.e. patients with +ve Tuberculin skin test and
had history of contact to a person proved to have TB)
 INH alone for 6 months or dual Rifampicin + INH
for 3 months.

46. REGIMEN OF TB THERAPY
TB during pregnancy:
 The only anti-TB drug which is absolutely
contraindicated is streptomycin because of the high risk of
congenital deafness.
 other first line anti-TB drugs are safe for use in
pregnancy.

47. REGIMEN OF TB THERAPY
TB with liver disease
 INH, rifampin, and pyrazinamide are hepatotoxic but
because of their effectiveness, they should be used depending
on monitoring of liver function tests.
 In severe liver damage, only one drug can be used.

48. used
Extrapulmonary TB
 In most cases, treat with same
regimens for pulmonary TB
depending on
 Treatment extended > 6
months site of disease
 In TB meningitis Streptomycin
replaces Ethambutol

49. Multi-Drug Resistance TB
 TB caused by strains of Mycobacterium tuberculosis
that are resistant to at least isoniazid and
rifampicin, the most effective anti- TB drug.
 3.6% are estimated to have MDR-TB.
 Treatment must be individualized
 should seek expert consultation
 6 months intensive treatment (always including an
injectable drug) followed by at least an 18
month continuation phase

50. Extensively drug resistance TB
 is a form of TB caused by bacteria that are
resistant to isoniazid and rifampicin (i.e. MDR-
TB) as well as any fluoroquinolone and any of the
second-line anti-TB injectable drugs (amikacin,
kanamycin or capreomycin).

51. Tuberculosis and HIV
 HIV positive people with pulmonary TB may have a
higher frequency of having sputum negative smears.
 The tuberculin test often fails to work, because the
immune system has been damaged by HIV; It
may not even show a response even though the
person is infected with TB.
 Chest Xray will show less cavitation.
 Cases of Extra pulmonary TB are more common.
 Management of HIV-related TB is complex

52. Thank
you!
Any Questions?