Tuberculosis (TB) is a potentially fatal contagious disease that mainly affects the lungs. It is caused by the bacterium Mycobacterium tuberculosis. Globally in 2011-2016, there were an estimated 8.7 million new TB cases. TB can affect any part of the body but most commonly the lungs. It is treated with a combination of antibiotic drugs over a period of 6-9 months. Strict adherence to treatment is important to cure the disease and prevent drug resistance.

1. Submitted By:
Maria Kristina Erika Buendia
Maria Vicky Rodriguez
MAN-2

2. 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 :
- Round nodule/Swelling
- Condition
“Tubercle”
“Osis”

3. Epidemiology:

5. In 2011-2016,there were an estimated 8.7million incidence
cases of TB globally.
Its equivalent to 125cases in 1,00,000 population.
Asian :
African :
59%
26%
Eastern Mediterranean Region: 7.7%
The European Region : 4.3%
Region of the America : 3%

7. Incidence of Tuberculosis

8. Classification
 Extra pulmonary
i. Lymph node TB
ii. Pleural TB
iii. TB of upper airways
iv. Skeletal TB
v. Genitourinary TB
vi. Miliary TB
vii. Pericardial TB
viii. Gastrointestinal TB
ix. Tuberculous
Meningitis
x. Less common forms
Pulmonary TB
- Primary Disease
- Secondary
Disease

9. Types of TB:

10. Types:
A. Pulmonary TB :
1. Primary Tuberculosis :-
The infection of an individual who has not been previously
infected or immunised is called Primary tuberculosis or
Ghon’s complex or childhood tuberculosis.
Lesions forming after infection is peripheral and
accompanied by hilar which may not be detectable on
chest radiography.
2. Secondary Tuberculosis :
The infection that individual who has been previously infected or
sensitized is called secondary or post primary or reinfection
or chronic tuberculosis.

11. B. Extra Pulmonary TB:
20% of patients of TB Patient
Affected sites in body are :
1) 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.
2) Pleural TB:
Involvement of pleura is common in Primary TB
and results from penetration of tubercle bacilli into
pleural space.

12. 3) TB of Upper airways:
Involvement of larynx, pharynx and epiglottis.
Symptoms : Dysphagia, chronic productive cough
4) Genitourinary TB:-
• 15% of all Extra pulmonary cases.
• Any part of the genitourinary tract get infected.
• Symptoms :- Urinary frequency, Dysuria, Hematuria.
5) Skeletal TB:
• Involvement of weight bearing parts like spine, hip, knee.
• Symptoms :- Pain in hip joints n knees, swelling of
knees, trauma.
6) Gastrointestinal TB :
Involvement of any part of GI Tract.
Symptoms : Abdominal pain, diarrhea, weight loss

13. 7) TB Meningitis & Tuberculoma:
5% of All Extra pulmonaryTB
Results from Hematogenous spead of 1%&2% TB.
8) TB Pericarditis:
• 1-8% of All Extra pulmonary TBcases.
• Spreads mainly in mediastinal or hilar nodes or
from lungs.
9) 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.
10)Less common Extra Pulmonary TB
• Uveitis, panophthalmitis, painfull
• Hypersensitivity related phlyctenular conjuctivis.

14. Mode of Transmission:
1. Coughing without covering the
mouth
2. Crowded places with poor
ventilation.
3. Spitting everywhere.
4. Cannot be transmitted by sharing
drinks, toys or personal items.

15. • When a person is exposed to the TB germ and becomes infected,
the person’s own immune system will usually build a wall around
the TB germs, keeping them from growing and multiplying. This is
called latent TB infection or LTBI. The germs can remain dormant in
a person’s body throughout his/her lifetime.
A TB skin test (Mantoux) can be given to see if someone has been
infected with the TB germ. If the skin test is POSITIVE, a chest X‐ray
and sputum test will be done to make sure the person does not
have TB disease. The skin test only determines TB infection. A
positive result does not necessarily mean the person has TB disease.

16. Early Signs and Symptoms:
 Cough
 Chest pain
 Loss of appetite
 Weight loss
 Tiredness
 Fever/chills/night
sweats.

17. Severe Symptoms:
• Persistent cough
• Chest pain
• Coughing with bloody
sputum
• Shortness of breath
• Urine discoloration
• Cloudy &reddish urine
• Fever with chills.
• Fatigue

18. Diagnosis:
1. Bacteriological test:
a. Zeihl-Neelsen stain
b. Auramine stain(fluorescence microscopy)
2. Sputum culture test:
a. Lowenstein –Jensen(LJ) solid medium: 4-18
weeks
b. Liquid medium : 8-14days
c. Agar medium : 7 to 14days

19. 3. Radiography:
Chest X-Ray(CXR)
4.Nucleic acid amplification:
Species identification ; several hours
Low sensitivity, high cost
Most useful for the rapid confirmation of
tuberculosis in persons with AFB-positive
sputa
Utility
AFB-negative pulmonary tuberculosis
Extra pulmonary tuberculosis

20. 5. 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.
1dose = 0.1 ml contains 0.04µg Tuberculin PPD.

21. Tuberculin test interpretation

22. 6. Other biologicalexaminations:
 Cell count(lymphocytes)
 Protein(Pandy and Rivalta tests) – Ascites,
pleural effusion and meningitis.

23. Preventive measures:
1) Mask
2) BCG vaccine
3) Regular medical follow
up
4) Isolation of Patient
5) Ventilation
6) Natural sunlight
7) UV germicidal
irradiation

24. • It is important for the patient to remain at home on isolation. As much as
possible, he/she should stay away from other people in the house by
staying in a separate room or wearing a surgical mask when leaving the
room. Separate bedrooms or beds are highly recommended, if
possible. The patient can not travel, go to work, go to school, go shopping
or participate in any other activity where there is contact with other people.
• The patient needs to cover his/her mouth and nose with a tissue when
coughing or sneezing. These tissues should be flushed, burned or placed in
a sealed leak proof bag before disposal.
• The patient can not leave home except to keep medical
appointments. He/she must wear a surgical mask to the clinic and doctor’s
offices.

25. • The patient should not allow anyone, other than those living with
him/her or those individuals providing care to him/her, into the
home and should stay away from young children.
• These isolation instructions remain in effect until the patient is told
by the health department that he/she no longer has to stay in
isolation.
• These isolation instructions may become effective again after the
patient has been told that he/she is no longer infectious should the
clinical situation change.

26. BCG vaccine
Bacille Calmette Guerin (BCG).
First used in 1921.
Only vaccine available today for
protection against tuberculosis.
It is most effective in protecting
children from the disease.
Given 0.1ml intradermally.
Duration of Protection 15to 20years
Efficacy 0 to 80%.
Should be given to all healthy infants
as soon as possible after birth unless
the child presented with symptomatic
HIV infection.

27. Infectious Period:
 The infectious period is the time when a patient sick with active TB can pass
the germs to other people.
 The infectious period begins 3 months prior to the onset of symptoms or
clinical sign of TB.
 The infectious period continues until all of the following criteria is met:
1. 3 consecutive smear negative specimens
2. The patient is on appropriate medications
3. The patient is getting better.
 The infectious period is important to determine in order to focus the contact
investigation

28. Management:

29. DRUGS MOA DIAGRAM
Isoniazid Inhibits mycolic acidsynthesis.
RIFAMPICIN Blocks RNA synthesis by blocking
DNA dependent RNA polymerase
PYRAZINAMIDE Bactericidal-slowly metabolizing
organism within acidic
environment of Phagocyte or
caseous granuloma.

30. DRUGS MOA DIAGRAM
ETHAMBUTOL • Bacteriostatic
•Inhibition of Arabinosyl
Transferase
STREPTOMYCIN Inhibition of Protein
synthesis by disruption of
ribosomal function

31. ADRs and its
Management

32. Dosage regimen
 Intensive phase + continuation phase
 HREZ (2 months) + HRE (4 months)

33. Treatment Regimen According to WHO
ISONIAZID (H) RIFAMPICIN (R) PYRAZINAMIDE (Z)
ETHAMBUTOL(E) STREPTOMYCIN (S)

34. DOTS
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 everydose.

36. Multi-Drug Resistance TB
 TBcaused by strains of
Mycobacterium tuberculosis
that are resistant to at least
isoniazid and rifampicin, the
most effective anti- TB drug.
 Globally, 3.6% are estimated to
have MDR-TB.
 Almost 50% of MDR-TB
cases worldwideare
estimated to occur in
China and India.

37. Extensively drug resistance TB:
Extensively drug-resistant TB (XDR-TB) is aform 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 orcapreomycin).

38. Tuberculosis and HIV
Worldwide the number of people infected with both HIV
and TB isrising.
The HIV virus damages the body’s immune system and
accelerates the speed at which TB progresses from a harmless
infection to a life threatening condition.
The estimated 10% activation of dormant TB infection over the
life span of an infected person, is increased to 10% activation
in one year, if HIV infection is superimposed.
It is the opputunistic infection that most frequently kills
HIV-positive people.

39. Epidemiological Impact
Reactivation of latent infection- People who are infected
with both HIV and TB are 25 to 30 times more likely to develop
TB again than people only infected with TB.
Primary Infection- New tubercular infection in people
with HIV can progress to active disease very quickly.
Recurring infection- in people who were cured of TB.

40. Diagnosis of TB in people with 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.

41. Discharge Instructions for Tuberculosis
(TB)
TB may scar the lungs and other parts of the body, such as the kidneys, bones, or
brain.
Here’s what you can do to take care of yourself and to prevent the spread of TB.
 Take your medicine exactly as directed. Continue taking it even if you start to feel better. You will
take medicine for at least 6 months and maybe longer. Not taking your medicine for the full course
may lead you to get sick again. It also increases the chance of drug-resistant TB. Drug-resistant TB
means that one or more of the usual medicines for TB don’t work.
 If you are taking birth control pills, use an additional backup method of birth control. Some TB
medicines may interfere with the pill’s effectiveness.
 Check with your healthcare provider before taking any over-the-counter medicines.
 Sleep in a room alone and with good air flow (ventilation).
 Limit your activity to avoid feeling tired. Plan frequent rest periods.
 Keep your healthcare appointments. You will need to be checked regularly for several months to a
year to make sure you are free from TB bacteria.

42. Reference:
 https://www.saintlukeskc.org/health-library/discharge-
instructions-tuberculosis-tb
 https://dph.georgia.gov/sites/dph.georgia.gov/files/TB-
ClinicForm12_Points_PtEd.pdf