The document outlines Dr. Darshna Sarvaiya's presentation on tuberculosis (TB). The objectives of the presentation are to discuss the history and milestones of TB, the global and Indian burden of TB, the natural history and epidemiology of the disease, and interventions for TB control up to diagnosis. Key points include that TB is caused by mycobacteria and affects the lungs in most cases. India accounts for a quarter of global TB cases. Control measures aim to reduce prevalence and incidence through early detection and treatment of active cases.

1. Presenter: Dr.Darshna Sarvaiya
1st year resident
Community Medicine
Tuesday, June 21, 2022
TB- An Overview
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2.  To enumerate the important milestones in the history of Tuberculosis
 To state the burden of Tuberculosis in India & globally
 To explain the Natural History of Disease
 To explain the different Epidemiological Indices
 To describe the interventions to control Tuberculosis (Up to Diagnosis)
Tuesday, June 21, 2022
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3. Chronic granulomatous disease
Causative agent : 1) Human : mycobacterium tuberculosis
2) Animal : mycobacterium bovis
Pulmonary Tuberculosis ( 85 % )
Extra – pulmonary Tuberculosis ( 15 % )
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4. Tuesday, June 21, 2022
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5. Hippocrates( 460 B.C. )
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6. ARISTOTLE( 384 B.C.)
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7. Tuesday, June 21, 2022
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8. Robert Koch – march 24,1882
Discovery of causative agent
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9. Von pirquet – 1907
Discovery of tuberculin test
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10. BCG vaccine – ( 1906 – 1921 )
Invention of BCG vaccine
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11.  Consumption
 Phthisis pulmonaries
 Scrofula
 King’s evil
 king’s disease
 Rajayakshma
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13. Tuesday, June 21, 2022
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14. Amitabh Bachchan.
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15. René Laennec
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16. Kamala Nehru
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17. Adolf Hitler
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18. Muhammad Ali Jinnah
the founder of Pakistan
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19. Kahlil Gibran
World famous Lebanese -American
artist and poet
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20. Desmond Tutu
human and social rights activist
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21.  World wide public health problem  top 10 causes of death worldwide
 10.0 million cases – diagnose with TB
 6.7million case - notified
 5.8 million men , 3.2 million women , 1 million child
 Only 6% of global cases were in the WHO European Region (3%) and WHO Region of the Americas
(3%)
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23. Tuesday, June 21, 2022
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24.  5,58,000  MDR –TB cases
 1,39,114  enrolled for treatment
 Three countries accounted for almost half of the world’s case MDR/RR-TB:
India , china , Russian federation
 The severity of national epidemics varies widely among countries.
In 2017 – fewer than 10 new cases per lac population in high income country
150 – 400 cases per lac population in most of 30 high TB burden
Tuesday, June 21, 2022
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25.  Treatment outcome :
 82% TB , 77 % HIV associated TB , 55 % MDR /RR-TB , 34 % XDR –TB
 The actual burden of paediatric TB is not known due to diagnostic difficulties
 Assumed that about 10 % of total TB load found in children
 Globally , 1 million cases of paediatric TB cases every year  > 1,00,000
deaths
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26.  India is the highest TB burden country in the world in
terms of absolute number of incident cases that occur
each year .
 Accounts for 1/4th of the estimated global incident TB
cases in 2017.
 Each year approx. 2,2o,ooo deaths
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27.  TB kills more women in reproductive age group
 Create more orphans than any other infectious disease
 children of the TB patient either leave the school or take up employment to
support their families
 Vast majority -> loss of life rather than morbidity
 Poor living condition , malnutrition , small housing , overcrowding
 HIV  increase susceptibility
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28. Natural history of disease
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29.  Mycobacterium Tuberculosis , mycobacterium bovis
 M. Tuberculosis complex : - M. africanum
- M. bovis
- M . Canetti
- M . microti
 Atypical Mycobacteria :
1) photo chromogens : M. kansasii
2) non- scotochromogen : M. intercellulare
3) scotochromogen : M. sacrofulaceum
4) rapid growers : M. fortuitum

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30.  Two sources : 1) human & 2) bovine
 1) Human source :
- Most common source of infection
- TB cases whose sputum is +ve for tubercle bacilli , who has not received treatment or not Treated fully
 2) Bovine source :
- Infected milk
- Not much problem in the country  boiling of the milk before consumption
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31.  Pts. are infective as long as they remain untreated
 Effective antimicrobial treatment reduces infectivity by 90% within 48 hours
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32.  Age : affect all the age group ( 2 % in 0- 14 years , 20 % in 15-24 years )
 Sex : more prevalent in male
 Hereditary : No
 Nutrition : malnutrition predispose to TB
 Immunity : no inherited
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33.  Poor socioeconomic status : -
- Over crowding
- Decrease hygiene & sanitary conditions
- Nutrition deficiency
- Poor quality of life
 Exposure to the silica : silicosis
 Hormonal factor : D.M.
corticosteroid
 HIV / AIDS
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34.  Reservoirs :
- human patients
- infected cattle
 Mode of spread :
1) Man to man : I) Micro-droplet ( airborne )
( coughing , spitting , sneezing , talking etc. .. )
II ) Dried sputum ( may survive dried sputum for months
without sun exposure )
2) Cattle to man : I ) drinking infected raw milk
Tuesday, June 21, 2022
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35.  Ranges from 3 to 6 weeks
 Depend upon closeness of contact
 Extent of disease
 Sputum positivity of the source case
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37.  Incidence :
- No. of new cases and recurrent ( relapse ) episodes of TB occurring in a given year
 Prevalence :
- No. of TB cases ( all forms) at a given point in time
 Mortality :
- No. of deaths caused by TB in HIV-negative people
 Case-fatality rate :
- Risk of death from TB among people with active TB disease
 Case notification rate :
- New or recurrent episodes of TB notified to WHO for a given year ,expressed per 1 lac population
 Case detection rate :
- No. of notification of new and relapse cases in a year divided by the estimated incidence of such
cases in a same year
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38.  Prevalence of drug resistant cases :
- prevalence of patient excreting tubercle bacilli resistant to anti – TB drug
 Prevalence of infection :
- percentage of individual who shows a positive reaction to the standard
tuberculin test
 Incidence of infection : ( annual infection rate ) :
% of population under study who will be newly infected by M. TB among
the non-infected of the preceding survey during the course of one year.
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39. A) Case definition :
a) Bacteriologically confirmed TB case
b) Clinically diagnosed TB case
Classify according to :
1) Anatomical site : pulmonary & extra pulmonary
2) History of previous treatment :
- Previously treated pt.- 1 or more month of Tx
- Relapse : person who returns smear +ve having previously treated and declare cure
- Tx after failure patients : person with smear +ve treated and again become +ve at end of their Tx
- Tx after loss to follow up : previously Tx for TB & declare loss to follow up at the end of Tx
- Patient with unknown previous TB treatment : do not fit into any of the category
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40. 3) Based on drug resistance :
- Mono resistance : resistance to one first –line anti –TB drugs only
- Poly drug resistance : > 1 first line anti TB drug
- Multi drug resistance: both isoniazid & rifampicin
- Extensive drug resistance : any fluoroquinolones & one of three second line inj. drugs
- Rifampicin resistance : without resistance to any other drug
- Total drug resistance : resistance to the all the first & second line anti-TB drug
4) Based on HIV status :
- HIV negative TB patient
- HIV status unknown by TB patient
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41. B) Treatment outcome
- Cured : bacteriologically confirmed TB  smear or culture –ve
- Tx completed : completed Tx without evidence of failure
- Tx failed : smear or culture +ve at 5 month or later during Tx
- Died : dies for any reason before or during TB treatment
- lost to follow –up : did not start treatment
- Not evaluated : no Tx outcome are assigned
- Treatment success cohort : cured & Tx completed
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42.  TB control means reduction in the prevalence and incidence of the disease in the community
 The WHO define that tuberculosis “ control” is said to be achieved when the prevalence of
natural infection in the age group 0-14 year is of the order of 1% . This is about 40 % in India .
 Control measure consist of :
1) Curative component
2) Preventive component
 Most powerful tool in containing the disease in Case finding & treatment
 Case finding : early detection of sputum +ve cases
 Case definition : WHO define – a pt. whose sputum is +ve for TB bacilli Tuesday, June 21, 2022
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43.  Live attenuated , freeze dried powder
 Common strain used – Danish 1331 produced at guindy , tamilnadu , India
 Reconstituted with sterile water
 Induced cell mediated immunity
 Primary infection is not prevented
 Duration of protection – 15 to 20 years
 Administration at birth provides – early protection
ensure compliance
convenient to implement
Tuesday, June 21, 2022
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44. Papule at site of injection
Increase size with diameter of 4-8 mm ( 5-6 weeks )
Breaks into shallow ulcer with crust
Healing occurs ( 6- 12 weeks )
Permanent tiny round 4-8 mm diameter
Phenomenon after vaccination
Tuesday, June 21, 2022
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45.  Ipsilateral axillary or cervical lymphadenopathy
 Disseminated infection
 Osteomyelitis
 Sacrofuloderma
 Immunodeficiency ( HIV , leukaemia , lymphoma )
 Generalized eczema
 Infective dermatosis
 Hypogammaglobulinemia
 Contraindication
Tuesday, June 21, 2022
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46. Tuesday, June 21, 2022
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