ACF_INTRODUCTION TB(1)kldsjkfldgkjlkgjkfjgjklfjg.pptx

tb

1. नेपालमा क्षयरोग अबस्था ( Prevalence Survey reports )

2. Ifo /f]u eg ]sf] s] xf ] < Ifo /f]u ;+ qmfds -;? jf _ /f]u xf ] . of] /f]u Mycobacterium Tuberculosis eGg ] cfFvfn ] b]Vg g;lsg ] ;'Id ls6f0f'jf6 x'G5 . Ifo /f]u Zjf ;– k|Zjf;sf ] dfWodaf6 ;g]{ /f]u xf ] . Ifo /f] usf ls6f0f'x? k|ydtM xfjfsf ] dfWod eP / kmf ] S;f ] df k'Ub5g\ . ToxfFaf6 oL ls6f0f'x?n] kmf ] S;f ] df jf z/L/ sf ] cGo s'g } klg efudf ;/L Ifo /f]u nfUg ] x'G5 . kmf ] S;f ]af6 Circulatory System/ LymphaticSystem /Bronchial Tract eP / ls6f0f'n] csf ]{ cËdf ;+qmd0f ub {5 . o;/L Ifo /f]u z/L/ sf ] h'g;'s } efudf klg nfUg ;S5 . Ifo /f] usf ] ls6f0f' Mycobacterium Tuberculosis @$ dfr { !**@ df hd { gsf j}1flgs 8f=/j{6 ssn ] (German Scientist Dr. Robert Koch) kQf nufPsf x'g \ .

3. Ifo /f]u ;g]{ dfWod खोक्दा हाच्छ्यु गर्दा हाँस्दा

4. Ifo /f]u ;g{] dfWod : jf ; k|: jf;sf ] dfWodaf6 ;b{5 . h:t} M vf ] Sbf !=% ld6/ 6f9faf6, xFflR5'p ubf { # ld6/ 6f9faf6 . Ps hgf Ifo /f] uLn ] ! jif { df !) b]lv !% hgf;Dd :j:y dflg;nfO { Ifo /f]u ; fg { ;S5 eg ] zx /L If] qdf @% hgf ; DdnfO { ; fg { ;Sb5 .

5. 5 Ifo /f]u ;g]{ dfWod ===== of] xfjfsf ] dfWodjf6 ;g]{ /f]u xf ] . Ifo /f]u nfu ]sf] JolQmn ] vf ] Sbf , xflR5p+ ubf {, y'Sbf / glhsjf6 s'/ fubf { cGo JolQmdf ;g{;S5 .

6. 6 Ifo /f]u ;g]{ dfWod ===== Ifo/f]u ;?jf /f]u ePsf] x'+bf of] /f]u la/fdLn] vf]Sbf jf xflR5pF ubf{ vsf/df ePsf Ifo/f]usf ls6f0f'x? ;fgf–;fgf y'ssf l56f (Droplet nuclei) ;Fu} aflx/ xfjfdf lg:sG5g\ . w]/} h;f] Droplet nuclei x? ;fgf–;fgf w"nfsf s0f h:t} 6f+l;P/ aflx/L jftfj/0fdf s]xL ;do dfq /xG5g\ eg] yf]/} dfq xfjfdf ldl;P/ aflx/L jftfj/0fdf cln nfdf] ;do ;Dd /xg ;Sg] x'G5g . !) dfO{qmf] ld6/ (10ựm) cfsf/ ePsf] / ;f] eGbf ;fgf Droplet nuclei x? dfq kmf]S;f]sf ;a}eGbf ;fgf] xfjf ePsf] efu alveoli ;Dd k'Ug ;Sb5g\ . To; eGbf 7"nf Droplet nuclei x? Zjf;–k|Zjf; gnLsf] dflyNnf] efu Upper Respiratory Tract df /x]sf] muco-ciliary stream n] /f]Sg] x'+bf kmf]S;f];Dd k'Ug kfp+b}g . oL Droplet nuclei lglnG5g\ jf aflx/ ˆofFlsG5g .

7. 7 Ifo /f]u ;g]{ dfWod ===== o;/L oL ls6f0f'x? kmf]S;f]df k'u]kl5 dfOqmf]km]hn] rf/}lt/af6 3]/]/ ls6f0f'x?nfO{ dfg]{ sf]lz; u5{, h;n] ubf{ kmf]S;f]sf ] k|efljt efudf ;'hg (Primary Focus) x'g yfNb5 . ToxfFaf6 oL ls6f0f'x?n] xfOn/ u|GyLnfO{ k|efj kfb{5 . Primary Focus / k| efljt xfOn/ u|GyLsf] ;+o'Qm ?knfO{ Primary Complex elgG5 . Ifo/f]usf ls6f0f'af6 k|efljt ePsf ;a} JolQmnfO{ Ifo/f]u nfUb}g . olb Ifo/f]usf ls6f0f'x?n] ;+qmd0f u/]sf JolQmx?df /f]u;Fu n8\g] Ifdtf /fd|f] 5 eg] /f]u nfUb}g . t/ /f]u;Fu n8\g] Ifdtf sd eP of] /f]un] l56f] ;+qmd0f ub{5 . h:t} M s'kf]if0f,Pr=cfO{=eL=;+qmd0f ePsf dflg;x?df of] /f]u l56f] ljsl;t x'G5 . Ifo/f]usf] ls6f0f'n] ;+qmd0f u/]sf JolQm dWo] sl/j !)Ü JolQmdf dfq Ifo/f]u ljsl;t x'g ;S5 cyf{t /f]usf nIf0f b]vf kb{5g\ .

8. Ifo/f]usf lsl;d ( Type of TB ) k/LIf0f lgbfgsf cfwf/df M @ k|efljt cËsf cfwf/dfM @ pkrf/ Oltxf;sf cfwf/dfM # Pr=cfO{=eL= ;x ;ª\qmd0fsf cfwf/dfM # cf}ifwLsf] k|efjsfl/tfsf cfwf/dfM @ cf}ifwL k|lt/f]wL cj:yfsf cfwf/dfM ^ ;+s|d0f cj:yfsf cfwf/dfM @

9. k/LIf0f lgbfgsf cfwf/df != Bacteriologically confirmed (BC): ;Defljt Ifo/f]usf la/fdLsf ] Microscopy , Culture jf dfGotf k|fKt cGo Rapid diagnostics kit ( Xpert MTB/RIF) ljlwaf6 ul/Psf]vsf/ gd'gfk/LIf0fdf glthf positive ePsf . @= Clinically diagnosed (CD): vsf/ gd'gf k/LIf0fdf glthf Positive gePsf t/ lrlsT;sn] zf/Ll/s k/LIf0f jf cGo hfFrsf cfwf/df Ifo/f]u nfu]sf] k|dfl0ft u/]sf la/fdL . Ifo/f]usf lsl;d ( Type of TB )

10. k|efljt cË != kmf]S;f]sf] Ifo/f]u (Pulmonary Tuberculosis) @=kmf]S;f]afx]s z/L/sf] cGo efudf nfUg] Ifo/f]u (Extra Pulmonary Tuberculosis) Ifo/f]usf lsl;d ( Type of TB )

11. Ifo/f]usf k|sf/ M k|efljt cËsf ] cfwf / df Ifo /f] unfO { b'O { efudf afF+l8Psf] 5 . -s_ kmf]S;f]df nfUg] Ifo/f]u (Pulmonary Tuberculosis) -v_ kmf]S;f] afx]s z/L/sf] cGo efudf nfUg] Ifo/f]u (Extra Pulmonary Tuberculosis) s'n Ifo /f] uL dWo ] *) k|ltzt kmf ] S;f ] sf Ifo /f] uL x'G5g\ . of] Hofb } ;g]{ lsl;dsf ] x'G5 . kmf]S;f]df nfUg] Ifo/f]u (Pulmonary Tuberculosis) kmf ] S;f ] df nfUg ] Ifo /f]u @ lsl;dsf x'G5 . vsf/ kf]h]l6e kmf]S;f]sf] Ifo/f]u (Bacteriologically Confirmed Pulmonary TB - PBC) vsf/ g]u]l6e kmf]S;f]sf] Ifo/f]u (Clinical Diagnosed Pulmonary TB - PCD )

12. TB – A Multi-system Infection

13. kmf ] S;f ]sf] Ifo /f]u (Pulmonary Tuberculosis) sf d'Vo d'Vo nIf0fx¿ M @ xKtf jf ;f] eGbf a9L ;do;Dd nuftf/ vf]sL nfUg' ;fFemkv xNsf Hj/f] / kl;gf cfpg' vfgf vfg dggnfUg' tf}n 36g' 5ftL b'Vg' / ;f; km]g{ ufx|f] x'g' vsf/df /ut b]lvg' oL dflysf dWo] s'g} jf ;a} nIf0fx¿ ePsf dflg;x¿sf] vsf/ hfFr u/L /f]usf] lgbfg ug'{k5{, ;fy} k/LIf0f ubf{ Bacteriologically Confirmed Ifo/f]usf la/fdLx¿sf] ;Dks{df /x]sf JolQmx¿ ;a}sf] vsf/ hfFr ;d]t ug'{ kb{5 .

14. kmf]S;f] afx]s z/L/sf] cGo efudf nfUg] Ifo/f]u (Extra Pulmonary Tuberculosis) kmf ] S;f ] afx ]s cGoq h'g;'s } cËdf klg Ifo /f]u nfu ] sf ] /x]5 eg ] To;nfO { Extra Pulmonary Tuberculosis elg5 . o;n ] ljleGg cËx¿df ;ª\j|md0f u/] sf ] x'g;S5 . h:t} u|GyLx ¿ - L ymphnode +_, xf8 hf ] gL {x¿, k|hgg tyf d"q k|0ffnL, : gfo ' k|0ffnL Nervous system _ k]6, cfGb|f / z/L/ sf ] cGo s'g } klg efudf of] /f]un] ;ª\j|md0f ug { ;Sb5 . Extra – pulmonary tuberculosis kQf nufpg ufx|f ] x'G5 / lgbfg ug { lrlsT;ssf ] cfjZostf k5{ . kmf ] S;f ] afx ]s z/L/sf] cGo efudf nfUg ] Ifo /f]u - Extra–pulmonary tuberculosis +_ ePsf ] /f]uLaf6 cGo :j:y dflg;df /f]u ;g]{ ; Defjgf w]/} sd x'G5 . kmf ] S;f ] afx ]s z/L/sf] cGo efudf nfUg ] Ifo /f] usf – Extra Pulmonary TB _ sf d'Vod'Vo nIf0fx¿ M Extra–Pulmonary Tuberculosis df z/L/ sf k|efljt cËsf cfwf / df nIf0fx¿ km/s km/s x'g ;S5g\ . h:t}M u|GyLsf] (Lymph Node) Ifo/f]u M ;'lGgg] / slxn] sxLF+ lkk lg:sg] x'G5 . xf8 hf]gL{sf] Ifo/f]u M hf]gL{ b'Vg] / ;'lGgg] x'G5 . TB Meningitis : 6fpsf] b'Vg], Hj/f] cfpg] / 3f+6L c//f] (Neck Stiffness) x'g], dfgl;s e|d x'g] cflb x'G5 . Miliary TB M s8f Hj/f], vf]sL cflb x'G5 . 3fF6Lsf] leqL efudf x'g] Ifo/f]u M 3fF6L b'Vg], wf]b|f] :j/ x'g], slxn] sxLF+ :j/ aGb x'g] . KNo"/];L - Pleuracy _ Ifo/f]u M sf]vf b'Vg], ;'Tg ufx|f] x'g], ;f; km]g{ sl7g x'g] . cfGb|fsf] Ifo/f]u M k]6 b'Vg], nfdf] ;do;Dd kvfnf nfUg], k]6 km'Ng] . k|hgg tyf d"q k|0ffnLdf x'g] Ifo/f]u M Hj/f] cfpg], lk;fadf /ut cfpg], dlxgfjf/L clgoldt x'g], afFemf]kg cfpg ;Sg] .

15. ;+s|d0f cj:yf !=;'if'Kt Ifo/f]u (Latent TB) @=;s[o Ifo/f]u (Active TB) Ifo/f]usf lsl;d ( Type of TB )

16. ;Defljt Ifo/f]u klxrfgM @ xKtf jf ;f]eGbf a9L ;do;Dd nuftf/ vf]sL nflu/x]sf] cj:YffnfO{ ;Defljt Ifo/f]u elgG5 . s'g} JolStdf o:tf] nIf0f b]vf k/]df ;Defljt Ifo/f]usf la/fdL egL Ifo/f]u lgbfgsf nflu vsf/ gd'gf k/LIf0f ug{ k7fpg' kb{5 .

17. lgDg JolQmx¿nfO{ Ifo/f]usf] ;Defjgf a9L x'g ;Sb5 !_ vsf /df sL6f0f' b] lvPsf / cf } ifwL k|lt /f] wL Ifo /f] usf la/ fdLsf ] ;Dk{ sdf /x]sf JolQm (Household or other close contact of PBC and DR TB patient) @_ s'kf ]lift afnaflnsf (Severe Acute Malnutrition-SAM, Moderate acute malnutrition-MAM) #_ Pr\= cfO eL ;ª\ j|mldt (HIV positive ) $_ dw'd ] xsf la/ fdL (Diabetes Mellitus patient) %_ SofG ;/ nfu ] sf la/ fdL (Cancer patient) ^_ 5ftLsf] PS;/] df ;d:of b] lvPsf la/ fdL (Abnormalities on chest X-ray) &_ nfdf ] ;do cf } ifwL vfO {/ xg ] la/ fdL (Patients on long term drug therapy ) *_ Ho]i7 gful /s (Elderly citizen)

18. कस्ता बिरामीलाई औषधी प्रतिरोधी क्षयरोग हुने संभावना हुन्छ ? निम्नानुसारका व्यक्तिलार्इ सम्भावित क्षयरोगका अनुमान गरी परीक्षण गरिनु पर्दछ । cf}ifwL प्रतिरोधी क्षयरोगका बिरामीको सम्पर्कमा रहेका , पुन ः उपचारमा आएका क्षयरोगका बिरामी , उपचार असफल भएका क्षयरोगका बिरामी , बीचैमा cf}ifwL सेवन छोडेका बिरामी , रोग प्रतिरोधी क्षमता कम भएका व्यक्तिहरू (एच आइ भी स ङ् क्रमित, मधुमेह का बिरामी, क्यान्सर भएका आदि )