tuberculosis epidemiology

3rd year BAMS syllabus topic

1. TUBERCULOSIS Dr. Jasminkumar Viramgami Reader & H.O.D., Dept. of Swasthavritta , Govt. Akhandanand Ayurved College, Ahmedabad , Gujarat

2. Introduction An infectious disease caused by M. tuberculosis . primarily affects lungs and causes pulmonary tuberculosis. chronic with varying clinical manifestations. also affects animals, known as " bovine tuberculosis ", sometimes communicated to man.

3. Problem statement TB is one of the top 10 causes of death worldwide. 1/3 of the global population asymptomatically infected with TB , of whom 5-10 % will develop clinical disease during their life. India is the highest TB burden country ( Nearly 20% of global) in the world . 2 out of every 5 Indians infected. infectious pulmonary TB patient can infect 10-15 persons in a year .

4. Agent factor Agent : M. Tuberculosis is a intra-cellular parasite. Strains = human and bovine. The human strain responsible for majority of cases bovine strain affects mainly cattle and animals . It grows slowly. can’t tolerate heat. can live in humid or dry or cold surroundings. Communicability : patients infective as long as untreated.

5. Source of infection two sources -human and bovine. human source- most common. human case whose sputum is positive and who has either received no treatment or has not been treated fully. Such sources can discharge the bacilli in their sputum for years. bovine source- usually infected milk. It is no problem in India because of the practice of boiling milk.

6. Host factors Age : affects all ages. in India more in adults than in children. It affects adults in the most productive age group (15-54 years). More than 80 % Sex : more in males . Nutrition : malnutrition influence to TB Immunity : no inherited immunity against TB. acquired as a result of natural infection or BCG vaccination.

7. Social factors include many non-medical factors such as poor quality of life, poor housing, and overcrowding, population explosion, under nutrition, lack of education, large families, early marriages, lack of awareness of causes of illness etc. these factors are interrelated and contribute to the occurrence and spread of TB.

8. Mode of transmission transmitted mainly by- droplet infection and droplet nuclei generated by sputum positive patients with pulmonary tuberculosis. It is not transmitted by fomites , such as dishes and other articles used by the patients.

9. Incubation period from receipt of infection to the development of a positive tuberculin test ranges from 3 to 6 weeks the IP may be weeks, months or years. development of disease depends upon various factors

10. Common Symptoms of TB Disease Productive Cough ( 2-3 weeks or more) Hemoptysis Chest pains Fever- evening Night sweats Feeling weak and tired Losing weight Decreased or no appetite Tachycardia If you have TB outside the lungs, you may have other symptoms

11. Types Pulmonary Extra-pulmonary

12. Milliary Tuberculosis acute milliary tuberculosis

13. The control of tuberculosis The control measures consist of a curative component - case finding and treatment; preventive component - BCG vaccination. first step is early detection of sputum positive cases.

14. Prevention Finding patients earlier Treatment and management of patients Prevention with medicines The systemic organization of prevention

15. Case-finding tools Target group: majority of pulmonary TB patients have one or more symptoms referable to chest, such as persistent cough and fever. The chest symptoms develop early . This is the most fertile group for case finding.

16. Investigations sputum examination - sputum AFB smear by direct microscopy. 3 sputum specimens, collected early in the morning Sputum culture - second in a case-finding. necessary for sensitivity tests and monitoring drug treatment. Chest x-ray- necessary as additional criteria for the diagnosis of pulmonary TB when only one sputum smear is positive out of three

17. Anti TB drugs There are now 12 or 13 drugs active against TB , of which, 6 are considered to be essential. Classified into two groups bactericidal and bacteriostatic . bactericidal = kill the bacilli drugs bacteriostatic = inhibit the multiplication of the bacilli and lead to their destruction by the immune mechanism of the host.

18. Bactericidal drugs : rifampicin ( rmp ), inh , streptomycin, pyrazinamide Bacteriostatic drugs : ethambutol , thioacetazone The second line drugs : fluoroquinolones (ciprofloxacin, ofloxacin , levofloxacin , moxifloxacin and gatifloxacin ), ethionamide , capreomycin , kanamycin and amikacin . Cycloserine , macrolides

19. BCG vaccination It induces a benign, artificial infection which stimulate an acquired resistance and thus reduce morbidity and mortality from primary TB . BCG is the widely used live bacterial vaccine . live bacteria derived from attenuated bovine strain.

20. Dose is 0.1 mg in 0.1 ml volume. given very early in infancy either at birth or at 6 wk age . injected Intra-dermally using tuberculin syringe just above the insertion of deltoid muscle. A satisfactory injection should produce a wheal of 5mm.

21. Role of hospitals some patients will be needing hospitalization. The main indications for hospitalization are - emergencies such as massive haemoptysis and spontaneous pneurnothorex surgical treatment management of serious types of tuberculosis such as meningeal tuberculosis certain social indications , such as when there is no one to look after the patient at home .

22. Rehabilitation Aim : Treating patients without interfering with their normal work and life. Who needs Rehabilitation? who are chronically ill and are still excreting tubercle bacilli. who had lung resection to suit their physical and mental abilities.

23. In 1882 Dr. Robert Koch discovered the cause of TB, the TB bacillus on March 24.

24. World TB Day, 24 March 2018 Theme All can be leaders of effort to end TB in their own work or terrain

25. Follow us : Facebook : https ://fb.me/SwasthavrittaGAAC Youtube : https ://www.youtube.com/channel/UCPvrBlyheQcqwBXs1egxzWw SlideShare : https :// www.slideshare.net/SwasthvrittaAkhandan THANK YOU Dr. J M Viramgami, HOD Swasthavritta, GAAC