PRESENTED

BY
ROBINA MAJEED
 CONTENTS
1. Definition of Tuberculosis
2. Causative Organisms
3. Host Factor of the TB
4. Epidemiological features of the TB
5. Epidemiological features of the TB
6. Source of Infection
7. Incubation period
8. Severe Symptoms
9. Pathogenesis
10. Types of TB
11. Diagnosis
12. Stop the Spread of TB
13. Management
 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.
Causative Organisms
Mycobacterium tuberculosis

Human
Mycobacterium Bovis

Animals
 Extra pulmonary
i. Lymph node TB
ii. Pleural TB
iii. TB of upper airways
iv. Skeletal TB
v. Genitourinary TB
vi. Miliary TB (Immunodeficiency virus (HIV) infection)
vii. Pericardial TB
viii. Gastrointestinal TB
ix. Tuberculosis Meningitis
x. Less common forms
 Host Factor of the TB
The clinical manifestations of TB are quite variable
and depend on host factors such as:
 age
 immune status
 coexisting diseases
 immunization with BCG, Nutrition
 Sex
 Overcrowding
 Poverty
 and microbial factors such as virulence of the organism
and predilection for specific tissues (American
 Epidemiological features

The epidemiological features of

pulmonary tuberculosis in China include a pattern of
seasonal fluctuations, with the highest rates of
infection in autumn and winter. The adequate contact
rate has increased slightly from an average of
0.12/month in 2010 to an average of 0.21/month in
2015.
 Source of Infection
Tuberculosis (TB) is caused by a type of bacterium
called Mycobacterium tuberculosis. It's spread
when a person with active TB disease in their lungs
coughs or sneezes and someone else inhales the
expelled droplets, which contain TB bacteria.
Bacilli are also found in the pus, plural, Peritoneal
fluid.
How to spread TB
 Incubation period

The incubation period may vary from about two

to 12 weeks.
 Severe Symptoms
 Persistent cough
 Chest pain
 Coughing with bloody
sputum
 Shortness of breath
 Urine discoloration
 Cloudy & reddish urine
 Fever with chills.
 Fatigue
Pathogenesis
 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.
B} Extra Pulmonary TB :-

1) Lymph node TB ( tuberculuous lymphadenitis):-

Seen frequently in HIV infected patients.
Symptoms :- Painless swelling of lymph nodes most commonly at
cervical and Supraclavicular
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.
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, knees, swelling of knees, trauma.

6) Gastrointestinal TB :-

Involvement of any part of GI Tract.

Symptoms :- Abdominal pain, diarrhea, weight loss
 7) TB Meningitis & Tuberculoma :-
5% of All Extra pulmonary TB Results from Hematogenous
spead of 10& 20 TB.

8)TB Pericardiatis :-
• 1- 8% of All Extra pulmonary TB cases.
• Spreads mainly in mediastinal or hilar nodes(lymph
nodes is a triangular ) 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(Inflammation of middle layer of eye),
Diagnosis
1.Bacteriological test:
 Microscopic examination
 culture
2. Sputum culture test:
 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
 AFB-negative pulmonary tuberculosis

 Extra pulmonary tuberculosis

 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.
1 dose = 0.1 ml contains
0.04µg Tuberculin (purified
protein derivative)PPD.
Mantoux test.
 6. Other biological examinations

 Cell count(lymphocytes)
 Protein – Ascites, pleural effusion and
meningitis.
 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
 Stop the Spread of TB
 Take all of your medicines as they're prescribed,
until your doctor takes you off them.
 Keep all your doctor appointments.
 Always cover your mouth with a tissue when you
cough or sneeze. ...
 Wash your hands after coughing or sneezing.
 Don't visit other people and don't invite them to
visit you.
BCG vaccine
 First used in 1921.
 Only vaccine available today for protection against
tuberculosis.
 It is most effective in protecting children from the
disease.
 Given 0.1 ml intradermally.
 Duration of Protection 15 to 20 years
 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.
Management
Drugs MO Diagram
A

Isoniazid Inhibits mycolic acid

synthesis.

RIFAMPICIN Blocks RNA synthesis by blocking

DNA dependent RNA polymerase

PYRAZINAMIDE • Bactericidal-slowly metabolizing

organism within acidic
environment of Phagocyte or
caseous granuloma.
Drugs MO Diagram
A
ETHAMBUTOL • Bacteriostatic
•Inhibition of Arabinosyl
Transferase

STREPTOMYCIN •Inhibition of Protein

synthesis by disruption of
ribosomal function
Dosage regimen
 Intensive phase + continuation
phase
 HREZ (2 months) + HRE (4 months)
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 every dose.
 DOTS
 Good Quality Diagnosis
 Good Quality Drugs
 Direct Observed Treatment
 Systemic Monitoring and Accountability
 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.
 Globally, 3.6% are estimated to have MDR-TB.
 Almost 50% of MDR-TB cases worldwide
are estimated to occur in China and India.
 Extensively (that covers or affects a large area)

drug resistance TB
Extensively drug-resistant TB (XDR-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).
 Tuberculosis and HIV
 Worldwide the number of people infected with both
HIV and TB is rising.
 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 inactive 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.
 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.
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.
 REFRENCES
Basavanthappa, B.T., 2008. Community health
nursingJaypee Brothers Publishers 2nd Edition .
•Jaypee Brothers Publishers 2nd Edition .
•http://www.dictionary.com/browse/rodent
•https://www.merriamwebster.com/dictionary/rodent
Thank you!