Tuberculosis and It

1
Tuberculosis and Its Control in India and
Uttarakhand
2
What is Tuberculosis?

• An infectious disease caused by Mycobacterium
  tuberculosis

3
Who discovered the Tubercle bacilli?

• Robert Koch

4
AFB

• Acid
• Fast
• Bacilli

5
How TB spreads ?

• Inhalation of droplets containing AFB in air

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Most common Symptom of PT
cough gt 2 weeks
7

symptom of PT
Loss of appetite
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another symptom of PT
loss of weight
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Another Symptom of PT

• Rise of Temperature in
  the evening

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another Symptom of PT

chest pain
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What are the symptoms of PT?

• Cough gt 2 weeks
• Loss of appetite
• Loss of weight
• Rise in temp. in the evening
• Chest pain
• Haemoptosis

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India Accounts for Nearly One Third of the Global
TB Burden

• India has more cases of tuberculosis than any
  other country in the world twice as many cases
  as China
• Although exact and current information on TB
  incidence and prevalence is not available,
  studies show an incidence rate of more than 200
  per lakh, among the highest in the world

13
TB - Disease Burden

• gt 40 of countrys population is infected
• 2 million new cases each year
• 450,000 deaths each year
• gt 5,000 people develop TB every day
• gt 1,000 people die every day
• TB kills more women than all causes of maternal
  mortality put together

All this despite TB being nearly 100 curable
14
TB is the leading single infectious cause of
death in India
Number of deaths (1000s)
Deaths from infectious agents in India
Source World Health Report, 1999
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How many die in India in 2 minutes due to TB?
Three

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Status of TB Control in India

• 1950s-60s Important TB research(TRC/NTI)
• 1962 National TB Programme
• 1992 Programme Review- only a third of patients
  diagnosed and only a third of those treated
  successfully
• 1993 DOTS pilots (RNTCP)
• 1998 DOTS scale-up begins
• 2000 gt 30 of country covered by DOTS
• Beginning of 2002 almost 50 of country covered
  by DOTS (460 million population)
• 2006 Whole India covered by DOTS

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DOTS

• Directly
• Observed
• Treatment
• Short Course

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• RNTCP
• Revised
• National
• Tuberculosis
• Control
• Programme

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Aims of RNTCP

• 1.To achieve 85 Cure Rate
• 2. To diagnose 70 of estimated new Sp. Sm.
  Pos. cases after achieving the above.

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Directly Observed Treatment, Short-course (DOTS)

• Political commitment

• Diagnosis by microscopy

• Adequate supply of SCC drugs

• Directly observed treatment

• Accountability

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How TB is diagnosed ?

• By the examination of Sputum for AFB
• X-ray examination

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What is the specific method for the diagnosis of
PT?

sputum exam.
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Advantages of Sputum Microscopy

• Simple
• Less expensive
• More reliable
• Rapid

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Take Home Messages

• 1. Anybody who is having Cough for more than 3
  weeks with or without other symptoms should get
  their sputum examined at the nearest Health
  Facility
• 2. TB Diagnosis and treatment are available free
  of cost in all the govt. hospitals

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Fight against TB
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How many sputum samples are examined for
diagnosis?
spot morning
Two
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CATEGORY I

• New sp.pos.
• New sp.neg. but seriously ill
• New extra-pulmonary but seriously ill

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CATEGORY II

• Sm. pos. relapse
• Sm.pos. failure
• Sm.pos treatment after default

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CATEGORY-III

• New sp.neg. not seriously ill
• New extra-pulmonary not seriously ill

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Recommended treatment regimens
Direct observation is recommended for all
patients and is particularly essential when
intermittent regimens are used
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How many specimens are examined during follow
up examination?

morning spot
two
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During treatment, when do you examine the sputum
for Cat-I patients ?

• Month 2 4 6

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During treatment, when do you examine sputum for
Cat-II patients ?

• Month 3 5 8

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During treatment, when do you examine sputum for
Cat-III Patients?

• Month 2 6

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What is to be done when the sp. sm. is pos. at
the end of IP ?

• IP to be continued for one more month.

36
What is to be done when the patients default in
the CP ?

• Action to be taken within a week of default.

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DOTS triples treatment success in India
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Anti TB drugs are available free of cost in all
the govt. hospitals.

true
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Fight against TB