Tuberculosis Amor N. Santiago

Topics to discuss:What is Tuberculosis or TB?Signs and symptoms of TBDetection of TB (Diagnostic and lab test)Mode of TransmissionTreatment of TBEconomic Burden of TBDifference between TB and Multidrug Resistant TBSigns and symptomsHow did MDR-TB occur?Treatment of MDR-TB

Tuberculosisabbreviated as TB for tubercle bacillus or Tuberculosis

Common and deadly infectious disease caused by Mycobacterium tuberculosis

usually attacks the lungs but can also affect other parts of the body

Dr. Robert Koch

Dr. Robert Koch discovered the tuberculosis bacilli.

isolated the tubercle bacillus in 1882 and established TB as an infectious disease

SYNONYMSconsumption phthisis and phthisis pulmonalisScrofulatabes mesenterica Lupus vulgariswasting disease white plague king's evil Pott's disease, or gibbus Miliary Tuberculosis or disseminated TB

SIGNS AND SYMPTOMS productive, prolonged cough for more than two weekschest painhemoptysis fever, chills, night sweats loss of appetite, weight lossPallorEasy fatigability

Chest X ray - the most common diagnostic test that leads to the suspicion of infection

Sputum exam/Acid fast stain

Mantoux Test - helps identify people infected withM. tuberculosisbut who have no symptomsDIAGNOSIS AND LAB TESTS

DIAGNOSIS AND LAB TESTS

fluorescent microscopyThoracentesisBronchoscopyQuantiFERON-TB Gold test - this is a blood test that is an aid in the diagnosis of TB

DIAGNOSIS AND LAB TESTSChest CTRarely biopsy of the affected tissue (typicallylungs, pleura or lymph nodes)crackles Enlarged or tender lymph nodes in the neck or other areasPulmunary edema Clubbing of the fingers or toes

Tuberculosis is spread by aerosols created by coughing, sneezing, talking, singing and spitting.MODE OF TRANSMISSIONTuberculosis is an airborne disease

TREATMENT

Antibiotics (around 6 to 12 months)1st line drugs Rifampicin (R)Isoniazid (H)Ethambutol (E)Pyrazinamide (Z)Streptomycin (S)

Economic Burden of TBTB robs an average Filipino worker of PhP451 per day for men PhP216 per day for women

The Philippines loses around PhP26.4 billion income due to premature deaths from TB.

PhP7.9 billion in wages alone- total annual losses to the Philippine economy associated with TB. - USAID 2000 Study

Difference between TB and MDR-TBFirst line drugsuses 4 ordinary drugs (first line drugs) and 2 months injection if needed6 8 monthsit often causes side effectsTB TreatmentMDR-TB TreatmentSecond line drugsuses different kinds of drugs which is more expensive and 6 7 months injection18 24 monthsIt causes lots of side effects

Signs and symptomsBack/chest painCough for two weeks or moreFever in the afternoonHemoptysisNight sweatWeight lossdyspnea

How did MDR-TB occur?Cross infectionNon-compliance to treatmentTreated outside a DOTS facilityLack of resourcesInadequate regimen (4 RELIABLE DRUGS)Poor knowledge of health care provider on the NTP guidelines MismanagementAttitude problemsStigmaDR-TB is a consequence of human error through:

TREATMENTCycloserineProthionamide, EthionamideFlouroquinolones ( Levofloxacin, Ofloxacin, Moxifloxacin, Gatifloxacin)Injectables (Amikacin, Kanamycin, Capreomycin)Para-Amino salicylic acid (PAS)- granulesREINFORCERS: Co-Amoxiclav and Clarithromycin

Where to refer?Health CentersMDR-TB Treatment CentersIlocos Training and Regional Medical CenterParian, San Fernando City, La UnionDr. Chester Directo at 09157112706since: July 2009services: accepts referrals of MDRTB suspects, facilitate diagnosis and provides treatment to patients all for free

If left UNTREATED.

...it can lead to Extensively drug-resistant TB (XDR-TB)

Or worst.

Total drug-resistant TB

TRANSMISSION and SPREAD of TB/MDR-TB or worse, XDR-TB to family, friends, community or even to YOU.

DEATH

If left UNTREATED.

Help us stop TB in our community.

Realize that the fight against TB is our COLLECTIVE STRUGGLE.

MESSAGE

We are the CURE !

THANK YOU!

Airborne by John Donnelly:Experts from the WHOs Stop TB Department and the Stop TB Partnership warn that:

if countries do not act now to stop TB and MDR-TB, the world will face an airborne contagion that will become increasingly untreatable and increasingly global. It will stop at no border, and it will infect much greater numbers of people.

The early signs are already apparent: At the beginning of 2007, 20 countries reported cases ofextensively drug-resistant TB (XDR-TB). At the end of 2008, the number had jumped to 55, in part because countries had started searching for cases.

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