Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Revised National Revised National Revised National Revised National Revised National Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Revised National Revised National Revised National Revised National Revised National Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Revised National Revised National Revised National Revised National Revised National Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Revised National Revised National Revised National Revised National Revised National Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Revised National Revised National Revised National Revised National Revised National Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Revised National Revised National Revised National Revised National Revised National Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Revised National Revised National Revised National Revised National Revised National Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Revised National Revised National Revised National Revised National Revised National Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Revised National Revised National Revised National Revised National Revised National Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Revised National Revised National Revised National Revised National Revised National Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Revised National Revised National Revised National Revised National Revised National Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Tuberculosis Control Programme Revised National Revised National Revised National Revised National Revised National Revised National Revis Revis ed Na ed Na tional tional Tuberc Tuberc ulosi ulosi s Cont s Cont rol P rol P rogram rogram me me Revi Revi sed Nat sed Nat ional ional R R e e v v i i s s e e d d N N a a t t i i o o n n a a l l T T u u b b e e r r c c u u l l o o s s i i s s C C o o n n t t r r o o l l P P r r o o g g r r a a m m m m e e s i i r l l l r
Transcript
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised NationalRevised NationalRevised NationalRevised National
Revised NationalRevised National
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised NationalRevised NationalRevised NationalRevised National
Revised NationalRevised National
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised NationalRevised NationalRevised NationalRevised National
Revised NationalRevised National
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised NationalRevised NationalRevised NationalRevised National
Revised NationalRevised National
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised NationalRevised NationalRevised NationalRevised National
Revised NationalRevised National
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised NationalRevised NationalRevised NationalRevised National
Revised NationalRevised National
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised NationalRevised NationalRevised NationalRevised National
Revised NationalRevised National
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised NationalRevised NationalRevised NationalRevised National
Revised NationalRevised National
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised NationalRevised NationalRevised NationalRevised National
Revised NationalRevised National
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised NationalRevised NationalRevised NationalRevised National
Revised NationalRevised National
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised NationalRevised NationalRevised NationalRevised National
Revised NationalRevised National
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised National Tuberculosis Control ProgrammeRevised National Tuberculosis Control Programme
Revised NationalRevised NationalRevised NationalRevised National
Revised NationalRevised National
RevisRevised Naed National tional TubercTuberculosiulosis Conts Control Prol Programrogrammeme ReviRevised Natsed Nationalional R R e e v v i i s s e e d d N N a a t t i i o o n n a a l l T T u u b b e e r r c c u u l l o o s s i i s s C C o o n n t t r r o o l l P P r r o o g g r r a a m m m m e e
ss
i i rr
ll
l l rr
ONTENTSNTENT
EFINITIONS: THE REVISED NATIONAL TUBERCULOSISEFINITI N : THE E I ED N TI N L TUBER UL IONTROL PROGRAMME 5NTROL PROGR MME 5
IAGNOSTIC ALGORITHM FOR PULMONARY TB 6IAGN TIC LG RITHM F R PULMONARY TB 6
TAINING METHOD 7T ININ METH 7
ey steps in the preparation and staining of smears 7t i t r r ti i i f 7
Ziehl - Neelsen Staining Method 8Zi l - N l t i i M t o 8
TREATMENT 9TREATMENT 9
ZONAL ARTIS AND ESTIMATED NSP CASES PER LAKHNAL RTI AND ESTI ATED N P ASES PER LAKHOPULATION 9L TI N
TREATMENT CATEGORIES AND SPUTUM EXAMINATIONTRE TMENT TE RIE ND PUT E MIN TI NCHEDULE 10HEDULE 10
ANAGEMENT OF PATIENTS WHO INTERRUPT TREATMENT 12NAGE ENT OF PATIENTS WH INTE RUPT TREATMENT 12
TREATMENT OF CHILDREN 15TREATMENT OF HILDREN 15
Algorithm for clinical monitoring of Pediatric TB 16l ri f li i l it i i i T
Chemoprophylaxis for Children 17o r yl i or il r 7
YMPTOM-BASED APPROACH TO EVALUATION OF POSSIBLE SIDEM TO -B SED A PR H TO EVALU TION F P I LE IDEFFECTS OF ANTI-TB DRUGS USED IN RNTCP 18FFECTS F ANTI-TB DR GS SED IN RNTCP 18
ANAGEMENT OF TB PATIENTS ON DOT IN SPECIALN E ENT F T TIENT N T IN E I LITUATIONS 19ITU TI NS
OSPITALIZATION OF TB PATIENTS 20OS ITALI TION OF T ATIENT 0
UPERVISORY VISITS 21UPE VISO Y ISITS 1
UMMARY OF KEY INDICATORS AND POSSIBLE CORRECTIVEU MAR F KEY INDICAT S ND POS IBLE RRECTIVEACTIONS 22TI N
EW INDICATORS 26EW INDI T
NTCP at a Glance6
IAGNOSTIC ALGORITHM FOR PULMONARY TB
COUGH FOR 3 WEEKS OR MORE
3 Sputum smears
or 3 Positives 3 Negatives
Antibiotics 10-14 days
Cough Persists
epeat 3 Sputumxaminations
Positive
X-Ray egative or 3 Positives
Suggestive of TB egative for TB Sputum PositiveTB (Anti-TBTreatment)
X-RaySputum Positive
TB (Anti-TBTreatment)
egative for TB uggestive of TB
Sputum Smearegative TB
Anti-TB Treatment)
on TB
NTCP at a Glance 7
STAINING METHOD
ey steps in the preparation and staining of smears
Step 1
Break a broomstickinto two
ick up the large, yellow purulentportion of sputum Spread evenlyonto 2/3 of central portion of the
numbered slide
Step 2
Spread evenly onto 2/3of central portion of the
numbered slide
ir-dry theslide for 15–30
minutes
Step 3
Fix the dry slide by heatingriefly 3–5 times for 3–4
seconds each time
lace the slides inserial order on the
staining rack
Stain the slidesith 1% carbol
fuchsin
Step 4
Step 5
Heat the slidesfrom underneathuntil vapours rise
Let the slides standfor 5 minutes
inse the slidesith tap water
Step 6 Step 7
Drain offexcess water
Decolourize with 25% sulphuric acid andlet it stand for 2–4 minutes (repeat, letting
stand for 1–3 minutes, if necessary)
Step 8
inse away excessstain with tap water
Drain off theater
Step 9
Step 10
Counterstain with 0.1%ethylene blue and let
stand for 30 seconds
Gently rinse the slides withtap water, drain the water
off, and allow the slide to dry
Examine the slides underhe microscope examine
at least 100 fields.
NTCP at a Glance8
iehl - Neelsen Staining Method
1. Select a new unscratched slide and label the slide with the Laboratory SerialNumber with a diamond marking pencil.
. Make a smear from yellow purulent portion of the sputum using a broom stick. Agood smear is spread evenly, 2 cms x 3 cms in size and is neither too thick nortoo thin. The optimum thickness of the smear can be assessed by placing thesmear on a printed matter. The print should be readable through the smear. Smearpreparation should be done near a flame. This is required, as six inches around theflame is considered as a sterile zone which coagulates the aerosol raised duringsmear preparation.
. Allow the slide to air dry for 15–30 minutes.
4. Fix the slide by passing it over a flame 3–5 times for 3–4 seconds each time.
. Pour 1% filtered carbol fuchsin to cover the entire slide.
. Gently heat the slide with carbol fuchsin on it, until vapours rise. Do not boil.
. Leave carbol fuchsin on the slide for 5 minutes.
8. Gently rinse the slide with tap water until all free carbol fuchsin stain is washedaway. At this point, the smear on the slide looks red in colour.
. Pour 25% sulphuric acid onto the slide.
10. Let the slide stand for 2–4 minutes.
11. Rinse gently with tap water. Tilt the slide to drain off the water.
12. A properly decolourised slide will appear light pink in color .If the slide is still red,reapply sulphuric acid for 1–3 minutes and rinse gently with tap water. Wipe theback of the slide clean with a swab dipped in sulphuric acid,
13. Pour 0.1% methylene blue onto the slide.
14. Leave methylene blue on the slide for 30 seconds.
15. Rinse gently with tap water.
16. Allow the slide to dry.
17. Examine the slide under the microscope using x 40 lens to select the suitable areaand then examine under x100 lens using a drop of immersion oil.
18. Record the results in the Laboratory Form and the Laboratory Register.
f the slide has: Result Grading No. of fields to be examined
More than 10 AFB per oil immersion field os 3+ 20
1-10 AFB per oil immersion field Pos 2+ 0
10-99 AFB per 100 oil immersion fields Pos 1+ 100
1-9 AFB per 100 oil immersion fields Pos Scanty-B* 100
No AFB in 100 oil immersion fields Neg 100
*Record actual number of bacilli seen in 100 fields – e.g. “Scanty 4”
19. Invert the slides on tissue paper till the immersion oil is completely absorbed.Do not use xylene for cleaning the slides, as it may give false results at repeatexamination after storage.
20. Store all positive and negative slides serially in the same slide-box until instructedby the supervisor.
21. Disinfect all contaminated material before discarding.
NTCP at a Glance 9
TREATMENT
Is the patient sputum-smear positive*
oes the patient have TB? as the patient been treatedfor TB for one month or more
previously
NO ES
NO
YES
o Anti-TBtreatment
s the patientseriously ill?**
O YES
O
CAT II
ES
Patients with extra-pulmonary TB should receive Category III treatment unless they are seriously ill, inwhich case they should receive Category I treatment.
* Examples of seriously ill patients are those suffering from meningitis, disseminated TB, tuberculouspericarditis, peritonitis, bilateral or extensive pleurisy, spinal TB with neurological complications, smear-negative pulmonary TB with extensive parenchymal involvement, intest inal, genito-urinary TB andco-infection with HIV. All forms of pediatric smear negative TB except primary complex and pediatricextrapulmonary TB except lymph node TB and unilateral pleural effusion.
