Transcript Chest Clinic. Tuberculosis

TUBERCULOSIS
* Prevention
* Treatment, and
* Challenges.
By
Dr. O.S. Lawal
Matron B.G. Ojelabi
CHEST CLINIC DEPT. GHLAGOS
OUTLINE
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Introduction
Classification of Tuberculosis
Mode of Transmission
Pathogenesis
Symptoms & Signs
Diagnosis
Treatment
DOTS Strategy
Stop TB Strategy
Monitoring of TB Patients
TB Prevention
Challenges
Conclusion
Introduction
• Tuberculosis (TB) is a disease
that can spread from one
person to another and is
caused by a bacteria called
Mycobacterium tuberculosis.
Introduction (Contd.)
• TB is curable but kills 4000 people
every day, nearly 2 million every year.
• 80% of the world’s TB burden occurs
in just 22 countries.
• Tuberculosis affects all ages.
• TB is the No. 1 killer among HIV
positive patients
LOCAL SITUATION
 Nigeria ranked 10th among the 22 high TB
burden countries and is the 3rd most
burdened country with HIV/AIDS
 Estimate for all forms of cases is
199/100,000 Population
 Estimated prevalence of HIV among TB
patients is 27%
 Lagos state carries 8.4% of Nigeria’s TB
burden.
CLASSIFICATION
• Pulmonary TB, or tuberculosis of the lungs
and is the most common form (80%).
• Extra-pulmonary TB is tuberculosis
affecting organs other than the lungs –
kidneys, intestines, liver, womb, testes,
skin, bones, joints, meninges, etc.
TB transmission
TB transmission
contd.
• TB is transmitted through the air.
• When a person with TB of the lungs or
throat coughs, sneezes, spits or talks
loudly, the germs get into the air.
• People nearby may breathe in these
bacteria and thereby become infected.
1 sneeze releases millions
Organisms Liberated
“Wells 1934, Duguid 1945, Wells/Riley 1953, et al.”
Number of Organisms Liberated:
Talking
0 – 200
Coughing 0 – 3 500
Sneezing 4500 – 1 000 000
PATHOGENESIS
EXPOSURE
INFECTION
LATENT
ACTIVE DISEASE
SIGNS AND
SYMPTOMS OF
TUBERCULOSIS
SIGNS AND SYMPTOMS
• The most important symptom of TB is
prolonged, persistent cough.
• Anyone with cough of 2 weeks or
more should be tested for
Tuberculosis.
SIGNS AND SYMPTOMS
Other symptoms and signs are
• Chest pain
• Difficulty in breathing
• Coughing out of blood
• Fever
• Weight loss
• Night sweats
• Palor
• Easy tiredness.
DIAGNOSIS
• This is mainly through examination of the
sputum (Sputum Microscopy).
• Suspect is asked to produce 2 samples of
sputum and these are examined in the
laboratory.
•
Other methods include Sputum Culture, Chest X-ray,
Mantoux and lately the GeneXpert.
TB germs
TREATMENT
• Is through the use of a combination of
drugs.
• These are taken orally except one of them
which is given as injection.
• The treatments have been standardized
and the drugs and injections made
available free of charge.
• A complete course lasts 6 to 8 months.
Standardized short-course
chemotherapy
• 2 regimens in use:
CATEGORY 1 for new cases.
CATEGORY 2 for re-treatment cases.
• CAT 1 means 2 months of 4FDC (Rifampicin –
150mg, Isoniazid – 75mg,Pyrazinamide – 400mg
and Ethambutol – 275mg) and 4 months of
Rifampicim and Isoniazid [2RHZE/4RH]
• CAT 2 – 2 months of Streptomycin injection with 3
months of 4FDC, then 5 months of Rifampicin, INH
and Ethambutol. [2SRHZE/1RHZE/5RHE]
• All treatment is expected to be directly observed
(DOT)
DOTS STRATEGY
It is the combination of best practises in different countries of
the world where TB disease was a challenge. It consists of the
following
• Political commitment with sustained financing.
• Case detection through quality-assured bacteriology.
• Standardized treatment with supervision and patient
support.
• An effective drug supply and management system.
• Monitoring and evaluation system, and impact
measurement.
NOTE: TB control Targets:
1. Case finding 70%
2. Cure rate 85%
STOP TB STRATEGY
• High quality DOTS
• TB/HIV
• MDR-TB
• Health system strengthening.
• Public-Private Mix (PPM).
• Promote Research on TB.
• Empower people with TB.
MONITORING OF TB PATIENT
Body Weight. [Monthly]
Assessment for ADR
Sputum Test 2/3,4,6/7 months.
CXR
PREVENTION OF TB
• BCG Vaccination: 40-80% effective
(up to 15 years of age)
• Chemoprophylaxis- eg IPT
• Cough Hygiene: cover the mouth and nose
when coughing or sneezing.
• Good nutrition: to prevent or reduce
progression from infection to disease. This is by
boosting host immunity.
PREVENTION OF TB
•
Good housing : that prevents overcrowding and affords good ventilation
reduces the risk of exposure to the
bacilli.
•
Screening of contacts of TB patients
• Control of HIV/AIDS
CHALLENGES
1.
2.
3.
4.
5.
Difficulty in Diagnosis
Limitation of Lab. InvestigationGeneXpert, FNAC.
Clinical delay – when surgery is
required
Delay at home, before presentation.
• Inappropriate therapy of Private
hospital
• Reduce case finding
TB/HIV
6.
7.
8.
MDR TB
EP
IPAC
Administrative controls to reduce risk of
exposure, infection, and disease through policy
and practice;
Environmental (engineering) controls to reduce
concentration of infectious bacilli in air in areas
where contamination of air is likely; and
Respiratory protection to protect personnel who
must work in environments with contaminated air
9. Admission in the hospital wards
10. DM Screening.
CONCLUSION
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TB is preventable and curable
TB treatment is available at Chest Clinic
TB treatment is free
Wherever you are, support TB control because
“TB ANYWHERE IS TB EVERYWHERE.”
•
The most important symptom of TB is
prolonged, persistent cough. Anyone with
prolonged, persistent cough of 2 weeks or more
is a TB suspect and should be tested for
Tuberculosis.
EKO O NI BAJE O
EKO O NI BAJE O
TB O NI WOLE WA O!
THANK YOU.