The Philippines has the ninth highest burden of tuberculosis in the world, according to the WHO Global TB Report 2006. TB is the sixth greatest cause of morbidity and mortality in the country. Approximately 78 Filipinos die from the disease every day, but significant strides have been made in recent years in increasing case detection and treatment. By 2004, the country achieved a TB case detection rate of 73 percent, exceeding the national and global target of 70 percent. The national TB treatment success rate is currently at 88 percent, above the national target of 85 percent. While the national performance levels are already high, many locales are still below target levels, given the difficulty of breaking down the stigma of TB that keeps many of those infected from seeking care.
USAID
USAID Approach and Key Activities
USAID is helping to fight TB in the Philippines on two fronts – enhancing the public sector National TB Control Program (NTP) and strengthening the private sector’s capacity to implement Directly Observed Therapy, Short-Course (DOTS). Between 2000 and 2005, USAID funds for TB programming in the Philippines averaged $1.9 million per year. USAID assistance has contributed significantly to increasing the availability of quality DOTS in the National Capital Region and in five provinces of the country where service delivery is especially difficult.
In the Philippines, people with TB symptoms are more likely to seek treatment from private providers than from public providers. Implementation of DOTS among private sector practitioners is thus critical to reducing TB prevalence. Between 2002 and 2005, the USAID-supported Philippines Tuberculosis Initiatives in the Private Sector (PhilTIPS) project improved cooperation with the NTP and strengthened TB diagnosis and treatment by private providers in 25 selected sites nationwide. In 2005, the private sector expanded provision of quality TB services to 30 service delivery points, including multispecialty clinics, hospital-based public-private physician practices, clinics, and workplace models; an additional public-private TB control project has also recently begun.
USAID’s assistance includes the following activities and interventions:
Enhancing national-level planning, monitoring, and supervisory capacity
Ensuring that health personnel are knowledgeable in all aspects of DOTS, policy reform, and advocacy
Strengthening TB surveillance, laboratory capacity, and quality control
Improving TB drug management
Implementing information, education, and communication activities
Providing microscopes, laboratory equipment and reagents, and vehicles to enable supervisors to monitor program activities
Conducting operations research
Providing grants to nongovernmental organizations to carry out TB education and replicate private sector efforts at the local level
USAID Program Achievements
USAID’s program has contributed to substantial improvements in human and infrastructure capacity and includes the following achievements:
Met its fiscal year 2005 target of 73 percent of participating units (facilities accredited in DOTS) achieving an 85 percent TB success rate
Assisted the Department of Health (DOH) in increasing the use of a community-based management information system by 18 percent in public and private clinics, thus enabling local government units (LGUs) to identify people with TB symptoms who are not consulting any health care provider
Improved case detection rates from 54 to 73 percent between 2000 and 2004
Facilitated substantial improvements in health worker capacity to implement DOTS by training 470 LGU health workers; 3,314 barangay (administrative unit) health workers; and 3,000 private sector physicians
Implemented through a DOH order a certification system for accrediting public and private sector DOTS centers by the Philippine Health Insurance Corporation (PHIC), with 303 centers certified to date and 200 of these accredited by PHIC, of which 20 percent are private clinics
Facilitated the establishment of 30 public-private mix DOTS service delivery points providing quality services with high patient satisfaction ratings
Assisted PHIC in developing a TB-DOTS outpatient benefit package, thus enabling accredited public and private centers to generate reimbursements from PHIC
Assisted the Department of Labor and Employment in implementing an order promoting TB control in the workplace
Developed a TB/DOTS core curriculum for medical schools and integrated DOTS into the curriculum at 10 major medical schools
Established 48 fully equipped TB microscopy centers in regional health units and quality control centers in three provinces and cities, coupling this with improved practice of 51 LGU medical technologists in laboratory diagnosis and 15 staff in laboratory management
Strengthened DOTS program monitoring and supervision as well as field management by personnel at the regional, provincial, and city levels
Partnerships
USAID partners in TB control include WHO, the Philippines NTP, the U.S. Centers for Disease Control and Prevention, the Philippines Coalition Against TB, the Tropical Disease Foundation, Inc., Chemonics International, the ReachOut Foundation International, and the New Tropical Medicine Foundation, Inc. WHO leads the technical collaboration of external partners. In addition to USAID, other key donors include the World Bank, the Canadian International Development Agency, and the Japan International Cooperation Agency. In 2003 and 2006, the Global Fund to Fight AIDS, Tuberculosis and Malaria approved the Philippines’ TB proposals for funding of $58.6 million over five years.
Monday, March 9, 2009
Profile of Tuberculosis in the Philippines
sources
www.mayoclinic.com
www.wrongdiagnosis.com
www.webmd.com
www.chesjournal.com
synthesis & summary
When the immune system is weak, confined tuberculosis bacteria can become active and spread to other parts of the body. This is called active tuberculosis.
Due to the recent milestones in medicine, treatment for active tuberculosis is now available and easily accessible. It is very important for the patient to follow the course of treatment religiously and completely to completely eradicate the bacteria and to prevent the illness from worsening or recurring.
The aforementioned illness can be prevented by practicing good hygiene including good ventilation, isolation of patients and suspected patients, and covering the mouth when coughing. The universal precaution for this is proper handwashing and isolation of infected patients.
prevention
Prevention
In general, TB is preventable. From a public health standpoint, the best way to control TB is to diagnose and treat people with TB infection before they develop active disease and to take careful precautions with people hospitalized with TB. But there also are measures you can take on your own to help protect yourself and others:
- Keep your immune system healthy. Eat plenty of healthy foods including fruits and vegetables, get enough sleep, and exercise at least 30 minutes a day most days of the week to keep your immune system in top form.
- Get tested regularly. Experts advise people who have a high risk of TB to get a skin test once a year. This includes people with HIV or other conditions that weaken the immune system, people who live or work in a prison or nursing home, health care workers, people from countries with high rates of TB, and others in high-risk groups.
- Consider preventive therapy. If you test positive for latent TB infection, your doctor will likely advise you to take medications to reduce your risk of developing active TB. Vaccination with BCG isn't recommended for general use in the United States, because it isn't very effective in adults and it causes a false-positive result on a Mantoux skin test. But the vaccine is often given to infants in countries where TB is more common. Vaccination can prevent severe TB in children. Researchers are working on developing a more effective TB vaccine.
- Finish your entire course of medication. This is the most important step you can take to protect yourself and others from TB. When you stop treatment early or skip doses, TB bacteria have a chance to develop mutations that allow them to survive the most potent TB drugs. The resulting drug-resistant strains are much more deadly and difficult to treat.
To help keep your family and friends from getting sick if you have active TB:
- Stay home. Don't go to work or school or sleep in a room with other people during the first few weeks of treatment for active TB.
- Ensure adequate ventilation. Open the windows whenever possible to let in fresh air.
- Cover your mouth. It takes two to three weeks of treatment before you're no longer contagious. During that time, be sure to cover your mouth with a tissue anytime you laugh, sneeze or cough. Put the dirty tissue in a bag, seal it and throw it away. Also, wearing a mask when you're around other people during the first three weeks of treatment may help lessen the risk of transmission.
treatment
Treatments and drugs
Medications are the cornerstone of tuberculosis treatment. But treating TB takes much longer than treating other types of bacterial infections. Normally, you take antibiotics for at least six to nine months to destroy the TB bacteria. The exact drugs and length of treatment depend on your age, overall health, possible drug resistance, the form of TB (latent or active) and its location in the body.
Several promising new TB drugs are in development, and some may become available within the next 10 years.
Treating TB infection (latent TB)
If tests show that you have TB infection but not active disease, your doctor may recommend preventive drug therapy to destroy bacteria that might become active in the future. You're likely to receive a daily or twice-a-week dose of the TB medication isoniazid. For treatment to be effective, you usually take isoniazid for nine months. Long-term use of isoniazid can cause side effects, including the life-threatening liver disease hepatitis. For this reason, your doctor will monitor you closely while you're taking isoniazid. During treatment, avoid using acetaminophen (Tylenol, others) and avoid or limit alcohol use. Both increase your risk of liver damage.
Treating active TB disease
If you're diagnosed with active TB, you're likely to begin taking four medications — isoniazid, rifampin (Rifadin), ethambutol (Myambutol) and pyrazinamide. This regimen may change if tests later show some of these drugs to be ineffective. Even so, you'll continue to take several medications. Depending on the severity of your disease and whether the bacteria are drug-resistant, one or two of the four drugs may be stopped after a few months. You may be hospitalized for the first two weeks of therapy or until tests show that you're no longer contagious.
Sometimes the drugs may be combined in a single tablet such as Rifater, which contains isoniazid, rifampin and pyrazinamide. This makes your treatment less complicated while ensuring that you get all the drugs needed to completely destroy TB bacteria. Another drug that may make treatment easier is rifapentine (Priftin), which is taken just once a week during the last four months of therapy, in combination with other drugs.
Medication side effects
Side effects of TB drugs aren't common, but can be serious when they do occur. All TB medications can be highly toxic to your liver. Rifampin can also cause severe flu-like signs and symptoms — fever, chills, muscle pain, nausea and vomiting. When taking these medications, call your doctor immediately if you experience any of the following:
- Nausea or vomiting
- Loss of appetite
- A yellow color to your skin (jaundice)
- Dark urine
- A fever that lasts three or more days and has no obvious cause
- Tenderness or soreness in your abdomen
- Blurred vision or colorblindness
Treating drug-resistant TB
Multidrug-resistant TB (MDR TB) can't be cured by the two major TB drugs, isoniazid and rifampin. Extensive drug-resistant TB (XDR TB) is resistant to those drugs as well as three or more of the second line TB drugs. Treating these resistant forms of TB is far more costly than is treating nonresistant TB.
Treatment of drug-resistant TB requires taking a "cocktail" of at least four drugs, including first line medications that are still effective and several second line medications, for 18 months to two years or longer. Even with treatment, many people with these types of TB may not survive. If treatment is successful, you may need surgery to remove areas of persistent infection or repair lung damage.
Treating children and pregnant women
Treating TB in children is largely the same as treating adults, except that ethambutol is not used for young children because of the possible side effect of vision problems. Instead of ethambutol, children may take streptomycin.
For pregnant women with active TB, initial treatment often involves three drugs — isoniazid, rifampin and ethambutol. Pyrazinamide isn't recommended because its effect on the unborn baby isn't known. Some second line TB medications also aren't recommended.
Completing treatment is essential
After a few weeks, you won't be contagious and you may start to feel better. It might be tempting to stop taking your TB drugs. But it is crucial that you finish the full course of therapy and take the medications exactly as prescribed by your doctor. Stopping treatment too soon or skipping doses can allow the bacteria that are still alive to become resistant to those drugs, leading to TB that is much more dangerous and difficult to treat. Drug-resistant strains of TB can quickly become fatal, especially if your immune system is impaired.
In an effort to help people stick with their treatment, a program called directly observed therapy (DOT) is recommended. In this approach, a nurse or other health care professional administers your medication so that you don't have to remember to take it on your own. Sometimes clinics provide incentives, such as food coupons or transportation, for people to show up for their appointments.
methods of diagnosis
Tests and diagnosis
If your doctor suspects TB, you will need a complete medical evaluation and tests for TB infection.
Skin test
The most commonly used diagnostic tool for TB is a simple skin test. Although there are two methods, the Mantoux test is preferred because it's more accurate.
For the Mantoux test, a small amount of a substance called PPD tuberculin is injected just below the skin of your inside forearm. You should feel only a slight needle prick. Within 48 to 72 hours, a health care professional will check your arm for swelling at the injection site, indicating a reaction to the injected material. A hard, raised red bump (induration) means you're likely to have TB infection. The size of the bump determines whether the test results are significant, based on your risk factors for TB.
The Mantoux test isn't perfect. A false-positive test suggests that you have TB when you really don't. This is most likely to occur if you're infected with a different type of mycobacterium other than the one that causes tuberculosis, or if you've recently been vaccinated with the bacillus Calmette-Guerin (BCG) vaccine. This TB vaccine is seldom used in the United States, but widely used in countries with high TB infection rates.
On the other hand, some people who are infected with TB — including children, older people and people with AIDS — may have a delayed or no response to the Mantoux test.
Blood tests
Blood tests may be used to confirm or rule out latent or active TB. These tests use sophisticated technology to measure the immune system's reaction to Mycobacterium tuberculosis. These tests are quicker and more accurate than is the traditional skin test. They may be useful if you're at high risk of TB infection but have a negative response to the Mantoux test, or if you received the BCG vaccine.
Further testing
If the results of a TB test are positive (referred to as "significant"), you may have further tests to help determine whether you have active TB disease and whether it is a drug-resistant strain.
These tests may include:
- Chest X-ray or CT scan. If you've had a positive skin test, your doctor is likely to order a chest X-ray. In some cases, this may show white spots in your lungs where your immune system has walled off TB bacteria. In others, it may reveal a nodule or cavities in your lungs caused by active TB. A computerized tomography (CT) scan, which uses cross-sectional X-ray images, may show more subtle signs of disease.
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Culture tests. If your chest X-ray shows signs of TB, your doctor may take a sample of your stomach secretions or sputum — the mucus that comes up when you cough. The samples are tested for TB bacteria, and your doctor can have the results of special smears in a matter of hours.
Samples may also be sent to a laboratory where they're examined under a microscope as well as placed on a special medium that encourages the growth of bacteria (culture). The bacteria that appear are then tested to see if they respond to the medications commonly used to treat TB. Your doctor uses the results of the culture tests to prescribe the most effective medications for you. Because TB bacteria grow very slowly, traditional culture tests can take four to eight weeks.
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Other tests. Testing called nuclear acid amplification (NAA) can detect genes associated with drug resistance in Mycobacterium tuberculosis. This test is generally available only in developed countries.
A test used primarily in developing countries is called the microscopic-observation drug-susceptibility (MODS) assay. It can detect the presence of TB bacteria in sputum in as little as seven days. Additionally, the test can identify drug-resistant strains of the TB bacteria.
What if my test is negative?
Having little or no reaction to the Mantoux test usually means that you're not infected with TB bacteria. But in some cases it's possible to have TB infection in spite of a negative test. Reasons for a false-negative test include:
- Recent TB infection. It can take eight to 10 weeks after you've been infected for your body to react to a skin test. If your doctor suspects that you've been tested too soon, you may need to repeat the test in a few months.
- Severely weakened immune system. If your immune system is compromised by an illness, such as AIDS, or by corticosteroid or chemotherapy drugs, you may not respond to the Mantoux test, even though you're infected with TB. Diagnosing TB in HIV-positive people is further complicated because many symptoms of AIDS are similar to TB symptoms.
- Vaccination with a live virus. Vaccines that contain a live virus, such as the measles or smallpox vaccine, can interfere with a TB skin test.
- Overwhelming TB disease. If your body has been overwhelmed with TB bacteria, it may not be able to mount enough of a defense to respond to the skin test.
- Improper testing. Sometimes the PPD tuberculin may be injected too deeply below the surface of your skin. In that case, any reaction you have may not be visible. Be sure that you're tested by someone skilled in administering TB tests.
Diagnosing TB in children
It's harder to diagnose TB in children than in adults. Children may swallow sputum, rather than coughing it out, making it harder to take culture samples. And infants and young children may not react to the skin test. For these reasons, tests from an adult who is likely to have been the cause of the infection may be used to help diagnose TB in a child.
signs & symptoms
Symptoms
Although your body may harbor the bacteria that cause tuberculosis, your immune system often can prevent you from becoming sick. For this reason, doctors make a distinction between:
- Latent TB. In this condition, you have a TB infection, but the bacteria remain in your body in an inactive state and cause no symptoms. Latent TB, also called inactive TB or TB infection, isn't contagious.
- Active TB. This condition makes you sick and can spread to others.
Signs and symptoms of active TB include:
- Unexplained weight loss
- Fatigue
- Fever
- Night sweats
- Chills
- Loss of appetite
Tuberculosis usually attacks your lungs. Signs and symptoms of TB of the lungs include:
- Coughing that lasts three or more weeks
- Coughing up blood
- Chest pain, or pain with breathing or coughing
Tuberculosis can also affect other parts of your body, including your kidneys, spine or brain. When TB occurs outside your lungs, symptoms vary according to the organs involved. For example, tuberculosis of the spine may give you back pain, and tuberculosis in your kidneys might cause blood in your urine.
When to see a doctor
See your doctor if you have a fever, unexplained weight loss, night sweats and a persistent cough. These are often signs of TB, but they can also result from other medical problems. Your doctor can perform tests to help determine the cause. TB can be diagnosed by your primary care doctor or by a doctor who specializes in lung diseases (pulmonologist) or by an infectious disease specialist. If you don't have a doctor, your local public health department can help.
causes
Causes
Although tuberculosis is contagious, it's not especially easy to catch. You're much more likely to get tuberculosis from a family member or close co-worker than from a stranger. Most people with active TB who've had appropriate drug treatment for at least two weeks are no longer contagious.
TB infection vs. active TB
If you breathe TB bacteria into your lungs, one of four things might happen:
- You don't become infected with TB. Your immune system immediately destroys the germs and clears them from your body.
- You develop latent TB infection. The germs settle in your lungs and begin to multiply. Within several weeks, however, your immune system successfully "walls off" the bacteria in your lungs, much like a scab forming over a wound. The bacteria may remain within these walls for years — alive, but in a dormant state. In this case, you're considered to have TB infection and you'll test positive on a TB skin test. But you won't have symptoms and won't transmit the disease to others.
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You develop active TB. If your immune defenses fail, TB bacteria begin to exploit your immune system cells for their own survival. The bacteria move into the airways in your lungs, causing large air spaces (cavities) to form. Filled with oxygen — which the bacteria need to survive — the air spaces make an ideal breeding ground for the bacteria. The bacteria may then spread from the cavities to the rest of your lungs as well as to other parts of your body.
If you have active TB, you're likely to feel sick. Even if you don't feel sick, you can still infect others. Without treatment, many people with active TB die. Those who survive may develop long-term symptoms, such as chest pain and a cough with bloody sputum, or they may recover and go into remission.
- You develop active TB years after the initial infection. After you've had latent TB for years, the walled-off bacteria may suddenly begin multiplying again, causing active TB, also known as reactivation TB. It's not always clear what triggers this reactivation, but it most commonly happens after your immune system becomes weakened. Your resistance may be lower because of aging, drug or alcohol abuse, malnutrition, chemotherapy, prolonged use of prescription medications such as corticosteroids or TNF inhibitors, and diseases such as HIV/AIDS.
Only about one in 10 people who have TB infection goes on to develop active TB. The risk is greatest in the first two years after infection and is much higher if you have HIV infection.
Wednesday, February 4, 2009
History
Tubercular decay has been found in the spines of Egyptian mummies. Pictured: Egyptian mummy in the British Museum
Consumption, phthisis, scrofula, Pott's disease, and the White Plague are all terms used to refer to tuberculosis throughout history. The term “phthisis”, consumption, appears first in Greek literature.
Around 460 BCE, Hippocrates identified phthisis as the most widespread disease of the times, and noted that it was almost always fatal. Tuberculosis (TB) is caused by Mycobacterium tuberculosis which has been present in the human population since antiquity - fragments of the spinal column from Egyptian mummies from 2400 BCE show definite signs of tuberculosis.
Folklore
Before the Industrial Revolution, tuberculosis may sometimes have been regarded as vampirism. When one member of a family died from it, the other members that were infected would lose their health slowly. People believed that this was caused by the original victim draining the life from the other family members. Furthermore, people who had TB exhibited symptoms similar to what people considered to be vampire traits. People with TB often have symptoms such as red, swollen eyes (which also creates a sensitivity to bright light), pale skin, extremely low body heat, a weak heart and coughing blood, suggesting the idea that the only way for the afflicted to replenish this loss of blood was by sucking blood. Another folk belief attributed it to being forced, nightly, to attend fairy revels, so that the victim wasted away owing to lack of rest; this belief was most common when a strong connection was seen between the fairies and the dead. Similarly, but less commonly, it was attributed to the victims being "hagridden"—being transformed into horses by witches (hags) to travel to their nightly meetings, again resulting in a lack of rest.
TB was romanticized in the nineteenth century. Many people believed TB produced feelings of euphoria referred to as "Spes phthisica" or "hope of the consumptive". It was believed that TB sufferers who were artists had bursts of creativity as the disease progressed. It was also believed that TB sufferers acquired a final burst of energy just before they died which made women more beautiful and men more creative. In the early 20th century, some believed TB to be caused by masturbation.
Study and treatment
The study of tuberculosis dates back to The Canon of Medicine written by Ibn Sina (Avicenna) in the 1020s. He was the first physician to identify pulmonary tuberculosis as a contagious disease, the first to recognize the association with diabetes, and the first to suggest that it could spread through contact with soil and water. He developed the method of quarantine in order to limit the spread of tuberculosis.
In ancient times, treatments focused on sufferers' diets. Pliny the Eld
er described several methods in his Natural History: "wolf's liver taken in thin wine, the lard of a sow that has been fed upon grass, or the flesh of a she-ass taken in broth". Although it was established that the pulmonary form was associated with "tubercles" by Dr Richard Morton in 1689, due to the variety of its symptoms, TB was not identified as a single disease until the 1820s and was not named "tuberculosis" until 1839 by J. L. Schönlein. During the years 1838 – 1845, Dr. John Croghan, the owner of Mammoth Cave, brought a number of tuberculosis sufferers into the cave in the hope of curing the disease with the constant temperature and purity of the cave air; they died within a year. The first TB sanatorium opened in 1859 in Görbersdorf, Germany (today Sokołowsko, Poland) by Hermann Brehmer.In regard to this claim, The Times for 15 January 1859, page 5, column 5, carries an advertisement seeking funds for the Bournemouth Sanatorium for Consumption, referring to the balance sheet for the past year, and offering an annual report to prospective donors, implying that this sanatorium was in existence at least in 1858.
Dr. Robert Koch discovered the tuberculosis bacilli.The bacillus causing tuberculosis, Mycobacterium tuberculosis, was identified and described on 24 March 1882 by Robert Koch. He received the Nobel Prize in physiology or medicine in 1905 for this discovery. Koch did not believe that bovine (cattle) and human tuberculosis were similar, which delayed the recognition of infected milk as a source of infection. Later, this source was eliminated by the pasteurization process. Koch announced a glycerine extract of the tubercle bacilli as a remedy for tuberculosis in 1890, calling it "tuberculin". It was not effective, but was later adapted as a test for pre-symptomatic tuberculosis.
Albert Calmette Camille Guerin(from left-right)
The first genuine success in immunizing against tuberculosis was developed from attenuated bovine-strain tuberculosis by Albert Calmette and Camille Guérin in 1906. It was called "BCG" (Bacillus of Calmette and Guérin). The BCG vaccine was first used on humans in 1921 in France, but it was not until after World War II that BCG received widespread acceptance in the USA, Great Britain, and Germany.
Tuberculosis, or "consumption" as it was commonly known, caused the most widespread public concern in the 19th and early 20th centuries as an endemic disease of the urban poor. In 1815, one in four deaths in England was of consumption; by 1918 one in six deaths in France were still caused by TB. In the 20th century, tuberculosis killed an estimated 100 million people. After the establishment in the 1880s that the disease was contagious, TB was made a notifiable disease in Britain; there were campaigns to stop spitting in public places, and the infected poor were pressured to enter sanatoria that resembled prisons; the sanatoria for the middle and upper
the fresh air and labor in the sanatoria, even under the best conditions, 50% of those who entered were dead within five years (1916).
The promotion of Christmas Seals began in Denmark during 1904 as a way to raise money for tuberculosis programs. It expanded to the United States and Canada in 1907 – 1908 to help the National Tuberculosis Association (later called the American Lung Association).
In the United States, concern about the spread of tuberculosis played a role in the movement to prohibit public spitting except into spittoons. In Europe, deaths from TB fell from 500 out of 100,000 in 1850 to 50 out of 100,000 by 1950. Improvements in public health were reducing tuberculosis even before the arrival of antibiotics, although the disease remained a significant threat to public health, such that when the Medical Research Council was formed in Britain in 1913 its initial focus was tuberculosis research.
It was not until 1946 with the development of the antibiotic streptomycin that effective treatment and cure became possible. Prior to the introduction of this drug, the only treatment besides sanatoria were surgical interventions, including the pneumothorax technique — collapsing an infected lung to "rest" it and allow lesions to heal — a technique that was of little benefit and was largely discontinued by the 1950s. The emergence of multidrug-resistant TB has again introduced surgery as part of the treatment for these infections. Here, surgical removal of chest cavities will reduce the number of bacteria in the lungs, as well as increasing the exposure of the remaining bacteria to drugs in the bloodstream, and is therefore thought to increase the effectiveness of the chemotherapy.
How does it spread or how is it acquired?
When infectious people cough, sneeze, talk or spit, they propel TB germs, known as bacilli, into the air. A person needs only to inhale a small number of these to be infected. The body's immune (defense) system, however, can fight off the infection and stop the bacteria from spreading. The immune system does so ultimately by forming scar tissue around the TB bacteria and isolating it from the rest of the body. Tuberculosis that occurs after initial exposure to the bacteria is often referred to as primary TB. If the body is able to form scar tissue (fibrosis) around the TB bacteria, then the infection is contained in an inactive state. Such an individual typically has no symptoms and cannot spread TB to other people. The scar tissue and lymph nodes may eventually harden, like stone, due to the process of calcification of the scars (deposition of calcium from the bloodstream in the scar tissue). These scars often appear on x-rays and imaging studies like round marbles and are referred to as a granuloma.
A person does not acquire TB by just merely touching the clothes or shaking the hands of someone who is infected. Tuberculosis spread (transmitted) primarily from person to person by breathing infected air during close contact.
What are the symptoms of tuberculosis?
generalized tiredness or weakness,
weight loss,
fever,
night sweats
chest pain,
coughing up of sputum (material from the lungs) and/or blood
shortness of breath.
How is tuberculosis diagnosed?
· Chest x-rays – which may show scarring (fibrosis) or hardening (calcification) in the lungs, suggesting that the TB is contained and inactive
· Analysis of sputum (sputum exam) - Examination of the sputum on a slide (smear) under the microscope can show the presence of the tuberculosis-like bacteria
· Skin tests – includes the Tine test and the Mantoux test, also known as the PPD (purified protein derivative) test. In each of these tests, a small amount of purified extract from dead tuberculosis bacteria is injected under the skin. If a person is not infected with TB, then no reaction will occur at the site of the injection (a negative skin test). If a person is infected with tuberculosis, however, a raised and reddened area will occur around the site of the test injection. This reaction, a positive skin test, occurs about 48 to 72 hours after the injection
What is DOTS?
In the United States, this was known as Directly Observed Therapy, or DOT. But in 1994, WHO TB Programme Advocacy Officer Kraig Klaudt, modified the DOT acronym to include another key element of the strategy-the Short-course chemotherapy from SCC- gave meaning to "DOTS." Thus "DOTS" was born and Stop TB-Use DOTS became a clarion call for TB control programmes around the world.
How is tuberculosis treated?
A person with a positive skin test, a normal chest x-ray, and no symptoms most likely has only a few TB germs in an inactive state and is not contagious. Nevertheless, treatment with an antibiotic may be recommended for this person to prevent the TB from turning into an active infection. The antibiotic used for this purpose is called isoniazid (INH). If taken for six to 12 months, it will prevent the TB from becoming active in the future. In fact, if a person with a positive skin test does not take INH, there is a 5%-10% lifelong risk that the TB will become active.
Active TB is treated with a combination of medications along with Isoniazid, Rifampicin (Rifadin), Ethambutol (Myambutol), and Pyrazinamide are the drugs commonly used to treat active TB. Four drugs are often taken for the first two months of therapy to help kill any potentially resistant strains of bacteria. Then the number is usually reduced to two drugs for the remainder of the treatment based on drug sensitivity testing that is usually available by this time in the course. Streptomycin, a drug that is given by injection, may be used as well, particularly when the disease is extensive and/or the patients do not take their oral medications reliably (termed "poor compliance"). Treatment usually lasts for many months and sometimes for years. Successful treatment of TB is dependent largely on the compliance of the patient. Indeed, the failure of a patient to take the medications is the most important cause of failure to cure the TB infection. In some locations, the health department demands direct monitoring of patient compliance with therapy. Thus the 5 combination of the drugs that treat tuberculosis can be easily remembered by the following acronym R.I.P.E.S which pertains to Rifampicin, Isoniazid, Pyrazinamide, Ethambutol and Streptomycin.
Surgery on the lungs may also be indicated to help cure TB when medication has failed, but in this day and age, surgery for TB is unusual. Treatment with appropriate antibiotics will usually cure the TB. Without treatment, however, tuberculosis can be a lethal infection. Therefore, early diagnosis is important. Those individuals who have been exposed to a person with TB, or suspect that they have been, should be examined by a doctor for signs of TB and screened with a TB skin test.
What are the five major components of DOTS?
Political commitment and resources:TB control is a public health responsibility and top-down support is crucial. This component must be the strongest link in the chain.
Microscopy: Accurate diagnosis using sputum smear microscopy among symptomatic patients is the first step in early detection of active TB infection. It sets the DOTS cure cycle in motion and protects others from infection;
Treatment:Standardized 6-8 month regimens for all patients with active TB, with directly observed treatment for at least the first two months. The success of this phase is contingent upon a sound, functional health sector infrastructure and trained personnel;
Medicines: Regular, uninterrupted supplies of the 4-6 most effective anti- TB drugs is essential. Full compliance with the drug regimen means nine out of ten patients can be cured;
Monitoring: A standardized recording and reporting system allows assessment of each patient's treatment and progress. Rigorous overall record keeping also acts as early warning for emerging disease trends (e.g. MDR-TB).
Introduction
There is a form of atypical tuberculosis, however, that is transmitted by drinking unpasteurized milk. Related bacteria, called Mycobacterium bovis, cause this form of TB. Previously, this type of bacteria was a major cause of TB in children, but it rarely causes TB now since most milk is pasteurized (undergoes a heating process that kills the bacteria).
Another group of organisms referred to as atypical tuberculosis involves other types of bacteria that are in the Mycobacterium family. Often, these organisms do not cause disease and are referred to a "colonizers," because they simply live alongside other bacteria in our bodies without causing damage. At times, these bacteria can cause an infection that is sometimes clinically like typical tuberculosis. When these atypical mycobacteria cause infection, they are often very difficult to cure. Often, drug therapy for these organisms must be administered for one and a half to two years and requires multiple medications.
