TUBERCULOSIS TUBERCULOSIS * Prevention * Treatment, and * Challenges. By Dr. O.S. Lawal Matron B.G....

TUBERCULOSISTUBERCULOSIS* Prevention* Treatment, and* Challenges.

ByBy

Dr. O.S. LawalDr. O.S. LawalMatron B.G. OjelabiMatron B.G. Ojelabi

CHEST CLINIC DEPT. GHLAGOS

OUTLINEOUTLINEo Introductiono Classification of Tuberculosiso Mode of Transmissiono Pathogenesiso Symptoms & Signso Diagnosiso Treatmento DOTS Strategyo Stop TB Strategyo Monitoring of TB Patientso TB Preventiono Challengeso Conclusion

IntroductionIntroduction

• Tuberculosis (TB) is a disease that can spread from one person to another and is caused by a bacteria called Mycobacterium tuberculosis.

Introduction (Contd.)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 SITUATIONLOCAL 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.

CLASSIFICATIONCLASSIFICATION

• 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 transmissionTB transmission

TB transmission TB transmission contd.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 millions1 sneeze releases millions

Organisms LiberatedOrganisms Liberated ““Wells 1934, Duguid 1945, Wells/Riley 1953, et al.”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

PATHOGENESISPATHOGENESIS

EXPOSURE

INFECTION

LATENT ACTIVE DISEASE

SIGNS AND SYMPTOMS OF TUBERCULOSIS

SIGNS AND SYMPTOMSSIGNS 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 SYMPTOMSSIGNS AND SYMPTOMS

Other symptoms and signs are• Chest pain• Difficulty in breathing• Coughing out of blood• Fever• Weight loss• Night sweats• Palor• Easy tiredness.

DIAGNOSISDIAGNOSIS• 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 germsTB germs

TREATMENTTREATMENT

• 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 Standardized short-course chemotherapychemotherapy

• 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 STRATEGYDOTS STRATEGYIt 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 STRATEGYSTOP 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 MONITORING OF TBTB PATIENT 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 over-crowding and affords good ventilation reduces the risk of exposure to the bacilli.

• Screening of contacts of TB patients

• Control of HIV/AIDS

CHALLENGESCHALLENGES1. Difficulty in Diagnosis2. Limitation of Lab. Investigation-

GeneXpert, FNAC.3. Clinical delay – when surgery is

required4. Delay at home, before presentation.

• Inappropriate therapy of Private hospital

• Reduce case finding5. TB/HIV

6. MDR TB7. EP8. IPACAdministrative 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 wards10. DM Screening.

CONCLUSIONCONCLUSION• 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 OEKO O NI BAJE O

TB O NI WOLE WA O!

THANK YOU.