Tuberculosis (Koch’s disease) :
Tuberculosis (TB): It is caused by mycobacterium tuberculosis, a facultative intracellular parasite. Tuberculosis is communicable through the air when an infected person coughs or sneezes. Tuberculosis is a bacterial infection that only affects the lungs and can also affect any part of the body such as kidney, spine and brain.
Mode of transmission: Droplet infection & droplet nuclei produced by sputum positive patients.
Incubation period: Weeks, month of years
Clinical manifestation:
• Chronic cough 3-4 weeks duration Continuous low- grade fever, chest pain, hemoptysis, night sweats, low weight, fatigue, a lot of patients infected with tuberculosis might not show any symptoms.
Diagnosis:
• Sputum examination (sputum sample)
• Day 1- Sample 1 ( on the stop) when presenting health facility.
• Day 2- Sample 2 ( early morning sample) and Sample 3 “on the spot”under supervision
• Tuberculin test/Mantoux test: 1 TU of PPD in 0.1 ml injected intradermally on the flexor surface of left forearm and result, i.e. induration is read on 3rd day (72 hours). PPD-RT with Tween 80 is used into India.
• Postive: 10 mm or more induration
• Negative: Induration less than 6 mm
• Chest X-Rays to diagnose military TB.
• Sputum culture: Use to isolate pathogens. It is a definitive (most reliable) diagnosis of tuberculosis.
• CBNAAT (cartridge based nucleic acid amplification test) : It is a recently launched PCR (polymerase chain reaction) based method for detection of TB.
Treatment and prevention :
• Chemotherapy/Anti Tuberculosis Drugs (12 drugs are active against M. tuberculosis, among 6 are essential)
• Bactericidal Drugs:
R=Rifampicin (it caused red urine),
H=INH (Isoniazid),
S=Streptomycin,
Z=Pyrazinamide
• Bacteriostatic Drug:
E=Ethambutol
Thioacetazone
Cycloserine
Kanamycin
Ethionamide
Bedaquiline
• All the BBC bacterial drugs including ethambutol are considered as a first line drugs and our rest are considered as second line drugs for TB .
Note: Prefix to the drug e.g (2) stand for a number of months. Pyrazinamide (Z) never used CP. There is a different treatment regimen for drug resistant TB (DR TB) and XDR TB.
• STOP-TB strategy : WHO launched the new “Stop TB strategy” in 2006. The core of this strategy is”DOTS”.
• In 2014 WHO approved “END TB strategy”.
• In May 2012 NIKSHAY software launched.
• Direct benefit transfer scheme through NIKSHAY.
I hope that you liked this article.
Thanking you!
Writer: Vandita Singh, Lucknow