TUBE

RCUL
OSIS

Prepared by:
Mecor M. Riego
BSM III

What You Need to Know About Tuberculosis (TB)

The TB Scenario
Defining TB: Cause, Transmission, and Manifestations
Risk of TB infection
Diagnosing Pulmonary Tuberculosis
TB Treatment and Cure
Preventing transmission
Proper Management of TB cases
DOH: National Tuberculosis Program (NTP)

9 million people fell ill with TB in 2013, including 1.1

million
cases
among people living with HIV.
TB Burden
in the
World
In 2013, 1.5 million people died from TB, including
360 000 among people who were HIV-positive.
510 000 women died from TB in 2013, including 180
000 among women who were HIV-positive. Of the
overall TB deaths among HIV-positive people, 50%
were among women.
TB is one of the top killers of women of reproductive
age. An estimated 550 000 children became ill with TB
and 80 000 children who were HIV-negative died of
TB in 2013.
The TB mortality rate has decreased 45% since 1990

Source: ww.who.int

TB Burden in the
Philippines

Tuberculosis is a major public health problem in the Philippines.

In 2010, TB was the 6th leading cause of mortality with a rate of 26.3 deaths for
every 100,000 population and accounts for 5.1% of total deaths.
More males died (17,103) compared to females (7,611).
An estimated 200,000 to 600,000 Filipinos have active TB.
Out of 196 countries, the Philippines has the distinction of being included in the top 22
high-burden tuberculosis countries in the world. This report is according to the World
Health Organizations (WHO), which ranks the Philippines at number nine worldwide.
Together, these 22 countries (including the Philippines) contribute 80 percent of the
global TB burden.
Seventy-five (75) Filipinos die of TB every day, most of them in the prime of their life.
If untreated, a person with tuberculosis can transmit the TB bacteria to as many as 10 to
15 people during the course of one year, who, in turn, may develop the disease.

What is Tuberculosis?
Tuberculosis (TB) is an infection caused by bacteria that usually affect the lungs. These bacteria, called
Mycobacterium tuberculosis, can be passed on to another person through tiny droplets spread by coughing and
sneezing. Even the accidental spread of saliva through laughing, singing, and spitting can pass on the TB
bacteria.
The Tubercle Bacilli or Mycobacterium Tuberculosis is the bacteria that cause Tuberculosis. It can be seen
under the microscope as red rods. The TB germ, as it is also called, is slow growing, thus no immediate signs
and symptoms can be seen in an infected person. It is only when the TB germ multiplies in number that the TB
infection will develop into a TB disease. When this happens, signs and symptoms will be manifested. The TB
germ can easily be killed when exposed to direct sunlight.

How it is TRANSMITTED?
A person with TB can transmit the bacteria when he or she coughs and/or sneezes, laughing,
shouting. The TB germ is airborne, thus inhalation of droplets from a person with TB may cause TB
infection. Invasion may occur through mucous membranes or damaged skin.

But is should be emphasized that being TB infected does not absolutely lead to TB disease.

How Are TB Germs NOT Spread?

Through quick, casual contact, like passing someone on the street

By sharing utensils or food
By sharing cigarettes or drinking containers
By exchanging saliva or other body fluids
By shaking hands
Using public telephones
A person is infected

How does PTB develop?

1. TB bacilli enters the body and lodges in the lungs (TB Infection).
2. In the lungs, they multiply and slowly eat the cells and the body begins to
experience symptoms (TB Disease)
3. If undiagnosed, lungs cells are eaten up leading that may lead death.

after inhaling droplets

from a person with
TB

TB INFECTION vs. TB DISEASE

TB infection: TB germs stay in your lungs, but they do not multiply or make you sick. You cannot pass TB germs to
others.
TB disease: TB germs stay in your lungs or move to other parts of your body, multiply, and make you sick. You can pass
the TB germs to other people

What are the signs and symptoms

of
TB?
Persistent cough for at least 2 weeks
Chest pains/ Back Pains (breathlessness)
Persistent low grade fever for more than a month significant weight loss with or without
loss of appetite
Hemoptysis (Blood-tinged sputum)
Feeling of weakness (tiredness)
Night Sweats

Treatment for TB Disease

TB disease is treated with medicine to kill the TB germs.
Usually, the treatment will last for 6-9 months.
TB disease can be cured if the medicine is taken as prescribed, even after you no longer feel sick.
The treatment for TB is a combination of 3-4 anti-TB drugs.
NEVER should we prescribe a SINGLE DRUG for TB treatment! This will worsen the patient's
condition.
o Drug formulations
1. Fixeddose combination (FDCs) Two or more first-line anti-TB drugs are combined in one tablet.
There are 2-, 3-, or 4-drug fixed-dose combinations, namely: HR, HRE and HRZE. These are usually
provided in kits with boxes of blister packs corresponding to treatment phases of an average-weight
patient.
o 2. Single drug formulation (SDF) Each drug is prepared individually, either as tablet, capsule, syrup or
injectable (Streptomycin) form.
o
o
o
o
o

Who are at risk of getting TB?

People who share the same breathing space with someone who has infectious TB
Health workers, especially those working in long-term facilities (prison, sanitariums, etc.)
People who are infected with HIV are 26 to 31 times more likely to become sick with TB Risk of active
TB is also greater in persons suffering from other conditions that impair the immune system.
People exposed to silica and those with jobs that compromise the respiratory system (mine workers)
People underweight and malnourished (esp. Children)
Alcoholics and IV drug users
Tuberculosis mostly affects young adults, in their most productive years. However, all age groups are at
risk. Over 95% of cases and deaths are in developing countries.
Over half a million children (0-14 years) fell ill with TB.
Tobacco use greatly increases the risk of TB disease and death. More than 20% of TB cases worldwide
are attributable to smoking.

How is TB diagnosed?
1. Sputum Microscopy
It shows the TB bacilli in the sputum.
It is the most definitive diagnostic tool of Tuberculosis.
2. Chest X-Ray
Determines extent of the lung damage
Not a very definitive diagnostic tool

How is TB cured?
TB can be cured.

DOTS (Directly-Observed Treatment Short Course) is the recommended strategy to cure TB. It ensures the right
combination and dosage of anti-TB drugs. It ensures regular and complete intake of anti-TB drugs.
Patient takes drugs every day with the help of a treatment partner.

With proper treatment

We want to treat patients with DOTS:
To make them get well as soon as possible
To make them stop spreading the disease onto others in the community
To avoid complications and multi-drug resistance (MDR)

How can TB be prevented?

BCG vaccination for infants (newborn to 1 year old). This gives 80-85% protection against development
of complicated TB among children;
Hygienic practices like covering the mouth when coughing and sneezing; and
Early diagnosis and treatment of TB infectious cases to stop transmission
Maintain open air circulation inside the house
Have enough sleep
Eat nutritious food that boost the immune system
Avoid smoking, drinking alcohol, and use of prohibited drugs

What are some misconceptions about TB?

What is DOTS?
D.O.T.S stands for Directly-Observed Treatment Short Course.
- It is a comprehensive strategy endorsed by the World Health Organization (WHO) and International Union Against
Tuberculosis and Lung Diseases (IUATLD) to detect and cure TB patients.

5 Components of TB-DOTS Program

1. Political commitment with increased and sustained financing
Legislation, planning, human resources, management, training
2. Case detection through quality-assured bacteriology
Strengthening TB laboratories, drug resistance surveillance
3. Standardized treatment with supervision and patient support
TB treatment and programme management guidelines, International Standards of TB Care (ISTC), PPM,
Practical Approach to Lung Health (PAL), community-patient involvement
4. An effective drug supply and management system
Availability of TB drugs, TB drug management, Global Drug Facility (GDF), Green Light Committee
(GLC)
5. Monitoring and evaluation system and impact measurement

TB recording and reporting systems, Global TB Control Report, data and country profiles, TB planning
and budgeting tool, WHO epidemiology and surveillance online training

The National TB Control Program (NTP) in the PHILIPPINES

The NTP is one of the public health programs being managed and coordinated by the Infectious Diseases for
Prevention and Control Division (IDPCD) of the Disease Prevention and Control Bureau (DPCB) of the DOH.
The NTP has the mandate to develop TB control policies, standards and guidelines, formulate the national
strategic plan, manage program logistics, provide leadership and technical assistance (TA) to the lower health
offices/units, manage data, and monitor and evaluate the program. The programs TB diagnostic and treatment
protocols and strategies are in accordance with the global strategy of STOP TB Partnership and the policies of
World Health Organization (WHO) and the International Standards for TB Care (ISTC).

Roles and Functions of a Midwife in the NTP

Under the supervision of a Nurse do the following;
- Identify presumptive TB patients and ensure proper collection and transport of sputum
specimen.
- Refer all diagnosed TB patients to physician and nurse for clinical evaluation and initiation of
treatment.
- Maintain and update NTP treatment cards.
- Provide continuous health education to patients.
- Supervise intake of anti-TB drugs.
- Collect sputum for follow-up examination.
- Report and retrieve defaulters within 2 days.
- Refer patients with adverse reactions to physician for evaluation and management.
- Supervise and mentor treatment partners.
Classifications of TB Disease
1. Classification based on bacteriological status
a. Bacteriologically-confirmed A TB patient from whom a biological specimen is positive by smear
microscopy, culture or rapid diagnostic tests (such as Xpert MTB/RIF [GeneXpert Mycobacterium
tuberculosis/Rifampicin assay]).
b. Clinically-diagnosed A PTB patient who does not fulfill the criteria for bacteriological confirmation but
has been diagnosed with active TB by a clinician or other medical practitioner who has decided to give the
patient a full course of TB treatment. This definition includes cases diagnosed on the basis of CXR
abnormalities or suggestive histology, and extra-pulmonary cases without laboratory confirmation.
2. Classification based on anatomical site
a. Pulmonary TB (PTB) Refers to a case of tuberculosis involving the lung parenchyma. A patient with both
pulmonary and extra-pulmonary TB should be classified as a case of pulmonary TB.

b. Extra-pulmonary TB (EPTB) Refers to a case of tuberculosis involving organs other than the lungs (e.g.,
larynx, pleura, lymph nodes, abdomen, genitourinary tract, skin, joints and bones, meninges). Histologicallydiagnosed EPTB through biopsy of appropriate sites will be considered clinically-diagnosed TB. Laryngeal TB,
though likely sputum smear-positive, is considered an extrapulmonary case in the absence of lung infiltrates on
CXR.
Classification based on drug-susceptibility testing
a. Monoresistant-TB Resistance to one first-line anti-TB drug only.
b. Polydrug-resistant TB Resistance to more than one first-line anti-TB drug (other than both Isoniazid and
Rifampicin).
c. Multidrug-resistant TB (MDR-TB) Resistance to at least both Isoniazid and Rifampicin.
d. Extensively drug-resistant TB (XDR-TB) Resistance to any fluoroquinolone and to at least one of three
second-line injectable drugs (Capreomycin, Kanamycin and Amikacin), in addition to multidrug resistance.
e. Rifampicin-resistant TB (RR-TB) Resistance to Rifampicin detected using phenotypic or genotypic
methods, with or without resistance to other antiTB drugs. It includes any resistance to Rifampicin, whether
monoresistance, multidrug resistance, polydrug resistance or extensive drug resistance.

TB drugs used to treat drug resistant TB according to group (class)

Group 1 TB drugs: First Line Oral Agents
Pyrazinamide
Ethambutol
Rifampicin
Group 2 TB drugs: Injectable Agents
Kanamycin
Amikacin
Capreomycin
Streptomycin
Group 3 TB drugs : Fluoroquinolones
Levofloxacin
Moxifloxacin
Ofloxacin
Group 4 TB drugs: Oral Bacteriostatic Second Line Agents
Paraaminosalicylic acid
Cycloserine
Terizidone
Thionamide

 Protionamide
Group 5 TB drugs: Agents with an unclear role in the treatment of drug resistant TB
Clofazimine
Linezolid
Amoxicillin/clavulanate
Thioacetazone
Imipenem/cilastatin
High dose isoniazid

Clarithromycin
Classification of Patients in Categories for Standardized Treatment Regimen

DOTS is THE MOST EFFECTIVE STRATEGY available for controlling the

worldwide TB epidemic today.
References;
http://www.doh.gov.ph/sites/default/files/NTCP-MOP.pdf
http://www.who.int/tb/en/
http://www.tbfacts.org/tb-drugs/