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Bulacan Medical Center

Mojon, Malolos Bulacan

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An Overview
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The most common and potentially most
contagious type of active TB.
The causal agent, Mycobacterium tuberculosis,
is easily transmitted through airborne droplet
nuclei when patients with pulmonary TB
cough or sneeze.
Treated within 6 months with DOTS (Directly
Observed Treatment Short-Course)


A condition which is resistant against at least
Isoniazid and Rifampicin

Maybe caused by partial treatment (relapse,
default, failure of treatment)

Treated within 18-24 months
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General
Symptoms
Pulmonary Symptoms Extra-Pulmonary
Symptom
Fever
Night sweats
Weight Loss
Fatigue
Loss of appetite
Dry or productive
cough
Chest pain
Shortness of breath
Later blood traces are
coughed in the sputum
(hemoptysis)
Localized
pain/swelling
(depending on site
of disease)
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Peruvian Mummy
(700 AC)
Child with spinal TB
(Potts disease) and
abdominal TB, in which
acid-fast
bacilli were isolated

Ica Museum (Peru)
One of the 22 high-burdened countries
(WHO TB Watchlist)
3rd (151/100,000) in the Western Pacific
Case Notification of all cases
6th leading cause of deaths (2003)
6th leading cause of morbidity (2003)
An average of 75 Filipinos die everyday due to
TB
Prevalence of Smear (+) cases 2.1/1,000
TB Situation in the Philippines
In 2006, the Philippines signed the Global Plan
on TB, which seeks to reduce the prevalence
and mortality of tuberculosis by 50% between
2006 and 2015.

The Global Plan outlines a benchmark figure of
70% case detection rate (CDR), 85% treatment
success rate (TSR) and 85% cure rate.
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TB Situation in the Philippines
0
10
20
30
40
50
60
70
80
90
100
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
CDR
Cure
Success
0
10
20
30
40
50
60
70
80
90
100
1 2 3
4
A
4
B 5 6 7 8 9
1
0
1
1
1
2
C
A
R
A
G
A
A
R
M
M
C
A
R
N
C
R
P
H
I
L
CDR of New Smear (+) cases, By CHDs
0
10
20
30
40
50
60
70
80
90
100
1 2 3
4
A
4
B 5 6 7 8 9
1
0
1
1
1
2
C
A
R
A
G
A
A
R
M
M
C
A
R
N
C
R
P
H
I
L
C ure C ompletion
Cure & Completion Rates, New Sm (+)s,
By CHDs, 2009
MDR-TB Prevalence (2004 Drug Resistance
Survey)
New cases : 4%
(compared to global average of 1.7%, now, 3.1%)
Re-treatment cases: 21%
(compared to global average of 7.7%,now, 19.3%)

8
th
among 27 priority countries with highest
number of MDR-TB cases



Global Tuberculosis Control 2009: Epidemiology, Strategy, Financing. WHO/HTM/TB/2009.411
27 High Burden Countries for MDR-TB responsible
for 435,470 cases
4. Sout h Af rica, 15,914
5. Bangladesh, 14,506
6. Pakist an, 13,218
7. Indonesia, 12,209
8. Philippines, 12,125
9. Nigeria, 11,700
10. Kazakhst an, 11,102
11. Ukraine, 9,835
12. Uzbekist an, 9,450
13. DR Congo, 7,336
14. Viet Nam, 6,468
15. Et hiopia, 5,979
16. Tajikist an, 4,688
17. Myanmar, 4,181
18. Azerbaijan, 3,916
21. Belarus, 1,101
22. Georgia, 728
23. Armenia, 486
24. Lit huania, 464
25. Bulgaria, 371
26. Lat via, 202
27. Est onia, 123
2. China, 112,348
1. India, 130,526
3. Russian Federat ion,
42,969
19. RepMoldova, 2,231
20. Kyrgyzst an, 1,290
0 20000 40000 60000 80000 100000 120000 140000
1.India
3.Russian Federation
5.Bangladesh
7.Indonesia
9.Nigeria
11.Uk raine
13.DRCongo
15.Ethiopia
17.Myanmar
19.Republic ofMoldov a
21.Belarus
23.Armenia
25.Bulgaria
27.Estonia
27 High MDR-TB burden countries account
for 86% of all MDR-TB cases

Four countries had the largest number of
MDR-TB cases in absolute terms
China: 100 000
India: 99 000
The Russian Federation: 38 000
South Africa: 13000 (10 000 16 000)
Philippines: 13 000 (8 900 17 000)

Magnitude of MDR-TB
Global TB Control: WHO Report 2010
WHO/HTM/TB/2010.7
ICN Code of Ethics:

To promote health
To prevent illness
To restore health
To alleviate the suffering


MDR-TB Management Framework
5 ELEMENTS OF DOTS
TB
Political commitment
Quality assured
microscopy
Supervised treatment
PMDT
Sustained Political
commitment
Rational case finding:
accurate & timely diagnosis
through quality assured
culture and DST
Appropriate treatment
strategies that utilize 1
st
and
2
nd
line drugs under proper
management conditions
P
MDR-TB Management Framework
Regular availability
of 1
st
line drugs
Standardized records
& reports
Uninterrupted supply of
quality assured 1
st
and 2
nd

line drugs
Standardized recording and
reporting system designed
for DR-TB program
5 ELEMENTS OF DOTS
TB MDR-TB
Good specimen: 3-5ml solid and purulent
material, best collected early in the morning
Accurate labeling and completion of sputum
request forms
Prevention of transmission: collection should
be done in a well ventilated area
Specimen transport: not more than 2 hours
Wide-necked, disposable containers with screw-top
lids.



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19
Category of Treatment Regimens
Treatment
Regimen
Type of TB Patients
I
2 HRZE/4HR

New smear-positive PTB;
New smear-negative PTB with extensive
parenchymal involvement; Extra-pulmonary TB
II
2 HRZES/
HRZE/5HRE
Previously treated PTB;
- Relapse;
- Treatment failure;
- Return After Default;
- Other
III
2 HRZE/4HR
New smear-negative PTB with minimal
parenchymal involvement
The most common drugs used for
active tuberculosis are:

Isoniazid (INH)
Rifampin (RIF)
Ethambutol
Pyrazinamide.

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Minor side effects of tuberculosis medications
can include:

Orange urine, saliva, or tears.

Sensitivity to the sun.

Reduced effectiveness of birth control pills and
implants.


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Serious side effects of tuberculosis medications:
No appetite
Nausea
Vomiting
Yellowish skin or eyes (jaundice)
Fever for three or more days
Abdominal pain
Tingling fingers or toes
Skin rash

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Serious side effects of tuberculosis medications:
Easy bleeding
Aching joints
Dizziness
Tingling or numbness around the mouth
Easy bruising
Blurred or changed vision
Ringing in the ears (tinnitus)
Hearing loss.

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TB Kit for Categories I and III
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I want to be a
nurse and help
others who are
sick. I want to
give back what
was given to
me.
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