Tuberculosis

Amor N. Santiago

Topics to discuss:
I.
II.
III.
IV.
V.
VI.
VII.
VIII.
IX.
X.

What is Tuberculosis or TB?

Signs and symptoms of TB
Detection of TB (Diagnostic and lab test)
Mode of Transmission
Treatment of TB
Economic Burden of TB
Difference between TB and Multidrug Resistant TB
Signs and symptoms
How did MDR-TB occur?
Treatment of MDR-TB

Tuberculosis

abbreviated as TB for tubercle bacillus or

Tuberculosis

Common and deadly infectious disease

caused by Mycobacterium tuberculosis

usually attacks the lungs but can also affect

other parts of the body

Dr. Robert Koch

Dr.

Robert Koch discovered the tuberculosis

bacilli.

isolated

the tubercle bacillus in 1882 and

established TB as an infectious disease

SYNONYMS

consumption
phthisis and phthisis pulmonalis
Scrofula
tabes mesenterica
Lupus vulgaris
wasting disease
white plague
king's evil
Pott's disease, or gibbus
Miliary Tuberculosis or disseminated TB

SIGNS AND SYMPTOMS

productive,

prolonged cough for more than

two weeks
chest pain
hemoptysis
fever, chills, night sweats
loss of appetite, weight loss
Pallor
Easy fatigability

DIAGNOSIS AND LAB TESTS

Chest X ray - the most common diagnostic test

that leads to the suspicion of infection

Sputum exam/Acid fast stain

Mantoux Test - helps identify people infected with M.

tuberculosis but who have no symptoms

DIAGNOSIS AND LAB TESTS

fluorescent microscopy
Thoracentesis
Bronchoscopy
QuantiFERON-TB Gold test - this is a blood
test that is an aid in the diagnosis of TB

DIAGNOSIS AND LAB TESTS

Chest

CT
Rarely biopsy of the affected tissue
(typicallylungs, pleura or lymph nodes)
crackles
Enlarged or tender lymph nodes in the neck
or other areas
Pulmunary edema
Clubbing of the fingers or toes

MODE OF TRANSMISSION

Tuberculosis is spread by aerosols

created by coughing, sneezing, talking, singing and
spitting.
Tuberculosis is an airborne disease

TREATMENT
Antibiotics

(around 6 to 12 months)
1st line drugs
Rifampicin (R)
Isoniazid (H)
Ethambutol (E)
Pyrazinamide (Z)
Streptomycin (S)

Economic Burden of TB

TB robs an average Filipino worker of

PhP451 per day for men

PhP216 per day for women

The Philippines loses around PhP26.4 billion income due

to premature deaths from TB.

PhP7.9 billion in wages alone- total annual losses to the

Philippine economy associated with TB.
- USAID 2000 Study

Difference between TB and MDR-TB

TB Treatment

First line drugs

uses 4 ordinary drugs
(first line drugs) and 2
months injection if
needed
6 8 months
it often causes side
effects

MDR-TB Treatment

Second line drugs

uses different kinds of
drugs which is more
expensive and 6 7
months injection
18 24 months
It causes lots of side
effects

Signs and symptoms

Back/chest

pain
Cough for two weeks or more
Fever in the afternoon
Hemoptysis
Night sweat
Weight loss
dyspnea

How did MDR-TB occur?

DR-TB is a consequence of human error
through:

Cross infection
Non-compliance to treatment
Treated outside a DOTS facility
Lack of resources
Inadequate regimen (4 RELIABLE DRUGS)
Poor knowledge of health care provider on the NTP guidelines
Mismanagement
Attitude problems
Stigma

TREATMENT
Cycloserine
Prothionamide, Ethionamide
Flouroquinolones ( Levofloxacin, Ofloxacin,
Moxifloxacin, Gatifloxacin)
Injectables (Amikacin, Kanamycin,
Capreomycin)
Para-Amino salicylic acid (PAS)- granules
REINFORCERS: Co-Amoxiclav and
Clarithromycin

Where to refer?
Health Centers
2. MDR-TB Treatment Centers
Ilocos Training and Regional Medical Center
Parian, San Fernando City, La Union
Dr. Chester Directo at 09157112706
since: July 2009
services: accepts referrals of MDRTB suspects, facilitate
diagnosis and provides treatment to patients all for free
1.

If left UNTREATED.

...it can lead to Extensively drug-resistant TB

(XDR-TB)
Or worst.
Total drug-resistant TB

If left UNTREATED.

TRANSMISSION

and SPREAD of TB/MDR-TB

or worse, XDR-TB to family, friends, community
or even to YOU.

DEATH

MESSAGE
Help us stop TB in our community.
Realize that the fight against TB is our
COLLECTIVE STRUGGLE.

We are the CURE !

THANK YOU!

Airborne by John Donnelly:

Experts from the WHOs Stop TB Department and the Stop TB
Partnership warn that:
if countries do not act now to stop TB and MDR-TB,
the world will face an airborne contagion that will become
increasingly untreatable and increasingly global.
It will stop at no border, and it will infect much greater numbers
of people.
The early signs are already apparent:
At the beginning of 2007, 20 countries reported cases of
extensively drug-resistant TB (XDR-TB).
At the end of 2008, the number had jumped to 55,
in part because countries had started searching for cases.