1. TB 101 “Basic Facts on Tuberculosis”
Good Day!
In order to prevent the spread of Tuberculosis, it is primary that each of us must be founded with the correct information about the disease. Thus, we will be discussing today “What we should know about Tuberculosis?”

2. What we should know… 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
In the next hour, we hope to understand the following….

3. TB Burden in the World 1/3 of the World Population is Infected
1 Person is Infected per Second
1.9 Million People Die of TB each Year
Philippines is 1 of the world’s 22 high-burden
countries for Tuberculosis
What is the world’s population to date?
When we say that 1/3 of the world population is infected with TB, it means that the bacteria which causes TB can be found lodged in the lungs of 1/3 of the world population.
WHO estimates that 1 person is infected per second and that 1.9 M people die of TB every year.
The Philippines is 8th of the 22 high burden countries for Tuberculosis today.

4. TB Burden in the Philippines
22 million reported infections
TB kills 75 Filipinos per day
TB is the 6th leading cause of Mortality and Morbidity
Undiagnosed TB cases remain high in local communities
In the Philippines, Tuberculosis remains to be the 6th leading cause of mortality and morbidity.
In 2000, 22M Filipinos were reported with TB accounting to 75 deaths per day.
The concentration of TB cases in the country can be located at the National Capital Region and Southern Tagalog Regions. However, undiagnosed TB cases remains high in local communities.

5. What is Tuberculosis?
TUBERCULOSIS is an infectious disease caused by a micro bacteria called “Tubercle bacilli”. It is airborne. It usually affects the lungs but may also affect other organs in the body like the meninges, bones, kidneys etc.
In discussing Tuberculosis, we must be reminded that first, TB is infectious disease; second, it is caused by a bacteria which is airborne and third, although the lungs remain to be the primary target of the TB germ, it may affect all body organs.

6. The Tubercle Bacilli Mycobacterium tuberculosis TB germ
Characteristics:
slow growing
can survive inside cells of the human body
exposure to direct sunlight can kill the bacteria in sputum
Other Names:
Mycobacterium tuberculosis
TB germ
The Tubercle Bacilli is the bacteria that causes 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.

7. How is it transmitted?
The TB Bacilli spreads through airborne inhalation of droplets of infection coming from a TB patient whenever a person coughs or sneezes, without covering his mouth.
A person with TB can transmit the bacteria when he or she coughs and/or sneezes. The TB germ is airborne, thus inhalation of droplets from a person with TB may cause TB infection.
But is should be emphasized that being TB infected does not absolutely lead to TB disease.

8. A person is infected after inhaling droplets from a person with TB
How does PTB develop?
TB bacilli enters the body and lodges in the lungs (TB Infection).
In the lungs, they multiply and slowly eat the cells and the body begins to experience symptoms (TB Disease)
If undiagnosed, lungs cells are eaten up leading that may lead death.
A person is infected after inhaling droplets from a person with TB
Following the progression of TB infection, the TB germ is first released from a person with TB disease when he or she coughs and/or sneezes. Inhaling these infected droplets will make a person TB infected. Therefore, TB infection happens when the TB germ successfully enters the respiratory system and lodges in the cells of the lungs.
In a person with a healthy immune system, the multiplication of the TB germ can de controlled through the production of antibodies and/or it can remain in the body for a very long time without developing into a TB disease.
In a person with a compromised immune system however, the TB germ proliferates and thus will begin to destroy the cells in the lungs, resulting to the development of a TB disease.
A person who develops a TB disease, when remain untreated, can then begin to infect others. In some cases, the TB germ migrates to other body organs and begin to destroy them, thus the advent of extra-pulmonary (outside) cases of Tuberculosis like TB of the meninges, bones, etc.
A TB disease that remains untreated leads to death.

9. 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 with out loss of appetite
Hemoptysis (Blood-tinged sputum)
Feeling of weakness (tiredness)
Night Sweats
A person who complains or is observed to experience SOME or ALL of these signs and symptoms can be suspected of Pulmonary Tuberculosis. Persons manifesting these symptoms should be subjected to Sputum Microscopy for TB diagnosis.
It must be noted however that during the early progression of the TB disease, some individuals DO NOT show any signs and symptoms and Sputum Microscopy Result may turn out negative.
This is usually the case seen among employees/workers undergoing Annual Physical Examination- Chest X-ray, whereby they show X-ray results consistent with TB and when subjected to Sputum Microscopy shows a negative result.– in these instances, TB diagnosis should be made by a DOTS trained pulmonologist.
Are there any questions so far?

10. Who are at risk of getting TB?
People who share the same breathing space with someone who has infectious TB
Health workers, specially those working in long-term facilities (prison, sanitariums, etc.)
People whose immune systems are compromised (People with HIV infection, Pneumonia, Chronic lung disease, etc)
TB does not discriminate. Anybody is at risk of getting Tuberculosis. But some factors can increase one’s risk of getting TB. Most often times, the groups at risk of getting TB includes: (1st ) People sharing the same breathing space with a person with TB disease, (2nd ) Health workers in prisons and sanitariums, (3rd ) immuno-compromised patients,

11. Who are at risk…
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
Others
(4th) People exposed to silica`and various dust particles/chemicals, (5th) those malnourished and underweight children, and (6th) Alcoholics, Smokers, and IV drug users.
Do you know other people who might be at greater risk than those already mentioned?

12. How is TB diagnosed? Sputum Microscopy
It shows the TB bacilli in the sputum
It is the most definitive diagnostic tool of Tuberculosis
A person can know if s/he is infected with TB though Direct Sputum Smear Examination, or Sputum Microscopy. This method allows the health professional to see the actual TB germ, thus making a definitive diagnosis that the person has pulmonary tuberculosis.
People manifesting signs and symptoms previously discussed should immediately be subjected for Sputum Microscopy in a DOTS accredited laboratory or at least be conducted by a DOTS trained microscopist.
IN your locality, ______ is your DOTS Center.

13. How is TB diagnosed? Chest X-Ray Determines extent of the lung damage
Not a very definitive diagnostic tool
Another test to diagnose TB is through Chest X Ray. However, it must be emphasized that X-Ray results can only “SUGGEST” the extent of lung damage which may be caused by the TB germ or other microorganisms. Therefore, TB diagnosis CANNOT BE MADE through X-Ray results alone, except in very special cases. (Ex. TB germ is just starting to proliferate)
In the picture, the arrow points out an “INFILTRATION” ( concentration of bacteria in an area) which suggests lung damage. This x ray result is consistent with TB, thus the patient should be recommended for sputum microscopy. In some cases however, people who have had TB in the past will show the same infiltration in their x ray even several years after their TB infection (like a scar). Therefore, medical records should reflect that the “scar” or “infiltrate” is a remnant of the past TB infection.
As an application of this fact, individuals subject to pre-employment medical examination showing “shadows”/ “Infiltrates” or “scars” consistent with TB should not be disqualified immediately but must be subjected to sputum microscopy to confirm TB status, unless previous x-ray results or treatment cards for TB can be provided to prove fitness to work.
In the workplace setting therefore, employees showing CXR results consistent with TB during APE SHOULD be subjected to Sputum Microscopy for proper TB diagnosis.

14. 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.
Although TB can be cured, many people still die of TB.
To successfully treat and cure TB, DOTS is the strategy of choice, as recommended by WHO. DOTS
Ensures (1) Proper Tb diagnosis is made (2) right drugs and appropriate dosage is ensured (3) drug intake is directly observed (4) treatment progress is monitored and reported and lastly (5) DOTS ensures the patient has a support group and environment that understands the disease.

15. 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)
Using DOTS, proper treatment is provided the TB patient, thus:…..

16. 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
TB can be cured and prevented. Some of the ways to prevent TB disease includes:
BCG for children. But this does not make children immune to the TB germ. It only decreases the possibility of children leading to TB disease in their adulthood.
Proper hygiene is important
Early diagnosis and treatment.. One a person shows the signs and symptoms previously discussed, s/he should be diagnosed for TB

17. Other Preventive Measures…
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
(4) Open air circulation dilutes the air of TB germs and other small particles that may cause infection or allergy. It is healthy to once in a while open the windows and refrain from using air conditioned air.
(5) Since TB germ is opportunistic, one must maintain a healthy lifestyle to include: enough sleep, right food, avoiding smoking, drinking alcohol, and use of prohibited drugs.
Do you know other ways of preventing Tb disease?

18. What are some misconception about TB?
Misconceptions
Facts
TB is mana-mana
TB is hawa-hawa
TB results from “Pasma” and “naulanan”
TB is due a bacteria known as the “Tubercle bacilli”
TB is transmitted through sharing utensils with a person with TB
TB is transmitted through inhalation of the droplet nuclei from a person with TB
TB is not curable. One should be ashamed of his disease.
TB can be cured. The patient’s commitment is important. Everyone’s support is important in fighting TB.
What are some misconceptions you know about TB?…clarify….

19. REMINDER If you experience the signs and symptoms of TB, do not be ashamed. Immediately visit our clinic for proper diagnosis and treatment