1. TUBERCULOSIS * Prevention * Treatment, and * Challenges.By
Dr. O.S. Lawal
Matron B.G. Ojelabi
CHEST CLINIC DEPT. GHLAGOS

3. OUTLINE Introduction Classification of Tuberculosis
Mode of Transmission
Pathogenesis
Symptoms & Signs
Diagnosis
Treatment
DOTS Strategy
Stop TB Strategy
Monitoring of TB Patients
TB Prevention
Challenges
Conclusion

4. Introduction
Tuberculosis (TB) is a disease that can spread from one person to another and is caused by a bacteria called Mycobacterium tuberculosis.

5. Introduction (Contd.)
TB is curable but kills 4000 people every day, nearly 2 million every year.
80% of the world’s TB burden occurs in just 22 countries.
Tuberculosis affects all ages.
TB is the No. 1 killer among HIV positive patients

6. LOCAL SITUATION
Nigeria ranked 10th among the 22 high TB burden countries and is the 3rd most burdened country with HIV/AIDS
Estimate for all forms of cases is 199/100,000 Population
Estimated prevalence of HIV among TB patients is 27%
Lagos state carries 8.4% of Nigeria’s TB burden.

7. CLASSIFICATION
Pulmonary TB, or tuberculosis of the lungs and is the most common form (80%).
Extra-pulmonary TB is tuberculosis affecting organs other than the lungs – kidneys, intestines, liver, womb, testes, skin, bones, joints, meninges, etc.

8. TB transmission

9. TB transmission contd. TB is transmitted through the air.
When a person with TB of the lungs or throat coughs, sneezes, spits or talks loudly, the germs get into the air.
People nearby may breathe in these bacteria and thereby become infected.

10. 1 sneeze releases millions

11. “Wells 1934, Duguid 1945, Wells/Riley 1953, et al.”
Organisms Liberated
“Wells 1934, Duguid 1945, Wells/Riley 1953, et al.”
Number of Organisms Liberated:
Talking 0 – 200
Coughing 0 – 3 500
Sneezing 4500 –

12. PATHOGENESIS
EXPOSURE
INFECTION
ACTIVE DISEASE
LATENT

13. SIGNS AND SYMPTOMS OF TUBERCULOSIS

15. SIGNS AND SYMPTOMS
The most important symptom of TB is prolonged, persistent cough.
Anyone with cough of 2 weeks or more should be tested for Tuberculosis.

16. SIGNS AND SYMPTOMS Other symptoms and signs are Chest pain
Difficulty in breathing
Coughing out of blood
Fever
Weight loss
Night sweats
Palor
Easy tiredness.

17. DIAGNOSIS
This is mainly through examination of the sputum (Sputum Microscopy).
Suspect is asked to produce 2 samples of sputum and these are examined in the laboratory.
Other methods include Sputum Culture, Chest X-ray, Mantoux and lately the GeneXpert.

18. TB germs

20. TREATMENT Is through the use of a combination of drugs.
These are taken orally except one of them which is given as injection.
The treatments have been standardized and the drugs and injections made available free of charge.
A complete course lasts 6 to 8 months.

21. Standardized short-course chemotherapy
2 regimens in use:
CATEGORY 1 for new cases.
CATEGORY 2 for re-treatment cases.
CAT 1 means 2 months of 4FDC (Rifampicin – 150mg, Isoniazid – 75mg,Pyrazinamide – 400mg and Ethambutol – 275mg) and 4 months of Rifampicim and Isoniazid [2RHZE/4RH]
CAT 2 – 2 months of Streptomycin injection with 3 months of 4FDC, then 5 months of Rifampicin, INH and Ethambutol. [2SRHZE/1RHZE/5RHE]
All treatment is expected to be directly observed (DOT)

22. DOTS STRATEGY
It is the combination of best practises in different countries of the world where TB disease was a challenge. It consists of the following
Political commitment with sustained financing.
Case detection through quality-assured bacteriology.
Standardized treatment with supervision and patient support.
An effective drug supply and management system.
Monitoring and evaluation system, and impact measurement.
NOTE: TB control Targets:
Case finding 70%
Cure rate 85%

23. STOP TB STRATEGY High quality DOTS TB/HIV MDR-TB
Health system strengthening.
Public-Private Mix (PPM).
Promote Research on TB.
Empower people with TB.

24. MONITORING OF TB PATIENT
Body Weight. [Monthly]
Assessment for ADR
Sputum Test 2/3,4,6/7 months.
CXR

25. PREVENTION OF TB
BCG Vaccination: 40-80% effective
(up to 15 years of age)
Chemoprophylaxis- eg IPT
Cough Hygiene: cover the mouth and nose when coughing or sneezing.
Good nutrition: to prevent or reduce progression from infection to disease. This is by boosting host immunity.

26. PREVENTION OF TB Control of HIV/AIDS
Good housing : that prevents over- crowding and affords good ventilation reduces the risk of exposure to the bacilli.
Screening of contacts of TB patients
Control of HIV/AIDS

27. CHALLENGES Difficulty in Diagnosis
Limitation of Lab. Investigation- GeneXpert, FNAC.
Clinical delay – when surgery is required
Delay at home, before presentation.
Inappropriate therapy of Private hospital
Reduce case finding
TB/HIV

28. MDR TB EP
IPAC
Administrative controls to reduce risk of exposure, infection, and disease through policy and practice;
Environmental (engineering) controls to reduce concentration of infectious bacilli in air in areas where contamination of air is likely; and
Respiratory protection to protect personnel who must work in environments with contaminated air
Admission in the hospital wards
DM Screening.

29. CONCLUSION TB is preventable and curable
TB treatment is available at Chest Clinic
TB treatment is free
Wherever you are, support TB control because “TB ANYWHERE IS TB EVERYWHERE.”
The most important symptom of TB is prolonged, persistent cough. Anyone with prolonged, persistent cough of 2 weeks or more is a TB suspect and should be tested for Tuberculosis.

30. EKO O NI BAJE O
EKO O NI BAJE O
TB O NI WOLE WA O!
THANK YOU.