National Tuberculosis Program NTP. WHAT IS TUBERCULOSIS. Tuberculosis is an infectious disease caused mainly by Mycobacterium tuberculosis . It can affect most organs in the body, but the lung is the main organ affected.
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1702MANGET explained miliary TB
1720BENJAMIN MARTIN (a new theory of consumption) TB could be caused by wonderfully minute living creature
1854 HERMANN BREHMER (TB is a curable disease) Established
first sanatorium in Germany , Beginning of sanatorium era.
1882 ROBERT KOCH, discovered the micro-organisms responsible
The source of infection can be either:
Without treatment, after 5 years.
Upon arrival in the alveolar region, the bacteria encounter three types of cells that potentially oppose infection:
The infection develops as interplay between virulence of the organism, and immunity of the host.
Progressive pulmonary component:
Progressive glandular component:
Haematogenous:dissemination by blood stream leads to multiple organs affection
Estimated new TB cases ('000s)
Tuberculosis in Egypt is considered an important public health problem.
No. of detected new SS+ cases = >70%
Estimated No of new SS+ cases
No. of detected new SS+ cases = 50 – 70%
Total No. of new pulmonary cases
No. of detected new SS+ cases = 50 – 60%
Total No. of TB cases detected
No. of patient cured + No. of patient completed treatment = > 85%
No. of patient registered
1) List the TB suspect in the Suspect Register
3) When the laboratory results are received, record results in the Register.
4) Decide on appropriate action in response to the laboratory results.
is an easy and quick procedure. A minimum of three samples must be examined.
Sensitivity of sputum smear microscopy
No certain x-ray pattern is specific to TB
INDICATIONS FOR CHEST X-RAY
b) frequent or severe haemoptysis (to exclude bronchiectasis or aspergilloma);
c) only 1 sputum smear positive out of 3 (in this case, an abnormal chest X-ray is a necessary additional criterion for the diagnosis of sputum smear-positive PTB).
A smear-negative pulmonary TB
The combination of drugs to avoid the development of resistance.
The need for prolonged chemotherapy to prevent disease relapse.
When three or more drugs are administered, the risk of resistance is practically zero.
The intensive phase
The continuation phase
DOTS means directly observed treatment with short course chemotherapy
Principles of DOTS strategy
- INADEQUATE REGIMENS:
- Poorly organized or funded TB control programs.
- Inappropriate, Absence of or Noncompliance with guidelines
- Poor training
- No monitoring of treatment.
2- PATIENTS through INADEQUATE DRUG INTAKE (patient incompliance):
- Poor adherence
- Lack of information, poor health education
- Adverse effects.
- Social barriers.
colonies are resistant to only one of the first-line anti-TB drugs.
colonies are resistant to more than one of the first line anti-TB drugs but do not combine resistance to both Isoniazid and Rifampicin. Examples of poly-resistance may include Streptomycin, Isoniazid and Ethambutol or Streptomycin, Rifampicin and Ethambutol.
colonies combine resistance to at least Isoniazid and Rifampicin.
Colonies are resistant to:
“Primary resistance” means that the patient was infected with already resistant bacilli.
“Acquired resistance” means that patient was initially infected with sensitive bacilli but developed resistance of any pattern during the course of treatment because of any or a combination of the previously mentioned causes