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TUBERCULOSIS
Rosa Marie N. Flores, M.D., MPH, FPAFP, DFM
2nd Shifting /August 29, 2008
Trans group: JaViCi Code
_____________________________________________
PHILIPPINE DATA ON TUBERCULOSIS Primary Infection
• Approximately 15M Filipinos are infected with TB
• 75 Filipinos die of TB each day Primary Infection
• About 200,000 to 600,000 are spreading the • Subclinical usually with non specific symptoms
disease annually • Subside in 2 – 3 weeks
• The state of the TB problem has not changed • Transient mycobacteremia seeding distant sites
significantly the past 14 years like the pulmonary apex, renal cortex, epiphyses
of long bones or meninges
Inadequate case finding
Poor case holding Common Sites of Extra-Pulmonary Tuberculosis
» Non adherence of patients • Pleura
» Non adherence of doctors and health providers • Central nervous system
Inadequate prevention programs • Lymphatic system
Poor physician adherence • Gastrointestinal system
» 70% of doctors initially follow but divert
• Genitourinary systems
treatment resulting in more than 100 variations
• Bones and joints
» Do doctors know what the NTP and DOTS is?
• Disseminated (miliary TB)
_____________________________________________
Just a little review…
Terminally:
BASIC FACTS ABOUT TUBERCULOSIS
• Wasting (consumption)
• Caused by Mycobacterium tuberculosis • Hemorrhage
• Transmitted via the airborne route mostly from • Respiratory failure
infected persons when coughing
• The primary lesion in the lung & lymph nodes What is the probability that exposure leads to
infection and disease?
often heal spontaneously leaving a focus of • Concentration of droplet nuclei in the
dormant bacilli that can be reactivated at any environment
moment in an individual’s lifetime • Duration of exposure
• An infected person has a 5 - 10 % chance of
developing full blown TB in his/her lifetime Number of bacilli generated by the TB patient is
• A sputum (+) person infects 10-15 other influenced by:
persons annually • Disease in the lungs, airways, larynx
• A 50 % chance of becoming infected • Presence of cough or other forceful expiratory
from TB patient if time spent around measures
MARY YVETTE ALLAIN TINA RALPH SHERYL BART HEINRICH PIPOY KC JAM CECILLE DENESSE VINCE HOOPS CES XTIAN LAINEY RIZ KIX EZRA GOLDIE BUFF MONA AM MAAN ADI KC
PENG KARLA ALPHE AARON KYTH ANNE EISA KRING CANDY ISAY MARCO JOSHUA FARS RAIN JASSIE MIKA SHAR ERIKA MACKY VIKI JOAN PREI KATE BAM AMS HANNAH MEMAY PAU
RACHE ESTHER JOEL GLENN TONI
FCM 3
TB
Page 2 of 7
• Presence of the bacilli in the sputum
• Extent of cavitation on chest radiograph
• Patient who does not cover mouth/ nose when
sneezing or coughing
ATS and CDC
A person who is infected with PTB coughs or
sneezes, releasing tiny particles of BACILLI . (This TB in Children
person may not even feel sick at the time.) Gold Standard of Diagnosis
COUGHING
Triad:
TALKING
1. Exposure to an infectious case
SNEEZING
2. (+) Tuberculin Test
3. Abnormal radiograph or PE
COMPARISON OF FEATURES OF THE AVAILABLE (STARKE, PIDJ, Nov 2000)
DIAGNOSTIC TESTS FOR TB
Adult versus Childhood TB
Test Sensitivit Specificity Field Cost Comments
y Use Cinical Pediatric TB Adult TB
Sputum 50-60% >95% High Free For Features
AFB to diagnosis
smear low & easier
response TB Primary Post-primary or
evaluation Pathogenetic tuberculosis Secondary or
Sputum 60 -90% > 99% Low High Takes stage reactivation TB
M. TB weeks;
Culture needed for
sensitivity
test Main Clinical features + Bacteriology
Chest x- 80% 70% Low Low For diagnostic history of (AFB smear and,
ray to to screening confirmation exposure to a if warranted,
mod mod. only; smear (+) case culture) Serial
needs to chest x-ray
be
confirmed
Serologic High* Mod* Low Mod. Not well
Tests to standardiz Bacillary load Low, hence, low High load (esp.
high ed; only infectiousness cavitary), highly
as an infectiousness
adjunct
PPD test High* Mod to Low Low Does not Treatment 2-3 drugs 4-5 drugs
High* to necessaril
mod y indicate
active TB
DOT Yes – by parent Yes – by health
PPD Testing Mandatory worker
TB
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Drugs active HRS HRZ HRZE Streptomycin 15 (12-18) mg/kg, and not to exceed
1g daily
TB
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* For TB Meningitis, Miliary TB and bone/joint TB: Corticosteroids in TB treatment
2HRZE / 10 HR Indications:
Renal Failure and TB treatment Miliary TB with ARDS and DIC
Safest regimen: 2HRZ/4HR TB meningitis when complicated
If needed, the following may be used or added in TB pericarditis
Normal doses but less frequent intervals: All Level 4 evidence
Strep, EMB, Kanamycin, Capreomycin,
Cycloserine,Thioacetazone DELAY IN CONSULTATION
Give Vit. B6 with the INH • Misinterpretation of symptoms
• Protean manifestations of TB
Grade C recommendation
HIV (+) Patient and TB treatment • Health care delivery system weaknesses
the control of tuberculosis lies in adequate case
Susceptibiltiy test available: holding
2HRZE / 4-7HR (or up to 6 mos. after sputum
conversion) STIGMA
“pandidirihian ako”
Susceptibiltiy test NOT available: “hindi na ako puede magtrabaho”
9HRZE ( 12 mos. if cavitary) “wala sa lahi namin yan!”
* Strict DOT for all cases
OTHERS
Chemoprophylaxis in Tuberculosis Historical : “consumption”
Regimens: Body image: The emaciated hungry look
INH alone - 6 - 9 month
INH + EMB - When primary drug resistance to INH is ADHERENCE IS THE KEY TO CONTROL OF
high TUBERCULOSIS
TB Situation
FCM 3
TB
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One of the 22 high-burdened countries • Passive case finding shall be implemented in all
(WHO TB Watchlist) health centers, health stations.
3rd (151/100,000) in the Western Pacific - Case • Sputum microscopy work shall be performed
Notification of all cases only by adequately trained health personnel.
6th leading cause of deaths (1998) • Quality control of smear examination must be
6th leading cause of morbidity observed. Validation system must be
Prevalence of Smear (+) cases – 3.1 /1,000 established.
(240,000 cases)
TB
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TB
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Proportion of 3 sputum examination (90%) 2. Described the various forms of TB , it’s diagnosis
= No. TB symptomatics with 3 specimens & management.
Total no. TB symptomatics examined 3. Described the National TB Control Program of
Positivity (15-20%) DOH.
= No. Sputum (+)s discovered_______
Total no. TB Symptomatics examined
Case Detection Rate (CDR=70%) Student Activity:
= No. of New Sputum (+) cases discovered
Group 1 – Role play – Disclosure to a patient that he/
TP x 145/100,000 (Incidence)
she has TB
COHORT ANALYSIS
Group 2- Role play – Convincing the patient to undergo
• A group of patients having the same attributes
6 months TB treatment
at a certain period of time to determine
treatment outcome. Group 3- Role play – Health education to group of
• Treatment Outcomes: mothers on how to prevent TB in the home
Cure Rate = 85 %
End of Tran
Completion Rate
• Tx Failure Rate Defaulter Rate Ei classmates snsya na, hndi yung mismong powerpoint yung
• Death Rate pnagkopyahan namin nito. Pnahiram lang kami ng sec A. Inayos
• Trans-Out Rate na lang namin sa abot ng aming makakaya para mas
maintindihan. Salamat! =)
Cure Rate
= Total no. New Sputum (+)cases who got CURED
Total no. New Sputum (+) cases evaluated
TREATMENT OUTCOMES
Cured Completed
Completed tx BUT no sputum
ff-up result at end of treatment
Treatment Failure
Smear (+) at 5 mos. of tx
Defaulter
Interrupted tx for 2 months or
more and not retrieved back
Transfer Out
Change in tx facility
Died (Hehe toxic pa din ang filler! Haha. Hi na lang sa inyong lahat!)
Transpires during course of tx.
SUMMARY
1. Described the TB health situation the Philippines.
FCM 3
TB
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FCM 3
TB
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