Introduction

Tuberculosis (TB) is a top infectious disease killer worldwide. In 2014, 9.6

million people fell ill with TB and 1.5 million died from the disease. Over 95% of TB
deaths occur in low- and middle-income countries, and it is among the top 5 causes
of death for women aged 15 to 44. In 2014, an estimated 1 million children became
ill with TB and 140 000 children died of TB. It is also a leading killer of HIV-positive
people: in 2015, 1 in 3 HIV deaths was due to TB. Globally in 2014, an estimated
480 000 people developed multidrug-resistant TB (MDR-TB). The Millennium
Development Goal target of halting and reversing the TB epidemic by 2015 has
been met globally. TB incidence has fallen by an average of 1.5% per year since
2000 and is now 18% lower than the level of 2000. The TB death rate dropped 47%
between 1990 and 2015. An estimated 43 million lives were saved through TB
diagnosis and treatment between 2000 and 2014. Ending the TB epidemic by 2030
is among the health targets of the newly adopted Sustainable Development Goals.
Tuberculosis is a disease caused by a bacterium called Mycobacterium
tuberculosis that is mainly acquired by inhalation of infectious droplets containing
viable tubercle bacilli. Infectious droplets can be produced through coughing,
sneezing, talking and singing. Coughing is generally considered as the most efficient
way of producing infectious droplets.
People infected with TB bacteria have a 10% lifetime risk of falling ill with TB.
However, persons with compromised immune systems, such as people living with
HIV, malnutrition or diabetes, or people who use tobacco, have a much higher risk
of falling ill.
About one-third of the world's population has latent TB, which means people
have been infected by TB bacteria but are not (yet) ill with the disease and cannot
transmit the disease.
When a person develops active TB disease, the symptoms (cough, fever,
night sweats, weight loss etc.) may be mild for many months. This can lead to
delays in seeking care, and results in transmission of the bacteria to others. People
with active TB can infect 10-15 other people through close contact over the course
of a year. Without proper treatment, 45% of HIV-negative people with TB on average
and nearly all HIV-positive people with TB will die.
The World Health Organization, ranks the Philippines in the top 10 countries
in TB prevalence. In the Philippines, TB claims lives every day. The Philippine
National Tuberculosis Prevalence Survey says there are approximately three cases
of tuberculosis out of every 1,000 people.

Definition of Terms
Term

Abbreviation (if any)

Active Tuberculosis

Acid-fast Bacilli

AFB

Decription
An illness in which TB
bacteria are multiplying
and attacking a part of
the body, usually the
lungs. The symptoms of
active TB disease include
weakness, weight loss,
fever, no appetite, chills,
and sweating at night.
Other symptoms of active
TB disease depend on
where in the body the
bacteria are growing. If
active TB disease is in the
lungs (pulmonary TB), the
symptoms may include a
bad cough, pain in the
chest, and coughing up
blood. A person with
active TB disease may be
infectious and spread TB
bacteria to others.
Microorganisms that are
distinguished by their
retention of specific
stains even after being
rinsed with an acid
solution. The majority of
AFB in patient specimens
are mycobacteria. The
term, mycobacteria,
includes Mycobacterium
tuberculosis complex as
well as nontuberculous
mycobacteria (NTM). A
positive nucleic acid
amplification (NAA) or
culture result is needed

AFB smear

Acquired
Immunodeficiency
Disease Syndrome

Alveoli

Antibiotic resistance

AIDS

to differentiate M.
tuberculosis from the
others.
A laboratory technique
for preparing a specimen
so bacteria can be
visualized
microscopically. Material
from the specimen is
spread onto a glass slide,
dried and stained. Smear,
stain, and microscopy
methods for
mycobacteria are specific
to this genus (see AFB).
The slide can be scanned
by light or fluorescent
high-power microscopy.
a disease in which the
immune system is
weakened and therefore
less able to fight certain
infections and diseases;
AIDS is caused by
infection with the human
immunodeficiency virus
(HIV).
The small air sacs of the
lung that are at the end
of the airway; when
droplet nuclei reach these
air sacs, TB infection
begins.
The ability of a
microorganism to
withstand the effects of
antibiotics. Antibiotic
resistance typically
evolves when random
mutation of the
microorganism develops
which makes it less
susceptible to the effects
of a particular drug, but it
can also be engineered
by applying an
evolutionary stress on a

Mycobacterium bovis
bacillus CalmetteGurin

BCG

Close contacts

Contact

Culture

Chest X-ray

CXR

population.
a vaccine for tuberculosis
named after the French
scientists Calmette and
Gurin. The vaccine is
effective in reducing the
risk of disseminated and
meningeal TB disease in
infants and young
children. However, the
effectiveness of BCG in
preventing pulmonary TB
in adults is highly
controversial.
It is used in multiple
countries where TB
disease is endemic.
Persons who had
prolonged, frequent, or
intense contact with a
person with TB while he
or she was infectious.
This group includes
persons who live together
or spend a great deal of
time together in close
quarters. Close contacts
are more likely to become
infected with M.
tuberculosis than
contacts who see the
person with TB less often.
Refers to someone who
has been exposed to M.
tuberculosis infection by
sharing air space with a
person with infectious TB.
A test to see whether
there are TB bacteria
sputum or other body
fluids. This test can take
2 to 4 weeks in most
laboratories.
An image, also known as
a chest radiograph of the
inside of the chest. The
image is created by

Demographic factors

Directly Observed
Therapy

DOT

Droplet nuclei

Drug-resistant TB

Dyspnea
Ethambutol

EMB

passing Xrays through

the chest and recording
the rays that are blocked
by organs or structures
within the body. A doctor
can look at this image to
see whether TB bacteria
have damaged the lungs.
Factors such as country of
origin, age, gender,
ethnic or racial group,
and occupation.
An adherence-enhancing
strategy in which a
healthcare worker or
other trained person
watches a patient
swallow each dose of
medication and is
accountable to the public
health system. DOT is the
preferred method of care
for all patients with TB
disease and is a preferred
option for patients under
treatment for latent
infection.
Very small droplets, 1 to
5 microns in diameter,
that may be expelled
when a person who has
infectious TB coughs or
sneezes; they can remain
suspended in the air for
several hours, depending
on the environment.
TB disease caused by
Mycobacterium
tuberculosis organisms
that are resistant to at
least one first-line
antituberculosis drug.
Difficult or labored
respiration.
A first-line drug for
treating all forms of TB. It

Human
Immunodeficiency Virus
HIV infection

Immunocompromised
and Immunosuppressed

HIV
HIV infection

is included in initial
treatment regimens
primarily to prevent
emergence of rifampin
(RIF) resistance when
primary resistance to
isoniazid (INH) may be
present. EMB may cause
vision problems and
should not be given to
children who are too
young to be monitored
for changes in their
vision.
Human
Immunodeficiency Virus
Infection with the human
immunodeficiency virus,
the virus that causes
AIDS. A person with both
latent TB infection and
HIV infection is at very
high risk for active TB
disease.
Conditions in which at
least part of the immune
system is functioning at
less than normal capacity.
According to some style
experts,
immunocompromised is
the broader term, and
immunosuppressed is
restricted to conditions
with iatrogenic causes,
including treatments for
another condition. Some
immunocompromised
conditions increase the
likelihood that M.
tuberculosis infection will
progress to TB disease.
Certain conditions also
make TB disease or
infection from M.
tuberculosis more difficult
to diagnose because

Isoniazid

INH

Latent tuberculosis
infection

LTBI

Mantoux method

M. tuberculosis or
Mycobacterium
tuberculosis

Mtb

manifestations of TB
disease differ, and tests
for infection rely on an
intact immune system.
A first-line agent for
treatment of all forms of
TB.
The drug that is most
often used for preventive
therapy and also used to
treat TB disease;
although relatively safe, it
may cause hepatitis and
other adverse reactions in
some patients.
A condition in which TB
bacteria are alive but
inactive in the body.
People with latent TB
infection have no
symptoms, don't feel
sick, can't spread TB
bacteria to others, and
usually have a positive TB
test. But they may
develop active TB disease
if they do not receive
treatment for latent TB
infection.
A skin test performed by
intradermally injecting
0.1 mL of PPD tuberculin
solution into the volar or
dorsal surface of the
forearm. This is the
recommended method for
tuberculin skin testing.
A type of tuberculosis
mycobacteria; grampositive bacterium that
causes tuberculosis. It is
sometime called the
tubercle bacillus.

Epidemiologic Triad

Host

Poor nutrition
Concurrent disease
Low immunity

TB
Environment

Agent

Mycobacterium

Virulence
Dose
Others
o Mycobacterial
exposure

Poverty,
crowding,
social disorder
Bad sanitation
Poor
ventilation
Nutrition
Infections

AHE interaction in Epidemiologic Triad

The agent in this study is Mycobacterium tuberculosis; an acid fast aerobic
rod that reproduces slowly and is hypersensitive to heat and ultraviolet light. The
transmission of the Mycobacterium tuberculosis is spread from person to person by
airborne droplets with vehicles being coughing, sneezing, and talking. The smaller
the droplet, the longer it can linger in the air after the infected person has left the

area, allowing increase probability of inhalation by another person. Passing TB from

a family member or co-worker is more likely than a stranger in a store or on the
street (Reichler, Reves, and Bur, 2002). Mycobacterium tuberculosis (infectious
disease agent) is readily spreaded to susceptible humans (host) through respiratory
exposure in communal settings or public gatherings (environment). Individuals with
poor nutrition, concurrent disease and impaired immunities, such as with diabetes
mellitus, cancer, corticosteroid therapy, and HIV/AIDs are at greatest risk for
acquiring the bacterium infection. External factors such as the environment can
influence the effects of the organism. There are many environmental factors that
induce the susceptibility of the body for TB, such as: ethnic/racial minority,
impoverished, homeless, overcrowded housing, bad sanitation and poor ventilation.
The denisity of the bacterium in the air also dictates the potential risk for aqcuiring
tuberculosis.
Stages of Disease Process
1. Primary Infection
During this stage, the mycobacteria invade the tissues at the port of entry
(usually the lungs) and multiply over a period of approximately 3 weeks.
They form a small inflammatory lesion in the lung before traveling to the
regional lymph nodes and throughout the body, forming additional lesions.
The number of lesions formed depends on the number of invading
bacteria and the general resistance of the host.
This stage is generally asymptomatic.
2. Latent infection
Lymphocytes and antibodies mount a fibroblastic response to the invasion
that encases the lesions, forming non caseating granulomas.
This marks the latent stage, and the individual may remain in this stage
for weeks to years, depending on the bodys ability to maintain specific
and nonspecific resistance.
3. Recrudescent Disease
This stage occurs when the body is unable to contain the infection, and a
necrotic and cavitation process begins in the lesion at the entry port or in
other body lesions.
Caseation occurs and the lesions may rupture, spreading necrotic residue
and bacilli throughout the surrounding tissue.
Disseminated bacteria form new lesions, which in turn become inflamed
and form noncaseating granulomas and then caseating necrotic cavities.
The lungs are the most common site for recrudescent disease, but it may
occur anywhere in the body.
Untreated disease has many remissions and exacerbations.
Level of Disease Prevention
1. Primary Level of Prevention

Aims to prevent disease or injury before it ever occurs. This is done by

preventing exposures to hazards that cause disease or injury, altering
unhealthy or unsafe behaviors that can lead to disease or injury, and
increasing resistance to disease or injury should exposure occur.

Modes of Prevention

Legislation and enforcement to ban or control the use of hazardous products

(e.g. asbestos)
Mandate safe and healthy practices (e.g. use of seatbelts and bike helmets)
education about healthy and safe habits (e.g. eating well, exercising
regularly, not smoking)

Specific Protective Measure

Immunization against infectious diseases

o BCG

2. Secondary Level of Prevention

Aims to reduce the impact of a disease or injury that has already occurred.

Modes of Prevention

Detecting and treating disease as soon as possible to halt or slow its

progress, encouraging personal strategies to prevent recurrence, and
implementing programs to return people to their original health and function
to prevent long-term problems.
Regular exams and screening tests to detect disease in its earliest stages
(e.g. Chest X-ray, Sputum exam, Skin test).

Screening

Infectious TB: all cases of respiratory (pulmonary or laryngeal) TB which are

sputum smear-positive and culture-positive (if culture is available).

Potentially infectious TB: all cases of respiratory (pulmonary or laryngeal) TB

which are sputum smear-negative and culture-positive (susceptible, MDR-TB
or XDR-TB).

Non-infectious TB: all cases of respiratory TB which have two consecutive

negative sputum-smear and negative culture (if culture is available) results.

3. Tertiary Level of Prevention

Aims to soften the impact of an ongoing illness that has lasting effects and to
limit disability and prevent further complications or death.

Modes of Prevention

Limitation of disability that may result from the disease.

Rehabilitation needed more in the chronically ill, those still excreting the
bacilli mostly need rehabilitation.
o Nutritional rehabilitation is important for people with TB. Proper
nutritional care improves nutritional recovery for people who are
undernourished, and therefore helps reduce future health risks.
Surveillance this involves the continuous scrutiny of the factors that
determine the occurrence and distribution of the disease, TB for effective
control and prevention.
o Involves the collection, analysis, interpretation, and distribution of
relevant data for action.

2 parts of surveillance:
- Surveillance of TB situation (annual infection rates)
- Surveillance of control measures of applied example BCG.