A.

REVIEW OF RELATED LITERATURE

In exposed individuals TB is transmitted by contaminated aerosols smaller than

5um which can bypass bronchial defense mechanisms and reach the alveoli. In over
90% of infected individuals alveolar macrophages and specific cell mediated
immunity prevent further multi implication of mycobacteria and hence TB disease
out break.
The infected individuals usually remain asymptomatic and can be diagnosed
only with a positive tuberculin skin test reaction.
Pulmonary TB is usually suspected and first detected when patients present with
cough of several weeks duration and the doctor thinks TB Continuous and
objective information of the public will hopefully shorten the patients delay despite
cost burdens due to managed care and copayment (user fee) systems. Doctors
should think TB especially in particular socioeconomic situations such as recent
immigration from high prevalence countries crowded living circumstances,
substance abuse, HIV infection and in close contacts with TB patients. Due to its
decreasing prevalence in developed countries, early detection of TB infection and
disease has to be performed by primary care physicians and not by mass screening
except for targeted screening programs for recent immigrants from high
prevalence countries.
Primary TB is mostly asymptomatic or can only be suspected by systemic
symptoms such as fever, malaise or weight loss, very seldom by symptoms of
pleural involvement. Reactivation TB typically presents with cough, slowly
progressing over weeks or months, easily missed in smokers.
TB is often detected incidentally in 22% of the cases in our experience - ,
without symptoms related to the chest. Very often TB is not included in the initial
diagnostic plan despite pulmonary symptoms. In the USA 5% of all TB cases, 10
15% in elderly patients, were diagnosed post mortem by autopsy only. In individuals
from high risk populations (contacts with TB patients, in institutions or prisons,
with HIV infection, recent immigrants from high prevalence countries), a higher
degree of suspicion should lead to further TB diagnoses even in the absence of
pulmonary or systemic symptoms.
Physical examination of the chest in pulmonary TB is mostly unrevealing. Rarely
localized rales or amphoric breath sounds or dullness to percussion are indicative of
pulmonary or pleural disease.
Fever is present in up to 66% of patients with pulmonary TB, rapidly
disappearing within 1 2 weeks under theraphy. In primary TB beautifully studied
by poulsen in the isolated population of 30,000 on the Faeroes from 1932 to 1947
70& of all individuals with recent tuberculin skin test conversion had a febril illness
of variable course with a temperature up to 40C of an average duration of 3 weeks
In 18% of theses untreated converters, mostly in young women, erythema
nodosum bluish red, tender nodules were found in the skin of the legs. Meningitis
developed in 3%, mostly within 6 months after tuberculin skin test conversion, in a
children as weel as in adults.
Signs and symptoms suggestive of extrapulmonary disease such as prolong pain
of the thoracic or lumbar spine or painless hematuria should be considered.
Laboratory signs such as elevated sedimentation rate and C reactive protein,
mild leukocytosis and lymphopenia or anemia are not diagnostic. A diminished
serum sodium or plasma cortisol can be a sign of inappropriate ADH secretion or
adrenal disease. Hypercalcemia is not directly associated with TB but rather due to
immobilization or vitamin D supplementation. But there is evidence that it may also
be a general phenomenon of granulomatous inflammation.
Brndli, O. (1998). The clinical presentation of tuberculosis. Respiration, 65(2), 97-105. Retrieved
from https://search.proquest.com/docview/228386145?accountid=139410

In 20010, it was estimated that over 500,000 disability adjusted life years
(DALYs) were lost due to illness and premature mortality from TB in the Philippines
annually. This was equal to 9% of all years of life lost. The combined economic
losses due to premature mortality and morbidity totaled PhP 8billion.
The economic burden of TB largely due to premature deaths and lost
productivity in the philippines from 2006 2015 is $US131.24 billion without DOTS.
With sustained DOTS, this could be reduced to $US81.49 billion and with the Global
Plan, to $US8.04 billion. The benefit cost ratios are 263 and 219, respectively