Tuberculosis (TB) is an
infectious disease that is caused by a bacterium called Mycobacterium tuberculosis. TB primarily
affects the lungs, but it can also affect organs in the central nervous system,
lymphatic system, and circulatory system among others. The disease was called
"consumption" in the past because of the way it would consume from
within anyone who became infected.
When a person becomes infected with
tuberculosis, the bacteria in the lungs multiply and cause pneumonia along with chest pain, coughing up blood, and a
prolonged cough. In addition, lymph nodes near the heart and lungs become
enlarged. As the TB tries to spread to other parts of the body, it is often
interrupted by the body's immune system. The immune system forms scar tissue or
fibrosis around the TB bacteria, and this helps fight the infection and
prevents the disease from spreading throughout the body and to other people. If
the body's immune system is unable to fight TB or if the bacteria breaks
through the scar tissue, the disease returns to an active state with pneumonia
and damage to kidneys, bones, and the meninges that line the spinal cord and
brain.
TB is generally classified as being either latent or active. Latent TB occurs when the bacteria are present in the body, but this state is inactive and presents no symptoms. Latent TB is also not contagious. Active TB is contagious and is the condition that can make you sick with symptoms.
TB is a major cause of illness and death worldwide, especially in Africa and Asia. Each year the disease kills almost 2 million people. The disease is also prevalent among people with HIV/AIDS.
TB is generally classified as being either latent or active. Latent TB occurs when the bacteria are present in the body, but this state is inactive and presents no symptoms. Latent TB is also not contagious. Active TB is contagious and is the condition that can make you sick with symptoms.
TB is a major cause of illness and death worldwide, especially in Africa and Asia. Each year the disease kills almost 2 million people. The disease is also prevalent among people with HIV/AIDS.
What causes tuberculosis?
Tuberculosis is ultimately caused by the Mycobacterium tuberculosis that
is spread from person to person through airborne particles. It is not
guaranteed, though, that you will become infected with TB if you inhale the
infected particles. Some people have strong enough immune systems that quickly
destroy the bacteria once they enter the body. Others will develop latent TB
infection and will carry the bacteria but will not be contagious and will not
present symptoms. Still others will become immediately sick and will also be
contagious.
What are the symptoms of tuberculosis?
Most people who become infected with the
bacteria that cause tuberculosis actually do not present symptoms of the
disease. However, when symptoms are present, they include unexplained weight
loss, tiredness, fatigue, shortness of breath, fever, night sweats, chills, and a
loss of appetite. Symptoms specific to the lungs include
coughing that lasts for 3 or more weeks, coughing up blood, chest pain, and
pain with breathing or coughing.
How is tuberculosis diagnosed?
Tuberculosis
diagnosis usually occurs after a combination of skin, blood, and imaging tests. The most common
diagnostic test is a simple skin test called the Mantoux test. The Mantoux test
consists of a small amount of purified protein derivative (PPD) tuberculin that
is injected into the forearm. After 48 to 72 hours, a doctor or nurse looks for
a reaction at the injection site; a hard, raised red bump usually indicates a
positive test for TB. Blood tests may also be used to determine whether TB is
active or latent (inactive), and microscopic sputum analyses or cultures can
find TB bacteria in the sputum.
Chest x-rays and computer tomography (CT) scans
are also used to diagnose TB. If the immune system traps the TB bacteria and
creates scar tissue, this tissue and the lymph nodes may harden like stone in a
calcification process. This results in granuloma (rounded marble-like scars)
that often appear on x-rays and CT scans. However, if these scars do not show
any evidence of calcium on an x-ray, they can be difficult to
distinguish from cancer.
Chest x-rays and computer tomography (CT) scans
are also used to diagnose TB. If the immune system traps the TB bacteria and
creates scar tissue, this tissue and the lymph nodes may harden like stone in a
calcification process. This results in granuloma (rounded marble-like scars)
that often appear on x-rays and CT scans. However, if these scars do not show
any evidence of calcium on an x-ray, they can be difficult to
distinguish from cancer.
Who gets tuberculosis?
Tuberculosis is spread from person to person through tiny droplets of
infected sputum that travel through the air. If an infected person coughs,
sneezes, shouts, or spits, bacteria can enter the air and come into contact
with uninfected people who breath the bacteria into their lungs.
Although anyone can become infected with TB, some people are at a higher risk, such as:
·
Those who live with others who
have active TB infections
·
Poor or homeless people
·
Foreign-born people who come
from countries with endemic TB
·
Older people, nursing home
residents, and prison inmates
·
Alcoholics and intravenous drug
users
·
Those who suffer from malnutrition
·
Diabetics, cancer patients, and
those with HIV/AIDS or other immune system problems
·
Health-care workers
·
Workers in refugee camps or
shelters
How is tuberculosis treated?
Treatment for TB depends on the whether the
disease is active of latent. If TB is in an inactive state, an antibiotic called
isoniazid (INH) is prescribed for six to twelve months. INH is not prescribed
to pregnant women, and it can cause side effects such as liver damage and
peripheral neuropathy.
Active TB is treated with INH as well as drugs such as rifampin, ethambutol, and pyrazinamide. It is also not uncommon for TB patients to receive streptomycin if the disease is extensive. Drug therapies for TB may last many months or even years.
If a patient has a drug-resistant strain of TB, several drugs in addition to the main four are usually required. In addition, treatment is generally much longer and can require surgery to remove damaged lung tissue.
The largest barrier to successful treatment is that patients tend to stop taking their medicines because they begin to feel better. It is important to finish medications in order to completely eradicate the TB bacteria from the body.
In December 2012, Sirturo (bedaquiline) was approved as part of a combination therapy for adults with multi-drug resistant TB. According to the FDA, bedaquiline was the first TB drug to be approved in the USA in forty years.
Active TB is treated with INH as well as drugs such as rifampin, ethambutol, and pyrazinamide. It is also not uncommon for TB patients to receive streptomycin if the disease is extensive. Drug therapies for TB may last many months or even years.
If a patient has a drug-resistant strain of TB, several drugs in addition to the main four are usually required. In addition, treatment is generally much longer and can require surgery to remove damaged lung tissue.
The largest barrier to successful treatment is that patients tend to stop taking their medicines because they begin to feel better. It is important to finish medications in order to completely eradicate the TB bacteria from the body.
In December 2012, Sirturo (bedaquiline) was approved as part of a combination therapy for adults with multi-drug resistant TB. According to the FDA, bedaquiline was the first TB drug to be approved in the USA in forty years.
How can tuberculosis be prevented?
There is a vaccine available for tuberculosis called the BCG vaccine that is used in several parts of the world where TB is common.This vaccine usually protects children and infants from the disease, but adults can still get TB after being vaccinated as children.
Better methods of preventing tuberculosis or TB relapses include eating a
healthful diet that takes care of your immune system, getting a TB test
regularly if you work or live in a high risk environment, and finishing TB
medications. To prevent transmitting the disease to others if you are infected,
stay home, cover your mouth, and ensure proper ventilation
Tuberculosis In INDIA
Tuberculosis (TB) is a major public health problem in India. India accounts
for one-fifth of the global TB incident cases. Each year nearly 2 million
people in India develop TB, of which around 0.87 million are infectious cases. It
is estimated that annually around 330,000 Indians die due to TB.
Since 1993, the Government of India (GoI) has
been implementing the WHO-recommended DOTS strategy via the Revised
National Tuberculosis Control Programme (RNTCP). The revised strategy was pilot-tested in 1993 and launched as a
national programme in 1997. By March 2006, the programme was
implemented nationwide in 633 districts, covering 1114 million (100%)
population. Phase II of the RNTCP started from October 2005, which is a step
towards achieving the TB-related targets of the Millennium Development Goals.
Since 2006, RNTCP is implementing the WHO recommended “Stop TB Strategy”,
which in addition to DOTS, addresses all the newer issues and challenges in TB
control.
The objectives of RNTCP are:
To achieve and maintain at least 85% cure rate amongst New Smear
Positive (NSP) pulmonary TB cases.
To achieve and maintain at least 70% detection of such cases.
The structure of the RNTCP comprises of five levels; National,
State, District, Sub-district and Peripheral health institutions. The Central
TB Division which is a part of the Directorate General of Health Services,
Ministry of Health and Family Welfare (MoH&FW), GoI, is
responsible for tuberculosis control at the national level, and is headed by a
Deputy Director General (TB).
At the State level, the State Tuberculosis Officer is responsible
for planning, training, supervising and monitoring theprogramme in their
respective states. The District TB Officer has the overall responsibility of
physical and financial management of RNTCP in the respective districts. An
innovation of RNTCP is the creation of sub-district “Tuberculosis Unit”
supervisory and monitoring team, for an approximate population of 500,000,
(250,000 in tribal and difficult areas), comprising of a designated Medical
Officer – TB Control, a Senior Treatment Supervisor and a Senior TB Laboratory
Supervisor, based in either a Community Health Centre, Taluk Hospital
or Block Primary Health Centre.
RNTCP has established across the country more than 12,000 quality
assured designated microscopy centres (DMC) providing sputum microscopy services, each DMC covering
roughly a population of 100,000 (50,000 in tribal and difficult areas).
Patients are provided directly observed treatment (DOT) by either a health care
worker or a community worker/volunteer at hundreds of thousands of sites called
DOT-centres. The entire course of anti-TB drugs for individual patients is
packaged in a ‘patient wise box’ which simplifies drug logistics, restores the
confidence of the patient on the health system and ensures that the patient
never interrupts treatment due to want of drugs.
The programme has developed standardised training modules for all categories of staff and documents and
guidelines on various aspects of the programme. Based on the consensus
between RNTCP and Indian Academy of Pediatrics, the existing RNTCP guidelines for the diagnosis and
treatment of pediatric cases have been modified and published. A web based
resource centre for Information, Education and Communication has been
developed. Researchers are being encouraged to conduct operational research in
identified key areas
Consistently since 2002, the expansion of RNTCP has accounted for
significant proportion of the additional smear-positive cases reported under
DOTS globally. The programme to date has treated about 10 million TB patients, with over 1.5
million registered for treatment in 2008 alone.The programme has achieved a treatment success rate of over 86% in new smear
positive cases and the case detection in 2008 was 72%. Death rates under RNTCP
have been cut 7-fold compared with those under the previous programme (NTP), from 29% to less than 5% among new smear positive cases.
With an approximate 18 additional lives saved per 100 patients treated under
RNTCP, the programme has substantially reduced deaths amongst patients treated and
saved an estimated over 1.7 million additional lives since its inception.
RNTCP has developed partnerships with a wide range of stake
holders. To date more than 2500 NGOs, over 19,000 private practitioners, 267 Medical Colleges and over
150 corporate sector health facilities are involved in the programme.
Public-private mix (PPM) DOTS has a significant role in achieving the national
objectives of case detection and treatment outcomes. National, Zonal and State
task forces have been created for the involvement of the medical colleges in
the RNTCP. Significant headway has also been made towards the involvement of
the Employees’ State Insurance, Central Government Health Scheme, Railways,
Armed Forces, Corporate Sector and other Public Sector Undertakings in the programme. Since
2003, PPM DOTS activities have been ongoing in almost all parts of the country.
Joint TB-HIV activities, in collaboration with the National AIDS
Control Organisation were started in 2001, initially in the 6 high HIV prevalent
states. These activities were subsequently expanded to 14 states and in 2007 a
decision was taken to scale-up to the entire country. For this purpose a
National TB/HIV Framework has been developed jointly by both programmes and a Technical Working Group meets regularly to advise both programmes on technical guidelines and related policy issues.
Having successfully expanded DOTS services to the entire country,
RNTCP is now scaling-up a plan to offer treatment for patients with multidrug-
resistant TB (MDR-TB) at DOTS-Plus sites. RNTCP DOTS-Plus guidelines are an
adaptation of the international guidelines on programmatic management of drug
resistant TB. In 2007, treatment for MDR-TB patients was started at two sites,
one each in Gujarat and Maharashtra. By the end of 2008, 190 MDR-TB patients were on
treatment in seven states. RNTCP plans to scale up DOTS Plus services across
the country in order to achieve universal coverage by 2012 for all re-treatment
cases notified under the programme. One of the important activities in this process is laboratory
strengthening for quality assured culture and drug susceptibility testing,
including the use of recently recommended newer technology for rapid detection
of MDR-TB. The RNTCP has also developed a response plan for the extensively
drug resistant TB (XDR-TB) which has also been reported from a few institutions
in India.
The majority of funding for RNTCP is from the Government of India
sources which includes a World Bank credit. Theprogramme is also supported with
funds from donor agencies including DFID of UK, the Global Fund and USAID. The
Global Drug Facility (GDF) procures about half of the drug requirement of RNTCP
using funds from DFID.
WHO is supporting the RNTCP by providing technical assistance
through a network of about 90 field level Consultants who work closely with the
district and state TB officers. In addition about 10 Consultants provide
technical support to the Central TB Division. At the WHO Country Office,
five international staff, and one national WHO staff provide technical
assistance to the Central TB Division, MoH&FW, GoI. WHO
India has provided technical support to the RNTCP in the following major areas:
1. In surveillance, quality assurance, TB/HIV collaboration,
reporting and data management and in drugs and logistics management.
2. In the development of the strategy document for the supervision
and monitoring of the RNTCP, guidelines for the quality assurance of smear
microscopy for diagnosing tuberculosis, concise module on RNTCP for medical
practitioners and the training modules on TB/HIV.
3. In the revision of the guidelines and technical modules for all
types of staff under RNTCP.
4. In the conducting of the national review meetings of the State
TB Officers and field consultants in addition to several other meetings with
the partners.
5. In the start-up of MDR-TB management, including in development
of the RNTCP DOTS-Plus guidelines, in the development of the GLC application,
initiation of services for MDR-TB patients and developing a response plan for
addressing XDR-TB.
6. In the strengthening of reference laboratories for quality
assured culture and drug susceptibility testing, including testing for first
and second line drug susceptibility and evaluation of newer laboratory
techniques for the purpose.
7. In organizing national and zonal meetings of the task force for
the implementation of RNTCP in the medical colleges.
8. In the preparation of funding proposals and multi-year project
implementation plans for securing funds from the World Bank and other funding
agencies.
9. In negotiating with funding agencies for anti-TB medicines and
financial support to maintain the consultant network.
10. In enhancing the Public-Private Mix (PPM) activities under
RNTCP, including the use of the international standards of TB care in involving
professional medical associations.
11. Technical support to TB-HIV activities of the RNTCP.
12. In the research activities with Tuberculosis Research Centre,
Chennai and with other agencies and in the surveys to assess the impact of
different tuberculosis control measures.
13. Technical support to National TB Institute in operational
research and impact assessment surveys.
14. In the development of GF proposals and in the monitoring of
the implementation of such projects


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