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TUBERCULOSIS

MARIYA ANTONY <br>NURSING STUDENT

Mariya6
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TUBERCULOSIS

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  1. Health talk onTUBERCULOSIS PRESENTED BY, MARIYA ANTONY 2ND YR BSC NURSING ST.THOMAS COLLEGE OF NURSING CHETHIPUZHA

  2. Introduction • Definition • Epidemiology • Types • Etiology and risk factors • Pathophysiology • Clinical manifestations • Management • DOTS • Control • Conclusion

  3. INTRODUCTION • Tuberculosis is a specific infectious disease caused by Mycobacterium tuberculosis. The disease primarily affect lungs and causes pulmonary tuberculosis . • It can also affect intestine, meninges, bones ,and joints, lymph glands , skin, and other tissues of the body . • The disease is usually chronic with varying clinical manifestations. The disease also affect the animals like cattle; this is known as “Bovine Tuberculosis” which may sometimes be communicated to man. • M. Tuberculosis is a slender ,straight and slightly curved rods with rounded ends. They are acid fast due to presence of mycolic acid in the cell wall.

  4. DEFINITION • Tuberculosis (TB) is a highly contagious infection caused by the bacterium called M. Tuberculosis that usually attacks your lungs.

  5. Incidence • India: • 2.640 million-number • 193 per 1lakh population • World • India rank 1st in the world TB statistics : • 2600 per10000 • 1,370,000 per 1000

  6. RECENT STUDY 2020GLOBAL TB REPORT 2020 • TB remains the top infectious killer in the world claiming close to 4000 lives a day. Millions of people continue to fall ill with TB- a preventable and curable disease each year. • The Global TB Report 2020 provides a comprehensive and up-to-date assessment of the TB epidemic, and progress in the response, at global, regional and country levels in the context of global commitments and strategies.

  7. EPIDEMIOLOGICAL INDICES • 1)Incidence : Defined as the number of new and recurrent occurrence of TB occurring in a given year. • 2)Prevalence: Defined as the no. of TB cases at a given point of time. • 3)Mortality: Defined as the no. of deaths caused by TB in HIV negative people • 4)Case Fatality Rate: the risk of death from TB among people with active TB disease. • 5)Case Notification rate: Refers to new and recurrent episodes of TB notified to WHO for a given year expressed as per 1lakh population. • 6)Case Detection Rate: No .of notification of new and relapse cases in a year divided by the estimated incidences in the same year.

  8. 7)Prevalence of Drug – resistant cases: It is the prevalence of patient excreting tubercle bacilli resistant to anti -tuberculosis drugs. This index is directly related to chemotherapy. • a)Prevalence of infection :It is the percentage who show a positive reaction to the standard tuberculin test. • b)Incidence of infection: (Annual Infection Rate):It is the percentage of population under study who will be newly infected by M. tuberculosis among the non-infected of the preceding survey during the course of one year,

  9. TYPES OF TUBERCULOSIS BASED ON ANATOMICAL SITE 1 PULMONARY TB EXTRA PULMONARY TB

  10. 1. • a)Pulmonary Tuberculosis • refers to any bacteriologically confirmed / clinically diagnosed case of TB involving lung parenchyma or the tracheobronchial tree . • b) Extra Pulmonary TB. • Refers to any bacteriologically confirmed or clinically diagnosed case of TB involving organs other than lungs, eg; Pleura, lymph nodes, abdomen, genitourinary tract, skin, joints, and bones , meninges.

  11. Forms of extra pulmonary TB • 1) Lymph node TB • Bacilli infect lymph nodes in neck and above the clavicles, which then swell and inflame the surrounding skin. Any lymph node in the body can also be infected by TB; swollen lymph nodes can also cause other problems. • 2) Pleural TB • It is the TB of thin skin around lungs. This external lining serves to separate the lungs from wall of the chest cavity. It is double layered and there is a small space in between layers, in between the layers , in which the TB bacilli can sit and multiply . As a result , the area can become inflamed resulting in fever and pain when breathing. This inflammation also leads the pleura to secrete liquid which then assembles in between 2 layers of the pleura- this is called a pleural effusion.

  12. 3) TB of the bone and the joint • TB bacilli can sit in the bones or the joints and cause pain and swelling of the affected area. • 4) TB of the central nervous system • The central nervous system is made up of the brain and the spinal cord. TB bacilli can infect both, and cause TB meningitis – an infection of the thin layer that covers the brain. Symptoms depend on where in the brain the TB bacilli are – usually people with TB meningitis experience drowsiness and lethargy, have delayed reactions, have difficulty moving their hands or feet and speaking or focus their eyes. TB meningitis is dangerous and difficult to treat..

  13. 5)TB of other places • TB can infect any part of the body, including the abdominal cavity (the belly region that contains important organs such as the liver, the spleen and the bowels; this is then called abdominal TB), and the kidneys, the bladder and the urinary tract, which is the system that urine flows through when it is excreted from the body– this kind of TB is called genitourinary TB (derived from “genital” and “urinary” as these are the sites where this type of TB manifests).

  14. Treatment after failure patients Treatment after loss to follow up patients 2 Relapse patients have previously been treated for TB. BASED ON HISTORY OF PREVIOUS TB Patients with unknown previous TB treatment history Other previously treated patients:

  15. 2. • a)Relapse patients have previously been treated for TB. • They were declared cured or treatmentcompleted at the end of their most recent course of treatment, are now diagnosed with a recurrent episodes of TB. • b)Treatment after failure patients • those who have previously been treated for TB and whose treatment failed at the end of their most recent course of treatment.

  16. c)Treatment after loss to follow up patients • they have previously been treated for TB and were declared lost to follow up at the end of their most recent course of treatment. • d)Other previously treated patients: • Those who have previously been treated for TB but whose outcome after their most recent course of treatment is unknown or undocumented • E)Patients with unknown previous TB treatment history

  17. E)Patients with unknown previous TB treatment history • They do not fit in to any of the category above.

  18. 3 Monoresistance Poly drug resistance Based on drug resistance Rifampicin resistance Extensive drug resistance Multidrug Resistance

  19. 3 • 1) Mono drug Resistance : • Resistance to one first line anti-TB drug • 2) Polydrug resistance • Resistance to more than one first line of anti-TB drug (either rifampicin or isoniazid)

  20. 3) Extensive drug resistance • Resistance to any fluoroquinolones and at least one of the three second-line injectable drugs (capreomycin, kanamycin ,and amikacin), in addition to multidrug resistance. • 4) Multi-drug resistance • Resistance to at least both isoniazid and rifampicin • 5) Rifampicin Resistance • Resistance to rifampicin detected using phenotypic or genotypic method , with or without resistance to other anti -TB drugs It includes resistance to rifampicin , whether monoresistance , multidrug resistance , polydrug resistance or extensive drug resistance.

  21. 4 BASEB ON HIV STATUS HIV-Positive TB patient HIV NEGATIVE TB PATIENT HIV STATUS UNKNOWN TB PATIENT

  22. 4 • 1) HIV-Positive TB patient • Refers to bacteriologically confirmed or clinically diagnosed case of TB who has a positive result from HIV testing conducted at the time of TB diagnosis or other documented evidence of enrolment in HIV care, such as enrolment in the pre -ART register or in the ART register once ART has started. • 2)HIV- Negative TB patient • Refers to any bacteriologically confirmed or clinically diagnosed case of TB who has a negative result from HIV testing conducted at the time of TB diagnosis.

  23. 3)HIV Status unknown TB • Refers to bacteriologically confirmed or clinically diagnosed case of TB who has no result of HIV testing and no other documented evidence of enrolment in HIV care

  24. Etiology and risk factors. • AGENT FACTORS • Agent • Source of infection • Communicability • HOST FACTORS • Age • Sex • Heredity

  25. Nutrition • Immunity • SOCIAL FACTORS

  26. AGENT I)Agent factors AGENT: MYCOBACTERIUM TUBERCULOSIS Facultative intracellular parasite . Of importance to man are the human and bovine strains. The human strain is responsible for vast majority of cases. The bovine strain affects cattle and other animals. In recent years a number of atypical mycobacterium have been isolated from man. These have been classified into 4 groups i)Photochromogens ii) Scotochromogens Iii)Non- photochromogens Iv)Rapid growers All these are mainly saprophytic. Disease attributed to them may mainly include pulmonary tuberculosis and chronic cervical lymphadenitis.

  27. 2)SOURCE OF INFECTION SOURCE OF INFECTION 1)HUMAN SOURCE: The most common human source of infection is the human case whose sputum is positive for tubercle bacilli and who has either received no treatment or has been treated fully. . An average estimation is that 10-15 persons contract the infection from one case of infectious pulmonary TB annually. 2)BOVINE SOURCE: It usually occur through infected milk. There is no definite evidence for Bovine TB.

  28. 3) COMMUNICABILITY COMMUNICABILITY Patients are infective as long as they remain untreated Effective antimicrobial treatment reduces infectivity by 90% within 48hrs.

  29. AGE HOST FACTORS a)AGE TB affects all ages. In developing countries a sharp rise in infection rates from childhood to adolescence. In India from an average of 2% in “0-14 age groups.”, the infection rate climbs to about 20 % at age 15-24 years age group . In developed countries, the disease is now more commonly in elderly.

  30. SEX b) SEX More prevalent in males than in females. c) HEREDITY TB is not inherited but, however twin studies inherited that susceptibility is a risk factor.. HEREDITY

  31. D)NUTRITION NUTRITION Malnutrition is widely believe to predispose to TB . As the malnutrition is a common in developing countries, there is a chance for development of TB.

  32. E) IMMUNITY IMMUNITY Man has no inherited immunity against TB. It is acquired as a result of natural infection or BCG vaccination. Past infection with tubercle bacilli is also credited with certain amount of naturally acquired immunity. It is known that both delayed hypersensitivity and acquired resistance to TB are CMI . In most cases , the cellular immunity proves adequate to limit further multiplication and spread of bacilli.

  33. SOCIAL FACTORS SOCIAL FACTORS The social factors include many non- medical factors such as: poor quality of life poor housing and overcrowding population explosion undernutrition, smoking, alcohol abuse lack of education large families, early marriage lack of awareness of illness

  34. MODE OF TRANSMISSION Direct contact with TB patients (5%) Droplet infection and contaminated urine and stool(3.3%) Droplet infection and blood (3.3%) • Droplet infection • Coughing, sneezing and consuming food contaminated by TB patients • Droplet infection and use of materials contaminated by TB patients(5%)

  35. TB is transmitted mainly by droplet infection and droplet nuclei generated by sputum positive patients with pulmonary tuberculosis. • To transmit infection , the particles must be fresh enough to carry a viable organism . Coughing generates the largest number of droplets of all sizes. The frequency and vigour of cough and the ventilation of the environment influence transmission of infection.

  36. TB is not transmitted by fomites , such as dishes and other particles used by the patients. Sterilization of these articles is therefore of little or of no value. • Patients with extra – pulmonary TB or smear negative TB constitute a minimal hazard for transmission of infection. • The time from receipt of infection to the development of positive tuberculin test ranges from 3 to 6 weeks, and thereafter , the development depends upon the closeness of contact, the extent of disease and sputum positivity of source case (dose of infection) and host parasite relation ship. • Thus the incubation period may be weeks, months, years.

  37. PATHOPHYSIOLOGY • Due to etiological factors • Exposure or inhalation of infected aerosol through droplet nuclei • Tubercle bacilli invasion in the apex of the lungs or near the plura of the lower lobe • Bronchopneumonia develops in the lung tissues as phagocytosed tubercle bacilli are ingested by the macrophages

  38. Neurotic degeneration occurs ie, the production of cavities filled with cheese like mass of tubercle bacilli, dead WBC’s , necrotic lung tissue. • Drainage of necrotic material into tracheobronchial tree. • Lesions may calcify (Ghon’s complex) • Tubercle bacilli immunity develops

  39. Acquired immunity leads to further growth of bacilli and development of active infection • Signs and symptoms • Medical interventions without medical intervention • TB DOTS, BCG vaccine reactivation of bacilli • Non recurrence recurrenceSecondary infection • Good prognosis Bad prognosis Severe occurrence of lesion in lungs

  40. Cavitation in lungs • Active infection spread throughout body system • SEVERE INFECTION

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