TUBERCULOSIS IN ENGLISH
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TUBERCULOSIS-
} Tuberculosis is a
communicable disease which is caused by a bacteria Micobacterium tuberculosis. The disease
mainly affects lungs and causes pulmonary TB. It can also affect other body
organs such as intestine, meninges, bones and joints, lymph glands, skin etc. which is known as extrapulmonary TB.
} The disease is usually
chronic with different clinical manifestations. The disease also affects
animals like cattle; this is known as bovine tuberculosis, which may sometimes
be spread to human population.
CAUSATIVE
AGENTS OF TB-
} Tuberculosis is caused by bacteria
Micobacterium tuberculosis. The human strain is responsible for the vast
majority of cases. The bovine strain affects mainly cattle and other animals
SOURCE OF INFECTION-
} There
are two sources of infection - human and bovine.
} (i)
Human source: The most common source of infection is the human case
whose sputum is positive for tubercle bacilli.
} (ii)
Bovine source: The bovine source of infection is usually infected milk.
Mode of Transmission-
Tuberculosis
is transmitted mainly by droplet infection and droplet nuclei generated by
sputum-positive patients with pulmonary tuberculosis. It may also spread though
fomites.
} Incubation period is the time taken from entry of infectious agent to appearance
of sign and symptoms. The incubation period of tuberculosis may vary from about
2 to 12 weeks
SIGN AND SYMPTOMS-
} Coughing that lasts three or
more weeks
} Coughing up blood
(Haemoptysis)
} Chest pain, or pain with
breathing or coughing
} Unexplained weight loss
} Fatigue
} Fever
} Night sweats
} Chills
} Loss of appetite
DIAGNOSTIC INVESTIGATIONS-
} (i) Sputum examination : Sputum
smear examination by direct microscopy is now considered the method of choice.
A pulmonary tuberculosis suspect should submit two sputum samples for
microscopy. One is early morning sputum sample and second is on the spot sputum
sample. This test is also known as Ziehl-Neelsen acid-fast test
} (ii) X-ray examination : Chest X-rays are useful for the diagnosis of
sputum negative pulmonary TB and TB in children. It is not routinely indicated
in sputum -positive cases.
} (iii) Sputum culture: Isolation
of mycobacterium from sputum samples by culture is very important for definitive diagnosis of tuberculosis .
} (iv) MANTOUX TEST : The
Mantoux test is carried out by injecting 1 TU of PPD in 0.1 ml intra-dermally
on the flexor surface of the left forearm, with a tuberculin syringe, injection
should produce a pale wheal on the skin. The result of the test is read after
48-96 hours but 72 hours (3rd day) is the ideal. Reactions exceeding 10 mm are
considered "positive". Those less than 6 mm are considered
"negative".
TREATMENT-
} Chemotherapy is indicated in
every case of active tuberculosis. DOTS is a strategy to ensure cure by
providing the most effective medicine and confirming that it is taken. It is
the only strategy which has been documented to be effective world-wide on a
programme basis. DOTS is recommended therapy for TB treatment under RNTCP.
} In DOTS, during the
intensive phase of treatment a health worker or other trained person (DOTS
provider) watches as the patient swallows the drug in his presence. During
continuation phase, the patient is issued medicine for one week in a
multiblister combipack, of which the first dose is swallowed by the patient in
the presence of health worker or trained person.
PREVENTION-
} Active case detection and
prompt treatment is the best control and prevention os spread of this disease
in the community.
} Isolation of active TB case
is effective for prevention and control of pulmonary TB.
} Proper disposal of sputum
and disnfection of fomites is also considered equally effective.
} Vaccination- BCG vaccination
to all children is recommended at birth.
} Health education regarding
prevention of TB is also very good measure.
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