TUBERCULOSIS

DMD4CGroup 5

Aquino, Anna PatriciaGharehdaghi, VahidMedina, Alyssa Fe

Khosravani, MehrdadNavarro, Lou Phyllis Nocete, Kristel FayePalaca, Bea Marie Tan, Helen Grace

Villanueva, Viel KatrineViloria, Viviene Mae

What You Need to Know About Tuberculosis (TB)

What is Tuberculosis? Tuberculosis is an infectious disease caused by

Mycobacterium tuberculosis

It is a serious condition, but can be cured with proper treatment.

TB mainly affects the lungs. However, it can affect any part of the body When you have TB disease of the lungs, you can

spread it to other people

Who's most at risk?Anyone can catch TB, but people particularly at risk

include those: who live in, come from, or have spent time in a

country or area with high levels of TB in prolonged close contact with someone who is

infected living in crowded conditions with a condition that weakens their immune system having treatments that weaken the immune system who are very young or very old in poor health or with a poor diet because of

lifestyle and other problems

How Are TB Germs Spread?

How Are TB Germs Spread? TB germs are passed through the air The condition is spread when a person with an

active TB infection in their lungs coughs or sneezes;someone else inhales the expelled droplets

Although it is spread in a similar way to a cold or the flu, TB is not as contagious.

WHY? You would usually have to spend prolonged periods in close contact with an infected person to catch the infection yourself.

WORRY NOT!

In most cases, your body is able to fight off the germs

Latent or active TBHowever, in some cases the bacteria infect the

body but don't cause any symptoms (latent TB), or the infection begins to cause symptoms within weeks or months (active TB).

Up to 10% of people with latent TB eventually develop active TB years after the initial infection.  

How Are TB Germs NOT Spread? Through quick, casual contact, like

passing someone on the street By sharing utensils or food By sharing cigarettes or drinking

containers By exchanging saliva or other body

fluids By shaking hands Using public telephones

TB Infection vs. TB Disease

TB infection: TB germs stay in your lungs, but they do not multiply or make you sick You cannot pass TB germs to others

TB disease: TB germs stay in your lungs or move to other parts of your body, multiply, and make you sick You can pass the TB germs to other people

A Person with Latent TB Infection A Person with TB Disease

•Does not feel sick Has symptoms that may include-a bad cough that lasts 3 weeks or longer-pain in the chest-coughing up blood or sputum-weakness or fatigue-weight loss-no appetite-chills-fever-sweating at night

•Does not feel sick •Usually feels sick•Cannot spread TB bacteria to others •May spread TB bacteria to others•Usually has a skin test or blood test result indicating TB infection

•Usually has a skin test or blood test result indicating TB infection

•Has a normal chest x-ray and a negative sputum smear

•May have an abnormal chest x-ray, or positive sputum smear or culture

•Needs treatment for latent TB infection to prevent TB disease

•Needs treatment to treat TB disease

Preventing Latent TB Infection from Progressing to TB Disease

Many people who have latent TB infection never develop TB disease. But some people who have latent TB infection are more likely to develop TB disease than others.

Those at high risk for developing TB disease include:-People with HIV infection-People who became infected with TB bacteria in the last 2 years-Babies and young children-People who inject illegal drugs-People who are sick with other diseases that weaken the immune system-Elderly people-People who were not treated correctly for TB in the past

If you have latent TB infection and you are in one of these high-risk groups, you should take medicine to keep from developing TB disease.

There are several treatment options for latent TB infection. You and your health care provider must decide which treatment is best for you. If you take your medicine as instructed, it can keep you from developing TB disease.

A person with TB disease has a large amount of TB bacteria in the body. Several drugs are needed to treat TB disease.

Common Symptoms of TB Disease Cough (2-3 weeks or more) Coughing up blood Chest pains Fever Night sweats Feeling weak and tired Losing weight without trying Decreased or no appetite If you have TB outside the lungs, you may

have other symptoms

Who Should be TestedCertain people should be tested for TB infection because they

are at higher risk for being infected with TB bacteria, including:

People who have spent time with someone who has TB disease

People from a country where TB disease is common (most countries in Latin America, the Caribbean, Africa, Asia, Eastern Europe, and Russia)

People who live or work in high-risk settings (for example: correctional facilities, long-term care facilities or nursing homes, and homeless shelters)

Health-care workers who care for patients at increased risk for TB disease

Infants, children and adolescents exposed to adults who are at increased risk for latent tuberculosis infection or TB disease

Testing & Diagnosis

TestingThere are two kinds of tests that are used to detect TB bacteria in the

body: the TB skin test (TST) TB blood tests. 

A positive TB skin test or TB blood test only tells that a person has been infected with TB bacteria.

It does not tell whether the person has latent TB infection (LTBI) or has progressed to TB disease.

Other tests, such as a chest x-ray and a sample of sputum, are needed to see whether the person has TB disease.

Diagnosis If a person is found to be infected with TB bacteria, other tests are

needed to see if the person has latent TB infection or TB disease.

Testing for TB Infection

• There are two types of tests for TB infection:the TB skin test and the TB blood test.  • A person’s health care provider should

choose which TB test to use. • Factors: -reason for testing-test availability-cost. • Generally, it is not recommended to test a

person with both a TB skin test and a TB blood test.

TB skin test The TB skin test is also called the Mantoux tuberculin skin test (TST). 

A TB skin test requires two visits with a health care provider.  On the first visit the test is placed; on the second visit the health care provider reads the test.

The TB skin test is performed by injecting a small amount of fluid (called tuberculin) into the skin on the lower part of the arm.

A person given the tuberculin skin test must return within 48 to 72 hours to have a trained health care worker look for a reaction on the arm.

The result depends on the size of the raised, hard area or swelling. Positive skin test: This means the person’s body was infected with TB

bacteria. Reading the result of a TB skin test Additional tests are needed to determine if the person has latent TB infection or TB

disease. Negative skin test: This means the person’s body did not react to the test, and

that latent TB infection or TB disease is not likely. There is no problem in repeating a TB skin test.  If repeated, the additional

test should be placed in a different location on the body (e.g., other arm).  The TB skin test is the preferred TB test for children under the age of five.

TB blood test. TB blood tests are also called interferon-gamma release assays or

IGRAs. 

A health care provider will draw a patient’s blood and send it to a laboratory for analysis and results.

Positive TB blood test: This means that the person has been infected with TB bacteria. Additional tests are needed to determine if the person has latent TB infection or TB disease.

Negative TB blood test: This means that the person’s blood did not react to the test and that latent TB infection or TB disease is not likely.

TB blood tests are the preferred TB test for:People who have received the TB vaccine bacille Calmette–Guérin (BCG).People who have a difficult time returning for a second appointment to

look for a reaction to the TST.

Testing in BCG-Vaccinated Persons

People who were previously vaccinated with BCG may receive a TB skin test to test for TB infection. Vaccination with BCG may cause a false positive reaction to a TB skin test. A positive reaction to a TB skin test may be due to the BCG vaccine itself or due to infection with TB bacteria.

TB blood tests (IGRAs), unlike the TB skin test, are not affected by prior BCG vaccination and are not expected to give a false-positive result in people who have received BCG. TB blood tests are the preferred method of TB testing for people who have received the BCG vaccine.

Testing Health Care Workers

Tuberculosis (TB) transmission has been documented in health care settings where workers and patients come in contact with people who have TB disease. 

Periodic testing of health care workers is recommended

TB testing programs should include anyone working or volunteering in health-care settings.  

There are two types of testing for TB in health care workers.

Initial baseline testing upon hire: Two-step testing with a TB skin test or a TB blood test

Annual or serial screening: determined by state regulations or risk assessment outcomes.

Testing During Pregnancy

There is a greater risk to a pregnant woman and her baby if TB disease is not diagnosed and treated.  

TB skin testing is considered both valid and safe throughout pregnancy.

TB blood tests also are safe to use during pregnancy.

Diagnosing latent TB infection and TB disease

Diagnosis of Latent TB Infection A diagnosis of latent TB infection is made if a person

has a positive TB test result and a medical evaluation does not indicate TB disease.

The decision about treatment for latent TB infection will be based on a person’s chances of developing TB disease by considering their risk factors.

Diagnosis of TB Disease TB disease is diagnosed by medical history, physical

examination, chest x-ray, and other laboratory tests. TB disease is treated by taking several drugs as

recommended by a health care provider.

People suspected of having TB disease should be referred for a complete medical evaluation, which will include the following:

1. Medical History Clinicians should ask about the patient’s history of TB exposure,

infection, or disease. It is also important to consider demographic factors that may increase the patient’s risk for exposure to TB or to drug-resistant TB. Also, clinicians should determine whether the patient has medical conditions, such as HIV infection or diabetes, that increase the risk of latent TB infection progressing to TB disease.

2. Physical ExaminationA physical exam can provide valuable information about the

patient’s overall condition and other factors that may affect how TB is treated, such as HIV infection or other illnesses.

3. Test for TB InfectionThe Mantoux tuberculin skin test (TST) or the TB blood test can

be used to test for M. tuberculosis infection. Additional tests are required to confirm TB disease.

4. Chest Radiograph A posterior-anterior chest radiograph is used to detect chest

abnormalities. Lesions may appear anywhere in the lungs and may differ in size, shape, density, and cavitation. These abnormalities may suggest TB, but cannot be used to definitively diagnose TB..

5. Diagnostic Microbiology Acid-fast microscopy is easy and quick, but it does not

confirm a diagnosis of TB because some acid-fast-bacilli are not M. tuberculosis. Therefore, a culture is done on all initial samples to confirm the diagnosis.

6. Drug Resistance For all patients, the initial M.

tuberculosis isolate should be tested for drug resistance. It is crucial to identify drug resistance as early as possible to ensure effective treatment. Drug susceptibility patterns should be repeated for patients who do not respond adequately to treatment or who have positive culture results despite 3 months of therapy.

TREATMENT

AIMS: to cure the patient of TB and restore

their quality of life and productivity to prevent relapse of TB to reduce the transmission of TB to

others to prevent the development and

transmission of drug resistant TB

TREATMENT When TB bacteria become active (multiplying in the body)

and the immune system can’t stop the bacteria from growing, this is called TB disease. TB disease will make a person sick. People with TB disease may spread the bacteria to people with whom they spend many hours.

It is very important that people who have TB disease are treated, finish the medicine, and take the drugs exactly as prescribed.

If they stop taking the drugs too soon, they can become sick again;

if they do not take the drugs correctly, the TB bacteria that are still alive may become resistant to those drugs.

TB that is resistant to drugs is harder and more expensive to treat.

TREATMENT TB disease can be treated by taking several

drugs for 6 to 9 months.  There are 10 drugs currently approved by the U.S. Food and Drug Administration (FDA) for treating TB. Of the approved drugs, the first-line anti-TB agents that form the core of treatment regimens are:

isoniazid (INH) rifampin (RIF) ethambutol (EMB) pyrazinamide (PZA)

First line drugs for TB treatment

Isoniazid Rifampicin Pyrazinamide Ethambutol and Streptomycin are those TB drugs that generally have

the greatest bactericidal activity when used for TB treatment. The amount of drug that a TB patient needs to take depends on the patient’s weight.

SAFETY

CONSIDERATIONS

FOR PREGNANT WOMAN

Untreated tuberculosis in pregnancy poses a significant threat to the mother, fetus and family.

Adherence to treatment is especially difficult in pregnancy because of the general fear of any medication and pregnancy-related nausea.

Supervised treatment is especially helpful in encouraging adherence.

All 4 first line drugs [isoniazid, rifampicin (rifampin), ethambutol and pyrazinamide] have an excellent safety record in pregnancy and are not associated with human fetal malformations. 

Streptomycin should not be used in pregnancy, as perhaps 1 in 6 babies will have problems with hearing and/or balance.

Ciprofloxacin has the best safety profile of second line drugs in the treatment of drug-resistant tuberculosis.

Preventive treatment with isoniazid can be undertaken safely during pregnancy.

Pyridoxine (vitamin B6) should be added to the drug treatment of tuberculosis in all pregnant women taking isoniazid.

Neither tuberculin nor the Bacille Calmette Guérin (BCG) vaccine are treatments for tuberculosis, but they play an important role in the management of the disease.

Tuberculin testing is safe, but BCG vaccination should be avoided in pregnancy and instead given earlier in life.

 

• Stopping treatment too soon or skipping doses can allow the bacteria that are still alive to become resistant to those drugs, leading to TB that is much more dangerous and difficult to treat.

Infection Control in Health Care Settings

Tuberculosis (TB) transmission has been documented in health care settings where health care workers and patients come in contact with people who have TB disease.

People who work or receive care in health care settings are at higher risk for becoming infected with TB

Therefore, it is necessary to have a TB infection control plan as part of a general infection control program designed to ensure the following:

prompt detection of infectious patients,airborne precautions, treatment of people who have suspected or confirmed TB

disease.

Use of respiratory protective equipment Use of respiratory protection equipment can further

reduce risk for exposure of health care workers to infectious droplet nuclei that have been expelled into the air from a patient with infectious TB disease.

The following measures can be taken to reduce the risk for exposure:

Implementing a respiratory protection program; Training health care workers on respiratory protection;

and Educating patients on respiratory hygiene and the

importance of cough etiquette procedures.

Thank YOU for listening