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ACTIVE TB
Only some 10 per cent among the infected
ones will develop TB disease some time in
adult life.
After infection only when a persons
immune system becomes weak for some
reason, active TB is developed. They have
symptoms of TB disease.
They spread the bacteria to others.
TYPES:
PULMONARY TB (PTB)
Affects the lungs.
EXTRAPULMONARY TB (EPTB)
It is also known as disseminated or miliary
TB. TB outside lungs. It occurs in the
central nervous, lymphatic, or genitourinary
systems, or in the bones and joints.
15- 20 % cases have EPTB. More common
in immunosuppressed persons and in young
children.
It is not given high priority on the public
health agenda is probably that it does not
contribute significantly to the transmission
of the disease
They dont spread TB bacilli.
Sputum test will not help in diagnosis of the
disease.
Symptoms: Can be same as PTB but there
can then be specific symptoms relating to
Drug Resistance TB
To treat TB four drugs are commonly used, Rifampicin, Isoniazid, Ethambutol and
Pyrazinamide, in different combinations for six months. These are also called as first line
drugs. Injectible drug Streptomycin is used in some cases.
Drug-resistant TB occurs when drugs are not properly taken, like incomplete treatment,
wrong dosage, wrong length of treatment, wrong combination, unavailability of drugs or
poor quality drugs.
MDR, XDR and TDR result from non-protocol drug treatment.
TYPES:
Multidrug Resistant TB (MDR TB)
It is caused by bacteria that do not respond to at least Isoniazid and Rifampicin,
the most powerful anti-TB drugs.
Its diagnosis and treatment is difficult.
The second line drugs used to treat MDR TB are 300 times costlier than the first
line drugs. These are ofloxacin/levofloxacin, ethionamide, cycloserine,
pyrazinamide, ethambutol and kanamycin.
These drugs are used for 24 months in different combinations and have severe
adverse events.
The government of India started DOTS Plus services for diagnosis and treatment
of MDR TB in 2007.
Extensively Drug-Resistant TB (XDR TB)
It is defined as TB that has developed resistance to at least Rifampin and
Isoniazid, as well as to any member of the fluoroquinolone family and at least one
of the aminoglycosides or polypeptides (second line drugs).
Diagnosis
1. Tuberculin Skin Test (TST)
2. Smear Microscopy
First diagnostic tool used to microbiologically confirm TB infection/disease.
A very thin layer of the sample (sputum) is placed on a glass slide, and this is
called a smear. A series of special stains are then applied to the sample, and the
stained slide is examined under a microscope for signs of the TB bacteria
Inexpensive and simple
Problems:
Performs poorly in children, especially in those under five years.
Sensitivity is only about 50-60%
3. Culture
4. X-rays
Acute pulmonary TB can be easily seen on an X-ray.
The picture it presents is not specific and a normal chest X-ray cannot exclude
extra pulmonary TB.
Problems: In countries where resources are more limited, there is often a lack of
X-ray facilities.
A new type of more accurate TB test. Results can be available within 24 hours.
These assays work by detecting a cytokine called the interferon gamma cytokine.
They are performed in practice by taking a blood sample and mixing it with
special substances to identify if the cytokine is present.
Used to detect TB infection/Latent TB but will not tell whether a person has
active TB or not.
An alternative test that is more sensitive than Smear Microscopy and takes less
time than Culture.
WHO endorsed Xpert for rapid diagnosis of drug-sensitive and multi-drug
resistant TB
Xpert can be used as the initial diagnostic test in all children presumed to have
TB.
There is limited number of Xpert diagnostic machines in India and is used for
testing drug-resistant TB.
Note: There are other tests but I have discussed the ones mentioned in Hindu articles.
DOTS
TB in children
Children account for about 12 per cent of the total TB cases in India as per RNTCP
TB disease in children under 15 years of age is also called paediatric tuberculosis.
Unlike adults, children under five years of age may develop the disease very soon after
infection.
This is proved correct in case of those from households where an adult has been recently
diagnosed with active pulmonary TB
Diagnosis is difficult in children because they are unable to produce sputum. A very few
TB bacilli are present in the sputum sample of young children. So there are many
children wrongly diagnosed as disease-free.
Children are less likely to spread TB bacteria to others. This is because the forms of TB
disease most commonly seen in children are usually less infectious than the forms seen in
adults.
Contact Screening of Children: Screening of children under five from households where
an adult has been newly diagnosed with sputum smear-positive pulmonary TB. This is a
new approach to diagnose the disease in children. This approach has twin advantages.
While the diseased would be put on treatment without delay, the asymptomatic children
would end up getting a preventive therapy.
Childhood TB has been ignored for years. In 2012 WHO estimated the global burden of
TB in children was 5.3 million across the world.
Childhood TB is a fundamental indicator of a Tuberculosis Control Program. This is
because almost all children aged under five get infected from a family member.
1993
1998
2001
2004
2006
2007
By 2012, free and quality assured treatment to all MDR-TB cases diagnosed
under RNTCP (~30,000 annually)
By 2015, universal access to MDR diagnosis and treatment for all smear positive
TB cases under RNTCP.
Current Challenges
References:
The Hindu Articles:
http://www.tbfacts.org/index.html
http://mrunal.org/2012/02/science-tuberculosis-and-dots-therapy.html