⚫ Tuberculosis :
It is a chronic necrotizing disease caused by Mycobacterium tuberculosis complex. It usually affects the lungs but almost all organs can be affected.
⚫Thus it conveniently classified into :
A. Pulmonary TB (80%) :
i. Smear positive or open case TB
ii. Smear negative or closed case TB
Viva question : Which one is more dangerous & why?
Ans : Open case TB due to in this time patient is infectious to others.
B. Extra-pulmonary TB : TB of organs other than lungs, e.g –
a. Pleura
b. Meninges
c. GIT ( Gastrointestinal tract)
d. Bones & joints
e. Peripheral lymph nodes etc.
⚫Epidemiology of TB :
Agent : Mycobacterium tuberculosis, Mycobacterium bovis.
Host :
️Age : All age group
Sex : Male > Female
Nutrition : Poor nutrition
Immunity : No passive immunity
Natural history:
Reservoir :
a. Human case
b. Bovine
Infectious period : May extend weeks, months or even years.
⚫Mode of transmission :
- Air-borne by droplets, droplet nuclei & dust
- Ingestion
- Inoculation
- Transplacental
- Incubation period : 3 – 6 weeks.
⚫Clinical Features :
Symptoms:
For Pulmonary TB –
- Chronic cough for 3 weeks or more.
- Fever
- Chest pain
- Shortness of breath
- Loss of weight
For extra-pulmonary TB : Depends on the site, eg.
- Swelling of lymph nodes
- Pain & swelling of joints
- Stiffness of neck & late confusion etc.
⚫Signs :
- Crepitation heard at lung apex posteriorly
- Signs of consolidations, cavitation, pleural effusion
⚫Investigation :
- Sputum for Acid – fast bacillus.
- Sputum for culture
- Tuberculin skin test
- Mantoux Test
- QuantiFERON-TB Gold
- Gene expert
- Chest X-ray
- Blood for ESR
⚫Treatment :
Anti – TB drugs :
H = Isoniazid
R = Rifampicin
E = Ethambutol
Z = Pyrazinamide
L = Levofloxacin
For treatment of TB, We use Fixed dose combination tablet (FDC).
- TB control program in Bangladesh : Directly observed Treatment Short-course ( DOTS).
- NGOs that help Bangladesh in TB treatment :
a. BRAC
b. Damien Foundations.
Now let’s discuss about the treatment :
- Category 1 ( New patient ) :
a. Initial phase : 4FDC daily for 2 months.
(2HRZE)
b. Continuation phase : 2FDC daily for 4months
(4HR)
6 মাস treatment এর পর patient এর sputum microscopy ( ২য়, ৫ম ও ৬ষ্ঠ মাসে) করতে হবে,
সব গুলো Test result negative পাওয়া গেলে, treatment 6 মাস পর্যন্ত চলবে।
But test গুলোর যে কোন একটি যদি positive আসে
তাহলে, এটাকে Gene expert পরীক্ষার আওতায় আনতে হবে।
Test এ Rifampicin Resistant পাওয়া গেলে patient কে MDR – TB এর treatment চালু করতে হবে,
But যদি Rifampicin sensitive result পাওয়া যায়, তাহলেঃ
Pulmonary (+) or extrapulmonary TB এর treatment এর জন্য (️ 4FDC + Levofloxacin ) for 6 months দিতে হবে।
But TB meningitis, Bone TB, neurological TB তে ( 4FDC + Levofloxacin ) for 12 months এর জন্য দিতে হবে।
সর্বোপরি, সকল রোগীকে DOTS এর আওতায় এনে নিবিড়ভাবে পর্যবেক্ষণ করতে হবে।
Ishrat Jahan Snigdha
Army Medical College,Jashore
Session :2017-2018
প্ল্যাটফর্ম একাডেমিক / নাসিম পারভেজ