Basics of Tuberculosis and It’s Treatment

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 :
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.
    b. Continuation phase : 2FDC daily for 4months

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

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