HIV/AIDS

TUBERCULOSIS

LEPROSY

MALARIA

Tuberculosis

  

 "Whatever the form in which the tuberculosis matter develops, it begins as a grey, semi-transparent matter that little by little becomes yellow, opaque, and dense. Then it softens, and slowly acquires a liquidity like pus, and, when it is expelled through the airways, it leaves cavities, commonly called ulcers of the lung, that we will designate as tuberculosis excavations. -René-Théophile-Hyacinthe Laennec, 1826"

Tuberculosis (TB) is an infectious disease caused by a bacterium, Mycobacterium tuberculosis disease, that can damage a person's lungs or other parts of the body and cause serious illness.
It infects several organs of the human body, including the brain, the kidneys and the bones, but most commonly, it affects the lungs causing Pulmonary Tuberculosis. However, this is a fully treatable condition.

What are the causes of Tuberculosis ?
The infection can develop after inhaling droplets sprayed into the air as from a cough or sneeze by someone infected with Mycobacterium tuberculosis. The disease is characterized by the development of granulomas (granular tumors) in the infected tissues. The usual site of the disease is the lungs, but other organs are also infected. Primary infection is usually without symptoms. Disseminated disease develops in those persons whose immune systems do not heal the primary infection. The disease may occur within weeks after the primary infection, or may lie dormant for years before causing illness. Infants and the elderly are at higher risk for rapid progression of the disease.

In disseminated disease, organs and tissues affected can include the lining of the heart (pericardium), lining of the abdominal cavity (peritoneum), larynx, bronchus, cervical lymph nodes, bones and joints, organs of the male or female urinary and reproductive (genitourinary) system, eye, stomach, lining of the brain and spinal cord (meninges), and skin.

What are the risk factors?
The risk of contracting TB increases with the frequency of contact with people who are infected, crowded or unsanitary living conditions and poor nutrition. Factors that lead to this increase is tuberculoses infection in people with HIV infection, and increasing number of homeless people. Another factor is the development of drug-resistant strains of TB. Incomplete treatment of TB infections can contribute to the proliferation of drug-resistant strains of bacteria.

How does the disease spread?
The TB bacteria are carried as droplets in the air, and can enter the body through the air passage. TB is spread when people who have active untreated TB germs in their lungs or throat cough, sneeze or speak, and send their germs into the air. People who breathe these germs into their lungs can become infected.
The process of catching tuberculosis involves two stages: first, a person has to become infected; second, the infection has to progress to disease. The second stage is called the "active stage". To become infected, a person has to be in close contact with a person having active tuberculosis.
People who breathe in TB germs usually have had very close, day-to-day, contact with someone who has the disease. That's why most people get TB germs from someone they spend a lot of time with, like a family member, friend or close co-worker.
TB can develop more easily if the immune system weakens, as happens with malnutrition, AIDS, diabetes, cancer, or treatment with immuno-suppressant drugs.

What are the symptoms of Tuberculosis ?
The first stage of the disease may be symptom-free. In the secondary stage or active phase of the disease, there might be a slight fever, night sweats, weight loss, fatigue and various other symptoms, depending on the part of the body affected. Tuberculosis of the lung (pulmonary tuberculosis) is usually associated with a dry cough that eventually leads to a productive cough with blood-stained sputum. Chest pain and shortness of breath are also noticed. This secondary stage, if affecting the lungs, is the contagious stage – whereby the bacteria can be spread to others.

How can we diagnose Tuberculosis ?
The initial screening test for tuberculosis is the tuberculin Mantoux skin test. A small amount of fluid is injected under the skin of the forearm; the fluid contains a protein derived from the bacteria causing TB, and is absolutely harmless to the body. The area is visually examined by a health professional after 48-72 hours to determine the result of the test. This test is known as Tuberculin Skin Test. A positive skin test does not mean that you have active disease, however it means that your body has been exposed to bacteria in the past. If the result of the skin test is positive, a chest x-ray is advised to ascertain whether there is any active disease.

Other laboratory tests conducted are:
Sputum cultures shows if TB germs are in the thick liquid a person coughs up.
Bronchoscopy for biopsy or culture
Open lung biopsy
Biopsies of affected organs or tissues
Retinal lesions revealed with fundoscopy.

How can Tuberculosis be treated ?
In TB infection or active TB disease, antibiotic therapy can be used. Treatment for active TB disease involves taking several anti-tuberculosis drugs for 6 to 9 months, and initial confinement is advised. Taking nourishing food, adequate rest, and following the doctor’s advise is essential for speedy recovery. Removal of a severely damaged part of the organ is also done to stop further damage. Periodic checkups is needed to ensure the health condition. Normal activity can be continued after the infectious period.

Prevention:
Vaccination BCG for tuberculin-negative persons exposed to persons with untreated TB.
Avoid contact with infected persons.

More Valuable information about Tuberculosis...
TB accounts for one third of AIDS deaths worldwide. It is the biggest killer of people who are HIV positive. If you are HIV positive then you are ten times more likely to fall sick once TB is infected.
Tuberculosis can affect the spinal cord and destroy the vertebrae. This is called Potts’s disease. The infection can lead to the compression of the cord and vertebrae and make the patient hunch backed.

Complications of Tuberculosis:
Drug resistance
Relapse of the disease
Tuberculous meningitis
Respiratory failure
Adult respiratory distress syndrome

How can we fight TB?
The best way to fight TB is to make sure that people who need medicine take it regularly. They include:
People who are sick with TB. These people have active germs that can infect others. The only way people with TB disease get well is to take medicine as directed.
People who are infected but are not sick. These people have inactive germs that are walled off. These people may not be sick now, but the TB germs can become active later on in life and make them sick. Taking preventive medicine every day, as prescribed by the doctor, is the best way to get rid of TB germs and prevent illness. In some instances, preventive medicine may not be prescribed to some infected people because of their age or certain medical conditions.
People who are close contacts to infective tuberculosis cases, regardless of age. These people should take medicine to prevent TB as directed by the doctor.
 

Frequently asked questions about Tuberculosis...
Who should get tested for TB?

People who have symptoms of TB.
People who have had close day-to-day contact with someone who has active TB disease (this could be a family member, friend or co- worker.)
People who have HIV infection, lowered immunity or certain medical conditions.
People who are required for work in community are likely to come in daily contact with people or children. eg. school teacher.

What is Drug Resistant TB?
Sometimes, TB germs are "resistant" to one or more of the TB medicines most often prescribed by doctors. When this happens combinations of other TB medicines are given to the patient. Drug resistant TB can take longer to cure than regular TB, but most patients can be cured.
Drug resistant TB develops when a person with active TB stops taking their medicine too soon, or if they have not been given the right TB medicine. A person with untreated drug resistant TB of the lungs or throat can transmit these resistant germs.

If someone gets TB, can it be treated easily?
Yes, TB can usually be treated easily. However a person with TB must take the proper medications for many months (usually at least six months). If a TB patient stops the medication early or misses many doses of medicine than the TB can come back. The kind of TB that comes back can be more difficult to treat.

How is TB treated?
TB is usually treated with four medicine taken together once a day. The medicines are usually Isoniazid, Rifampin, Ethambutol and Pyrazinamide. Most people are also given vitamin B-6. Depending on how the medicines have been prescribed, the doctor treating TB may stop the ethambutol and pyrazinamide after the first two months of treatment.

What happens if I discontinue the medicine?
The primary stage of tuberculosis infection is usually without symptoms, ignoring the disease at this stage will allow it to progress to the secondary stage, or allow it to flare up later. Many a times, if there are symptoms, they start to disappear and you may start feeling better after a few weeks/months of treatment. If treatment is discontinued at this stage, or medications are not taken as prescribed, the bacteria will have an opportunity to develop a resistance to the drugs, and treatment will become ineffective later on. If you are diagnosed with active TB disease, take the medicines as prescribed by the doctor to avoid future complications.

How long does TB need to be treated for?
Most of the time TB is treated for six to nine months. Some types of TB need to be treated even longer. It is very important that people with TB not stop their treatment before this time even if they are feeling better. TB that is not treated long enough can come back. When the TB returns, it may be harder to treat.

If you have HIV, is it easier to get sick with TB?
It is much easier for people with HIV infection to get sick from TB. However, if you have HIV, your doctor can help prevent you from getting TB by performing frequent TB skin tests and treating you with INH if you test positive.

What are the common side effects of anti TB drugs and how to manage them?
The common side effects while on anti TB drugs are Nausea, vomiting, headache, joint pains, vision disturbance . Many of these side effects are mild, if so you need not worry as they are transitory as one's body gets accustomed to the drugs. In case they are of a severe nature do consult your doctor.

 
 

          PHYSICAL TERGETS & ACHIEVEMENT, NATIONAL TUBERCULOSIS CONTROL PROGRAMME

  SPUTUM EXAMINATION CASE DETECTION SMEAR POSITIVE TOTAL CASE DETECTION
YEAR TARGET ACH % TARGET ACH % TARGET  ACH %
1997-98 3700 2916 78.8 N.R. 443 - 1300 1999 153.8
1998-99 7275 9764 134.2 243 402 165.4 655 2015 307.6
1999-00 2455 8676 353.4 250 472 188.8 660 1970 298.5
2000-01 2800 6764 241.6 280 471 168.2 757 1811 239.2
2001-2002 2750 6883 250.3 275 511 185.8 740 1568 211.9
                 

N.B:- From 1999 onwards, Target of sputum examination was set for number of symptomatic patient instead of total no. of samples examined.
Source : T.B. Cell, H & F.W. Department.

REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME-2006-07
      Revised National Tuberculosis Control Programme(RNTCP) is implemented in the State since March 2002. The Objectives of RNTCP is to implement the WHO recommended strategy of DOTS( Directly Observed Treatment Short Course ) which has five principles, the most important being of treatment under direct supervision. The aim of RNTCP is to achieve cure rate of 85% and detection rate 70% of new smear positive cases per lakhs of population in the community.

       The organizational infrastructure under the RNTCP in State is as under :-

1.State Tuberculosis Cell     -     01 At State Headquarter

2.District TB Centres          -       04 at 4 districts

3.Tuberculosis Unit             -       05 at 4 districts

4. Microscopic centre         -       31 20 DMC and 21 ND-MC

5. DOT Centres                  -        586 Nos. All over the State.

Manpower

Apart from the regular staff, supporting and supervisory staff are appointed on contractual basis by the State and Districts Societies. They are:-

1. Senior Tuberculosis Laboratory Supervisor - 05 in each TU

2. Senior Tuberculosis Supervisor                   - 05 in each TU

3. Data Entry Operator                                   - 04 in each TU

4. Driver                                                        - 04 in each TU

5. Medical Officer, STC                                 - 01 in State TB Cell

6. Accountants, STC                                      - 01 in State TB Cell

7. IEC Officer, STC                                       - 01 in State TB Cell

8. Secretarial Assistant                                   - In State TB Cell

RNTCP is funded through two sources

1. World Bank funds through GOI as CSS

2. State Plan fund for regular staff and establishments.

World Bank fund is provided to State through state TB Control Society and allocated to District through District Control Societies.

Expenditure- 2006-07(World Bank)

Funds are received in two installments. Once during April- May and next during Nov-December but funds are provided as always a buffer fund to meet the expenditure requirement of one quarter at any time thereby creating a pool of unspent balance at the end of each financial year.

               Receipt

  Opening Balance                                     -Rs. 3.60 lakhs

1st Installment- June 2006                         -Rs. 40 lakhs

2nd Installment- March 2007                     -Rs. 25 lakhs

     Total                                                    -Rs.68.6 lakhs

 

               Expenditure

Allotments of Districts                                -Rs.31,42,000/-

Expenditure at STBC                                 -Rs.25,00,000/-

        Total                                                 -Rs.56,42,000/-

 Closing Balance                                        -Rs.12.18 lakhs

State plan fund 2006-07

Budget allocated                                         - 53.25 lakhs

Reappropriation                                          - 1.04 lakhs

Total                                                           - 54.29 lakhs

Expenditure                                                - 54.17 lakhs

     PHYSICAL TARGET & ACHIEVEMENT - 2005-06

             Case Detection Rate                   Cure Rate
Target                   70%                       85%
Achievements                 112%                       88%

 

 

 
 
 
 

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