1. Tuberculosis

2. TB is a common infectious disease caused by the bacterium Mycobacterium tuberculosis. The bacteria usually affects the lungs but it can attack any part of the body. If not treated properly, TB can be fatal

3. History of TB TB has affected humans for millennia Historically known by a variety of names, including: Consumption Wasting disease White plague TB was a death sentence for many

4. History of B Before TB antibiotics, many patients were sent to sanatoriums Drugs that could kill TB bacteria were discovered in 1940s and 1950s TB death rates in U.S. began to drop dramatically Most TB sanatoriums in U.S. had closed by the mid 1970s

5. History of TB Increase in TB in mid 1980s Contributing factors:  Inadequate funding for TB control programs  HIV epidemic  Increased immigration from countries where TB is common  Spread in homeless shelters and correctional facilities  Increase and spread of multidrug-resistant TB

6. Symptoms 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

7. Transmission TB is spread person to person through the air via droplet nuclei M. tuberculosis may be expelled when an infectious person:  Coughs  Sneezes  Speaks  Sings Transmission occurs when another person inhales droplet nuclei

8. Transmission Probability that TB will be transmitted depends on:  Infectiousness of person with TB disease  Environment in which exposure occurred  Length of exposure  Virulence (strength) of the tubercle bacilli The best way to stop transmission is to:  Isolate infectious persons  Provide effective treatment to infectious persons as soon as possible

9. Treatment A person with active TB disease has a large amount of TB bacteria in the body.active TB disease TB disease can be treated by taking several drugs for 6 to 12 months. It is very important that people who have TB disease finish the medicine If the drugs are not taken correctly, the germs that are still alive may become resistant to those drugs. TB that is resistant to drugs is harder and more expensive to treat.

10. Directly Observed Therapy, Short course DOTS is the internationally recommended strategy for TB control that has been recognized as a highly efficient and cost-effective strategy. DOTS comprises five components:  Sustained political and financial commitment  Diagnosis by quality ensured sputum-smear microscopy  Standardized short-course anti-TB treatment (SCC) given under direct and supportive observation (DOT).  A regular, uninterrupted supply of high quality anti-TB drugs.  Standardized recording and reporting DOTS costs only US $3 - $7 for every healthy year of life gained.

11. LTBI vs. TB Disease Latent TB Infection (LTBI) TB Disease (in the lungs) Inactive, contained tubercle bacilli in the body Active, multiplying tubercle bacilli in the body TST or blood test results usually positive Chest x-ray usually normalChest x-ray usually abnormal Sputum smears and cultures negativeSputum smears and cultures may be positive No symptomsSymptoms such as cough, fever, weight loss Not infectiousOften infectious before treatment Not a case of TBA case of TB

12. Multidrug Resistance Tuberculosis (MDR TB) Caused by M. tuberculosis organisms resistant to at least one TB treatment drug  Isoniazid (INH)  Rifampin (RIF)  Pyrazinamide (PZA)  Ethambutol (EMB) Resistant means drugs can no longer kill the bacteria

13. Resistance Description Mono-resistantResistant to any one TB treatment drug Poly-resistantResistant to at least any 2 TB drugs (but not both isoniazid and rifampin) Multidrug resistant (MDR TB) Resistant to at least isoniazid and rifampin, the 2 best first-line TB treatment drugs Extensively drug resistant (XDR TB) Resistant to isoniazid and rifampin, PLUS resistant to any fluoroquinolone AND at least 1 of the 3 injectable second-line drugs (e.g., amikacin, kanamycin, or capreomycin)

14. How does drug resistance happen? Resistance to anti-TB drugs can occur when these drugs are misused or mismanaged. When patients do not complete their full course of treatment When health-care providers prescribe the wrong treatment, the wrong dose, or length of time for taking the drugs When the supply of drugs is not always available When the drugs are of poor quality.

15. TB and HIV Worldwide, TB is a leading cause of death among persons infected with HIV The epidemics drive and reinforce one another: HIV activates dormant TB in a person, who then becomes infectious and able to spread the TB bacillus to others

16. Epidemiology TB is one of the leading causes of death due to infectious disease in the world Almost 2 billion people are infected with M. tuberculosis Each year about:  9 million people develop TB disease  2 million people die of TB

17. People at risk for tuberculosis infection Close contacts of people infected with TB Foreign-born persons Low-income groups and homeless persons Individuals who live and/or work in special settings Health care workers who serve high-risk groups Racial and ethnic minorities Infants, children, and adolescents People who inject drugs

18. Worldwide TB incidence rates, 2000