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  • Tuberculosis

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    Figure: Causative agent for Tuberculosis is Bacillus: Mycobacterium tuberculosis (M.tb)

     

    • Tuberculosis (TB) is a communicable disease that is a major cause of ill health.

    • TB is caused by the bacillus Mycobacterium tuberculosis (M.tb)

    • TB disease typically affects the lungs (pulmonary TB) (80%) but can also affect other parts of the body (extra pulmonary TB) (20%)

    • It spreads when people who are sick with TB expel bacteria into the air (for example by coughing, sneezing, shouting or singing)

    • It is one of the top 10 causes of death worldwide and the leading cause of death from a single infectious agent

     

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  • TB Causative organism

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    Figure Mycobacterium tuberculosis

     

    TB is caused due to the infection by a bacterium called Mycobacterium tuberculosis.

     

    Figure: Extra-Pulmonary Tuberculosis

     

    It often affects the lungs, and in such cases it is called Pulmonary Tuberculosis. But, it can affect almost any part of the body (except the hair and the nails), in which it is known as Extra-Pulmonary Tuberculosis.

     

     

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  • Mode of TB Transmission

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    Tuberculosis is transmitted mainly through the air via droplet nuclei generated when a TB patient coughs or sneezes. 

    It is estimated that every sputum smear-positive patient spreads the infection to 10 – 15 persons annually, if untreated..

    Figure: Transmission of TB bacteria through air via droplet

     

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  • Exposure to TB Bacilli

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    Patients suffering from microbiologically confirmed pulmonary TB (PTB) constitutes the most important source of infection.

    • The infection occurs most commonly through droplet nuclei generated by coughing, sneezing etc., inhaled via the respiratory route.
    • M. tuberculosis spreads from the respiratory tract in small respiratory droplets or within dust particles that can travel long distances in the air.

    Image removed.

    Figure: How Exposure to TB Bacilli Happens

    The chances of getting exposed and infected depend on the: 

    • Duration of exposure to an active TB patient
    • Frequency of exposure
    • Bacterial load of the TB patient
    • Virulence of TB bacilli
    • Immune status of the exposed individual
    • Other factors (air circulation, overcrowding, temperature and humidity etc.)

     

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  • TB Infection

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    • TB Infection (or previously known as Latent TB infection) is a stage in between uninfected and having active TB. In this stage the person has no symptoms and can only be identified using laboratory tests.

    • The vast majority of infected people may never develop TB disease. However, to achieve TB elimination, it is important to treat TB infection in people at risk of developing active TB disease.

    • It is a state of persistent immune response to stimulation by Mycobacterium tuberculosis antigens with no evidence of clinically manifested active TB.

    • There is no single acceptable/reliable test for direct identification of Mycobacterium tuberculosis infection in humans. Tuberculin Skin Test (TST) and Interferon-gamma release assay (IGRA) are commonly used tests for identifying TB infection.

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  • Global Burden of TB

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    • Globally, an estimated 11 million people fell ill with TB (incidence) in 2021.
    • Historically, it has been the top infectious disease killer. In 2021, there were an estimated 1.4 million TB deaths and an additional 187 000 deaths among HIV-positive people.
    • Three countries accounted for 42% of global cases in 2021: India (26%), the Russian Federation (8.5%) and Pakistan (7.9%).

     

    Estimated Global TB incidence 2021

    Figure: Estimated TB incidence in 2021, for countries with at least 100 000 incident cases; Source: Global TB Report, 2022.

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  • Burden of TB in India

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    TB is one of the top burdensome infectious diseases in India. It is estimated that, around 1/4th (26%) of the world's TB cases are in India, translating to about 30 Lakhs new TB cases emerging each year (TB incidence). Against this estimated incidence the National TB Elimination program reported around 19 lakh new and relapse cases in the year 2021.

    An estimated 5 Lakhs deaths occur due to TB each year in the country, translating to about 1 case of TB death every one-two minutes. Compared to this, there are only about 60 thousand deaths due to HIV and about 77 deaths due to Malaria each year.

    TB diagnosis and treatment services although provided free of cost in the public sector, the cost of accessing these services and related loss of wages drive the affected people with poverty (catastrophic costs). TB also has a huge impact on the world's and the country's economy because of loss of workdays (100 million workdays per year).

     

    Assessment

    Question​ Answer 1​ Answer 2​ Answer 3​ Answer 4​ Correct answer​ Correct explanation​ Page id​ Part of Pre-test​ Part of Post-test​
    What is the estimated number of incident TB cases that emerge each year in India? 35 Lakh cases 26 Lakh Cases 26% of the Global Burden 19 Lakh Cases 2 The estimated number of new and relapse (incident) cases in India that emerge each year is about 26 Lakh ​ Yes Yes
    How many cases of deaths are estimated to be caused by TB in India Approximately One death every 2-3 minutes Approximately 5 Lakh deaths 60 Thousand deaths each year 1 and 2 4 In India it is estimated that there is around one death caused due to TB every one to two minutes, translating to about 5Lakh deaths each year in India   Yes Yes

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  • Stages in TB Patient's Lifecycle

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    Those who are suspected of having TB disease are first screened for symptoms like cough and fever for more than 2 weeks, blood stained sputum and weight-loss. If found positive on screening, then TB patients are referred for testing to the nearest health facility. If diagnosed with TB, then they are subsequently initiated on treatment. The TB patients initiated on treatment are regularly monitored with the help of field staff or digital interventions like 99DOTS and MERM (Medication Event Reminder Monitor) technology. NTEP staff also ensures that the TB patients are regularly followed up on monthly basis till their treatment completion.

     

    Figure: Patient Flow

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