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  • Tuberculosis

    Content

    Tuberculosis (TB) is a communicable disease* that is a major cause of ill health, one of the top 10 causes of death worldwide and the leading cause of death from a single infectious agent (ranking above HIV/ AIDS).

    TB is caused by the bacillus Mycobacterium tuberculosis, which is spread when people who are sick with TB expel bacteria into the air; for example, by coughing.

    TB is a disease of poverty. Economic distress, vulnerability, marginalization, stigma and discrimination are often faced by people affected by TB.

    TB is curable and preventable. About 85% of people who develop TB disease can be successfully treated with a 6-month drug regimen.

    *Communicable diseases are diseases that can be spread from one person to another and cause a large number of people to get sick

     

    Resources:

    • Key facts on Tuberculosis: https://www.who.int/news-room/fact-sheets/detail/tuberculosis

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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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  • 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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  • Determinants of TB Disease

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    Determinants are any characteristics that affect the health of a patient.

    Biological Determinants Behavioral Determinants Socio Economic Determinants Occupational Determinants
    • People living with HIV(PL HIV)
    • History of contact with a case of TB
    • People with underlying medical conditions like Diabetes, Kidney disease, Cancer etc.
    • Existing lung disease
    • Old age
    • Use of tobacco and alcohol
    • Malnutrition
    • Person in contact with TB infected patient
    • Person living in areas with poor ventilation & over crowding
    • Poverty and Malnutrition
    • Homeless
    • Mining work
    • Quarry work(Silicosis)
    • Construction work
    • Migrant worker
    • Daily wagers

  • Vulnerable Population for Tuberculosis

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    TB can affect anyone but it is more prevalent in some communities which are vulnerable to TB disease due to various factors which are mentioned below:

    Increased exposure of TB due to where they live or work

    • prisoners
    • slum dwellers
    • miners
    • hospital visitors
    • healthcare workers

    Limited access to Quality TB services

    • Migrant workers
    • Women in settings with gender disparity,
    • Children
    • Physically challenged
    • Transgender population
    • Tribal and population living in hard to reach areas
    • Refugees or internally displaced people
    • Illegal miners and undocumented migrants

     

    Increased risk because of biological or behavioural factors that compromise immune functions in people who:

    • People who live with HIV
    • have diabetes or silicosis
    • undergo immunosuppressive therapy
    • are undernourished
    • use tobacco
    • suffer from alcohol use disorders.
    • inject drugs 

  • Progression to TB Disease

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    After exposure to infective droplets containing M.TB, only a small proportion gets infected and further progresses to active TB disease.

    • Majority of those that get infected persist in a stage of clinical latency known as TB infection (previously known as Latent TB infection). They do not have TB disease and do not show any symptoms of TB and no evidence of any TB related changes on chest X-ray.
    • A small proportion of those with prior infection may progress to active TB disease due to various environmental/ agent/ host factors.

    Figure: Flow chart for TB disease progression

     

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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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  • TB Infection Vs Active TB Disease

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    TB Infection Active TB Disease
    May not have any signs & symptoms Has sign and symptoms such as cough for more than two weeks, fever, weight loss and blood in sputum
    Has dormant, contained bacteria is the body Has active, multiplying bacteria in the body
    Doesn't spread TB bacteria to others May spread TB bacteria to others
    Chest X-ray usually normal Lesion in Chest X- ray (usually)
    May advance to active TB. It is estimated that the lifetime risk of an individual with TB infection for progression to active TB is 5–10%. Needs treatment for TB disease

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  • Drug-Sensitive Tuberculosis(DS-TB)

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    What is Drug-Sensitive Tuberculosis (DS-TB)?

    • DSTB is a case where a person is infected with TB bacteria that are susceptible to all first line anti-TB drugs. It means that all of the first line TB drugs will be effective as long as they are taken properly and regularly.

    • This type of TB has the best prognosis and the shortest treatment duration.

    • Patients diagnosed with TB are considered to be DS-TB case, till such time s/he detected with resistance to any anti-TB drugs.

      

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  • Drug-Resistant Tuberculosis(DR-TB)

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    What is Drug-Resistant Tuberculosis?

    • Drug-Resistant TB occurs when bacteria become resistant to the drugs used to treat TB. This means that the drug can no longer kill the TB bacteria.

    • Multidrug-resistant TB (MDR TB) is a type of DR-TB where TB bacteria is resistant to both Isoniazid and Rifampicin, the two most potent anti-TB drugs.

                                   Figure: High Risk for Drug-Resistant Tuberculosis (DRTB)

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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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  • Nikshay

    Content

    Nikshay is an Integrated ICT system for TB patient management and care in India. Nikshay was launched in 2012 and since then, various improvements have been made in the system.

    Nikshay provides-

    • A Unified interface for public and private sector health care providers
    • Different types of Logins such as State, District, TU, PHI, Staff logins, Private providers, Chemist, Labs and PPSA/JEET Logins
    • Integration of all adherence technologies such as 99DOTS and MERM
    • Unified DSTB and DRTB data entry forms
    • Mobile friendly website with mobile app

    Nikshay is accessible either via web browser(https://Nikshay.in ) or mobile App called ‘Nikshay’ that can be downloaded from Google Play Store(Android).

    Figure: Nikshay Login Pages

  • TB Arogya Saathi Application

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    TB Aarogya Sathi empowers Citizens (including TB Patients under NTEP) and to serve as a Direct interface with the national TB program.

    Citizen: The App is aimed at  increasing awareness among the citizens. It is available for all Citizens using the App (no login required to access this content)

    • Information on TB (Symptoms, Side Effects)
    • Health Facility Search
    • BMI Assessment
    • Nikshay Sampark Helpline
    • Nutritional Advice

    Patient: Patients registered with Nikshay will have access to the Adherence, Treatment Progress and DBT Details.

    • Patients registered under Nikshay get access to their TB health record additional information (after login)
      • Adherence Details
      • Treatment Progress Details
      • DBT Details

    TB Aarogya Sathi App is available in Google play store and can be download using this QR Code

     


    Figure: TB Aarogya Sathi Application snapshot

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