Tuberculosis and Revised National TB Control Programme (RNTCP)
TB is one of the most prevalent chronic infection in our country and is responsible for high morbidity and mortality. TB is caused by Mycobacterium tuberculosis and affects the lungs most commonly. in one third or more, extrapulmonary involvement is seen. Tubercular lymphadenopathy is the commonest form of extrapulmonary tuberculosis.
All cases of TB is a notifiable disease should be reported to the local /district/ State Health authorities, as it is a notifiable disease.
- pulmonary TB usually presents with fever, malaise, chronic cough with sputum production, anorexia, and weight loss.
*sometimes chest pain and hemoptysis may be the presenting symptoms.
*extrapulmonary tuberculosis presents most commonly as prolonged FEVER and cervical, mediastinal or mesenteric lymphadenopathy.
*abdominal tuberculosis may present as Ascites, chronic abdominal pain, diarrhea, recurrent subacute intestinal obstruction, etc.
*CNS tuberculosis presents as irritability, headache, vomiting, chronic meningitis, seizures or focal neurological deficits, altered sensorium.
- skeletal tuberculosis they present as POTT’s spine, tuberculous osteomyelitis, monoarticular arthritis.
*Tubercular constrictive pericarditis presents with edema/ ascites.
*symptoms Of genitourinary TB include tubo-ovarian masses, secondary amenorrhea
in women, chronic epididymo orchitis in men and painless hematuria in both the sexes.
- definite diagnosis is made an only by the demonstration of AFB on smear or culture of the bottom of bronchial secretions.
chest cardiograph nearly localised the site of Pathology and does not define an aetiology.
there are no pathognomonic radiological signs of Tuberculosis.the test is sensitive but less specific with higher inter and intra reader variation, should be used judiciously. definitely diagnosis of extrapulmonary Tuberculosis is made on the basis of FNAC or findings of TCS granuloma with the presence of FB in the tissue, fluid cystology, biochemical analysis and smear examination; although ultrasonography and radiological examination of the system involved are useful investigations. CT scan is rarely necessary and is not caused and radiation effective. chest CT scan, however, may offer and opportunity for CT guided biopsy for tissue diagnosis. Tests not recommended in the diagnosis of Tuberculosis are BCG test, serology (IgM, IgG, IgA antibodies against MTB antigens), PCR test and gene expert.
childhood tuberculosis is suspected, when an ill child has the history of chronic illness that includes cough and fever, weight loss or failure to thrive, and inability to return to normal health after measles or whooping cough, and history of contact with an adult case of Pulmonary tuberculosis. the diagnosis of Tuberculosis in children is extremely challenging due to relative inability to demonstrate AFB the gold standard.
TYPES OF CASES
A patient who has never taken treatment for TB or has taken ATT for less than 1 month.
A patient declared cured of TB by a physician, but who reports back to the
health service and is found to be bacteriologically Positive.
A Patient who received ATT for one month or more from any source and
who returns to treatment after having defaulted, 1. e., not taken ATT
consecutively for two months or more and found to be smear positive.
A smear-positive patient, who continues to be smear-positive at 5 months
or more after starting treatment. The failure also includes a patient who was initially smear-negative but becomes smear-positive during treatment.
A patient who remains smear-positive after completing the treatment regimen for previously treated but not initiated on MDR-TB treatment.
Includes patients who do not fit into the above- mentioned categories.
The reasons for putting a patient in this category must be specified.
Treatment Outcome Cured
Initially, smear-positive who has completed treatment and had negative sputum smears, on at least two occasions one of which was at the completion of treatment.
Sputum smear-positive case who has completed.
Smear-positive pulmonary TB(PTB)
TB in a patient with at least two initial sputum smear examinations (direct smear microscopy) Positive for AFB,
TB in a patient with one sputum examination positive for AFB and radiographic abnormalities consistent determined by the treating medical officer.
TB in a patient with one sputum specimen positive for AFB and culture positive for M tuberculosis.
Smear-negative pulmonary tuberculosis
TB in a patient with symptoms suggestive oF TB with at least 3 sputum examinations negative for AFB, and radiographic abnormalities consistent
with active pulmonary TB as determined by an MO, followed by a decision to treat the patient with a full course of anti-tubercular therapy (ATT),
Diagnosis based on a positive culture but the existence of negative AFB sputum examinations.
Extrapulmonary tuberculosis (EPTB)
TB of organs other than the lungs, such as the pleura (TB pleurisy), lymph nodes, abdomen,
genitourinary tract, skin, joints and bones, tubercular meningitis,
tuberculoma of the brain, etc. The diagnosis should be based on one culture-positive specimen for an extra-pulmonary site, or histological evidence, or strong clinical evidence consistent with active extrapulmonary TB, followed by MO’s decision to treat with a full course of anti-TB therapy. A patient diagnosed with both pulmonary and extrapulmonary TB should be classified as a case of pulmonary TB. pleurisy is classified as an extrapulmonary TB.
An initially smear-positive Patient, who has completed the treatment and has negative sputum smears On at least 2 occasions (one of which is at completion of treatment.
A sputum smear-positive case who has completed the treatment, with negative smears at the end of intensive phase but none at the end of
A sputum smear-negative smears at the end of the intensive phase but none at the end of treatment.
An extrapulmonary TB patient who has received a full course of treatment
and has not become smear-positive during or at the end of treatment
A patient who died during treatment, regardless of the cause.
A smear-positive patient who continues to be smear positive at 5 months or more after starting treatment. The failure also includes a patient who
was initially smear-negative but becomes smear-positive during treatment.
A patient who, at any time after registration has not taken ATT for two months or more consecutively.
A patient has been transferred to another tuberculosis unit/district and Ms/her treatment results are not known.
Switched over to MDR-TB treatment
A patient who has been diagnosed as having MDR-TB by an RNTCP-MDR-TB
Accredited lab prior to being declared as”failure” and is placed on MDR treatment.