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Tuberculosis or TB as it is more popularly known, is an infectious disease that is caused by a bacterium called Mycobacterium tuberculosis. TB primarily affects the lung (80%) but can also affect other parts of the body like lymph nodes, gastro intestinal tract, genito-urinary tract, coverings of the brain (called meninges), linings of the lungs(pleura), heart(pericardium), brain, bones, joints, skin, eyes and other organs. Only hair and nails are not affected by TB. Tuberculosis germ spreads through the air that we breathe.


TB that affects the lung tissue is called pulmonary tuberculosis. Pulmonary TB can be of two types based on whether the patient produces the TB germs in his sputum or not.

Patients who have TB germs in the sputum are called sputum positive pulmonary TB, while those patients whose sputum is negative are called the sputum negative pulmonary TB patients.
Generally the sputum positive TB patients are the people who spread the disease in the community.


A single infected untreated person can spread the disease to 10-15 individuals in his community.
TB bacteria are carried as droplets in the air. Tuberculosis spreads 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 .
When a person inhales the droplets of the TB germ in the air, he becomes infected with the bacteria. The initial infection is not associated with any symptoms. But infection does not denote disease. The germs are harbored in the body and they lie in the dormant state. Ten percent of the people who harbor the infection develop the disease in a time span of 60 years.

When the immunity of the person goes down in conditions such as diabetes, cancer, chronic illness, malnutrition, HIV, treatment, treatment with immunosuppresive drugs as in after transplant surgery the chances of Tuberculosis disease developing in the person becomes higher.


A person infected with TB is usually symptom free. Once the infection flares into disease the patient has symptoms like:

-> Cough (for 3 weeks or more )
-> Fever (Evening rise of temp)
-> Loss of appetite
-> Loss of weight
-> Chest pain
-> Difficulty with breathing


Pulmonary TB can be diagnosed by sputum test. Three sputum samples (2 on the spot and I overnight collection) are tested and based on the results, the patients are classified as sputum positive TB patients. If the sputum is negative but the Chest X ray shows features suggestive of active TB then the patient is a sputum negative TB patient.


-> Chest X-ray
-> Sputum culture and sensitivity tests
-> Bronchoscopy
-> Bronchoalveolar lavage
-> CT scan of Lungs
-> MRI of Lungs
-> Lung Biopsy
-> Fundoscopy


-> Drug resistance
-> Multi Drug Resistance
-> Relapse of the disease
-> Miliary or generalised Tuberculosis
-> Pleural Effusion
-> Respiratory failure
-> Adult respiratory distress syndrome
-> Death


There are two phases of treatment:


This is bactericidal phase in which majority of tubericle bacilli is killed.
The duration of this phase is 2 months.


The is the phase of sterlization in which remaining tubericle bacilli are elimanited and organ is sterlized.
The duration of this phase is 7 months.



-> INH (with Vitamin B6)
-> Isoniazid
-> Pyrazinamide
-> R.fampicin
-> Steoptomycin


-> Capreomycin
-> Cycloserine
-> Kanamycin
-> Ofloxacin
-> Para-aminosalicyclic acid.

The second line dugs are used when the organism is resistant to more than one drug.(known as multi-drug resistant or MRD).


BCG vaccination has to be taken under the Universal Immunization Program. BCG vaccination protects against developing the severe forms of TB in childhoods but does not protect adults from developing the adult forms of pulmonary TB.



One of the major causes of treatment is non-compliance of the patient because of longer treatment, poverty as the patient is unable to purchase drugs and a large number of tablets. To overcome this problem a health care worker physically observe the patient ingest medications in the home, clinics or hospitals 3 times per week.
Free drugs and breakfast may be another incentive. To reduce number of tablets, combination preparations may be used in which anti-tuberculus drugs are combined in one tablet. The dosage of drug is increased 50%.


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