Know the Disease and Know its Management

TB is the most common opportunistic infection and the leading cause of death among people living with HIV and AIDS. Tuberculosis a disease caused by a microorganism called Mycobacterium tuberculosis. Pulmonary TB is an airborne disease. When people with active pulmonary TB cough, sneeze, speak, sing, or spit, they expel infectious aerosol droplets 0.5 to 5.0 μm in diameter. One third of the world's population is thought to have been infected with M .tuberculosis, with new infections occurring at a rate of about one per second. In 2010, there were an estimated 8.8 million new cases and 1.5 million associated deaths, mostly occurring in developing countries. The 22 high burden countries, as defined by WHO, are those countries that cover 63% of the world’s population and that account for approximately 80% of the estimated number of new TB cases occurring worldwide each year; some of these countries are also among those with the highest incidence rates of TB per capital. One third of the world’s population, two billion people, carries the TB bacteria. More than nine million of these become sick each year with active TB that can be spread to others. Latent TB disease cannot be spread. HIV has been documented as the most important risk factor for TB incidence and death. It has also been documented that TB co‐infection enhances the multiplication of HIV and accelerates the progression of the infection. Because each speeds up the progression of the other, the alliance between TB and HIV has greatest impact in regions of the world where the two infections are on the increase, particularly Africa and the Asia. Tuberculosis (TB)—a contagious bacterial infection that mainly affects the lungs—is a global public health problem. In 2009, 9.4 million people developed TB, and 1.7 million people died from the disease; a quarter of these deaths were in HIV-positive individuals.

2013

Objective: To trace the source of tuberculous infection of patients with CNS tuberculosis. Material and methods: We analyzed clinical records of 100 patients with tuberculosis affecting the central nervous system, who presented to Department of Neurology Civil Hospital Karachi,between Jan 2007 To June 2010. All patients with confirmed diagnosis of CNS tuberculosis, supported by clinical, laboratory, and radiological evidence were included. Case histories were analyzed and notes were made in each case of past history of tuberculosis, history of affected family members at that time and in past, and presence or absence of concurrent extra-neural tuberculosis. All patients with disseminated tuberculosis were investigated for immunocompromised states like HIV. Patients with positive contact history were divided into those with tuberculosis affected person within their household, those with their first degree relatives with history of tuberculosis, and those with workmates or other regular contacts with tuberculosis. Contacts of all these patients were also investigated to find out the new cases amongst them according to the WHO guidelines. Results were analyzed on SPSS 17.Results: Among the total of 100 patients, male to female ratio was 1:3 with ages ranging from 8 to 82 years. Mean age was 34. Fifty six people had tuberculosis affecting brain and 44 had spinal involvement. Thirty five patients had tuberculous meningitis, 13 had tuberculous meningitis with tuberculomas, and 8 had tuberculomas only. Major complications of tuberculous meningitis, like stroke(60%), hydrocephalus(40%) and optic neuropathy(1.5%) were seen in 20 patients. One patient had sagittal sinus thrombosis in addition to tuberculous meningitis. 44 patients had spinal cord involvement, they presents with compressive myelopathy, (tuberculous abscess &/or prolapsed vertebrae) and/or myelitis. Twelve patients showed involvement of cervical spine, 16 dorsal spine and 15 had lumbar spine involvement. One patient had disease of dorsolumbar spine. Neurosurgical procedures were required in those who developed hydrocephalous and epidural spinal cord abcesses. At the time of presentation, 20 patients had tuberculous infection in extra-neural tissues /organs as well. Four patients had abdominal tuberculosis, 6 had disseminated tuberculosis, and 10 had pulmonary tuberculosis. Baseline chest xray was abnormal in 20% of patients (10% with active concurrent pulmonary tuberculosis while other 10% were asymptomatic. Fourteen patients had history of tuberculosis in past. Six had pulmonary tuberculosis in past but x-ray evidence of tuberculosis was available in other two, 2 were diagnosed with abdominal tuberculosis, 3 had tuberculous lymph adenitis, and one patient was diagnosed as tuberculous meningitis. Twenty six percent of patients could trace the source of infection among their relatives, while majority (74%) did not give history of any affected family member, relative or contact, at that time or in past. Fourteen percent had an affected household (parent, sibling), and 12% gave history of an affected first degree relative. Conclusion: Tracing the source of infection with clinical methods alone was not very much beneficial. We need advance strategies to supplement our clinical methods to find out the source of transmission of this illness and to eradicate and manage effectively the spread of infection in our community.

Elite Journal of Public Health, 2024

Tuberculosis is an airborne disease caused by the bacterium Mycobacterium tuberculosis (M. tuberculosis). Mycobacterium tuberculosis is carried in airborne particles, called droplet nuclei, of 1-5 microns in diameter. Infectious droplet nuclei are generated when persons who have pulmonary or laryngeal TB disease cough, sneeze, shout, or sing. Depending on the environment, these tiny particles can remain suspended in the air for several hours. Mycobacterium tuberculosis is transmitted through the air, not by surface contact. Transmission occurs when a person inhales droplet nuclei containing Mycobacterium tuberculosis, and the droplet nuclei traverse the mouth or nasal passages, upper respiratory tract, and bronchi to reach the alveoli of the lungs. Tuberculosis (TB) is a major cause of morbidity and mortality worldwide. It is estimated that 25% of the world's population are infected with Mycobacterium tuberculosis, with a 5-10% lifetime risk of progression into TB disease. Early recognition of TB disease and prompt detection of drug resistance are essential to halting its global burden. Culture, direct microscopy, biomolecular tests and whole genome sequencing are approved methods of diagnosis; however, their widespread use is often curtailed owing to costs, local resources, time constraints and operator efficiency. TB disease most commonly affects the lungs; this is referred to as pulmonary TB disease. Patients with pulmonary TB disease usually have a cough and an abnormal chest radiograph, and may be infectious. Although the majority of TB cases are pulmonary, TB can occur in almost any anatomical site or as disseminated disease.

Infection occurs when a person inhales droplet nuclei containing tubercle bacilli that alveoli of the lungs. These tubercle bacilli are ingested by alveolar macrophages; the majority of these bacilli are destroyed or inhibited. A small number may multiply intracellularly and are released when the macrophages die.

E3S web of conference , 2023

Pulmonary Tuberculosis (PTB) is an airborne bacterial infection that can be deadly if not treated. PTB is most common in developing countries, ecologically problematic, where it kills about 1 million people each year. Pulmonary tuberculosis is a dreaded disease that can have a devastating impact on its victims. Tuberculosis is a serious respiratory infection caused by the bacterium Mycobacterium tuberculosis. It commonly affects the lungs but can also affect other parts of the body, such as the kidney, spine and brain. This review article discusses the PTB risks and challenges word wide. The global burden of TB remains high, with approximately one-third of the world's population being infected with the bacterium. Overall, more needs to be done to improve the management of TB worldwide in order to ensure that no person is left to suffer from the devastating effects of this disease.

2012

Journal of Medical Microbiology, 2008

Since 1992, Mycobacterium tuberculosis strain PG004 has been responsible for a large outbreak of tuberculosis in one northern Californian community. There are no epidemiological or host factors to explain this outbreak. PG004 was therefore analysed for biological characteristics that might explain its widespread distribution. BABL/c mice were infected intravenously with PG004, non-PG004 M. tuberculosis strains CCC20 and CCC23 isolated from patients in the same community, and the laboratory strain H37Rv. The susceptibility of PG004 to reactive nitrogen intermediates (RNIs) was compared with that of H37Rv. Because of the reported association of phenolic glycolipid production with mouse virulence, a junction sequence in the polyketide synthase gene cluster (pks15/1) was compared among strains. It was found that the most virulent strain, based on mouse mortality, was not the outbreak strain PG004, but the non-outbreak strain CCC20. This strain had an intact pks15/1 sequence identical to that of another non-outbreak strain, CCC23, which caused death in only one out of ten mice in 300 days of follow-up. The outbreak strain PG004 had a frameshift mutation in the pks15/1 sequence identical to the sequence of H37Rv, and it was no more resistant to RNIs than H37Rv. The most distinguishing feature of PG004 was its failure to produce well-organized, coalescing granulomas in mouse lungs. The lack of organized granulomas and reduced pathology may prevent restriction of PG004 in the lungs and allow it to spread into alveolar air spaces and escape the host to transmit to others. Humans with reduced lung pathology may remain undiagnosed and untreated in the community longer than those with severe disease. The over-representation of an M. tuberculosis strain in a community, therefore, may be more associated with strains that cause reduced rather than severe lung pathology.

New England Journal of Medicine, 1998