DANIEL M.

JAYME 13 February 2023

ALL ABOUT

TUBERCUL
OSIS
Bachelor of Science in Nursing Clinical Instructor: CHARITY A. RUBENECIA
 01 Introduction to Tuberculosis

02 Stages of Tuberculosis

03 TB in the Philippine Setting

DOH Natural Tuberculosis

04
TOPICS FOR Control Program

05 Vaccines and Treatments for TB

DISCUSSIO 06 Frequently Asked Questions of TB

N
 01
INTRODUCTI
ON TO
TUBERCULOS
DEFINITION OF TUBERCULOSIS
According to Centers For Disease Control and Prevention, Tuberculosis (TB) is a disease caused by
germs that are spread from person to person through the air. TB usually affects the lungs, but it can
also affect other parts of the body, such as the brain, the kidneys, or the spine. A person with TB can
die if they do not get treatment.

SIGNS AND SYMPTOMS OF TUBERCULOSIS

The general symptoms of TB disease include feelings of sickness or weakness, weight loss, fever,
and night sweats. The symptoms of TB disease of the lungs also include coughing, chest pain, and the
coughing up of blood. Symptoms of TB disease in other parts of the body depend on the area
affected.
HOW IS TUBERCULOSIS SPREAD?
TB germs are put into the air when a person with TB disease of the lungs or throat coughs, sneezes,
speaks, or sings. These germs can stay in the air for several hours, depending on the environment.
Persons who breathe in the air containing these TB germs can become infected; this is called latent
TB infection.

DIFFERENCE BETWEEN LATENT TB INFECTION AND

TB DISEASE
People with latent TB infection have TB germs in their bodies, but they are not sick because the
germs are not active. These people do not have symptoms of TB disease, and they cannot spread the
germs to others. Meanwhile, People with TB disease are sick from TB germs that are active, meaning
that they are multiplying and destroying tissue in their body. They usually have symptoms of TB
disease.
HISTORY OF TUBERCULOSIS
• TB in humans can be traced back to 9,000 years ago in Atlit Yam, a city now
under the Mediterranean Sea, off the coast of Israel.
• The earliest written mentions of TB were in India (3,300 years ago) and China
(2,300 years ago).
• On March 24, 1882, Dr. Robert Koch announced the discovery of
Mycobacterium tuberculosis, the bacteria that causes tuberculosis.
• Antibiotics were a major breakthrough in TB treatment. In 1943, Selman
Waksman, Elizabeth Bugie, and Albert Schatz developed streptomycin.

• A century later, March 24 was designated World TB Day: a day to educate the
public about the impact of TB around the world.
 02
STAGES OF
TUBERCULOSIS
STAGES OF
TUBERCULOSIS
STAGE 3: ACTIVE INFECTION

STAGE 2: LATENT INFECTION

STAGE 1: PRIMARY INFECTION

PRIMARY INFECTION
Mycobacterium tuberculosis is the organism that is the causative agent for
tuberculosis.

The bacteria can spread through the air, and when inhaled by an
unsuspecting person, the bacteria travels through the respiratory tract
and multiplies in the lungs.

When the bacteria multiply in the alveoli, they can travel across the
bloodstream to more distant tissues and organs. This dissemination
prompts the immune system to trigger a response to keep the bacterial
multiplication under control.
LATENT INFECTION /LTBI
Latent infection begins when the white blood cells surround the bacteria
following the immune response. At this stage, the infected person have M.
Tuberculosis in his body, but does not have the TB disease and cannot
infect another person.

The 2nd stage of Tuberculosis infection is established when the immune

system controls the progression of the bacteria. A person with LTBI is not
regarded as having a case of TB. LTBI may be detected by using the
tuberculin skin test (TST) or an interferon-gamma release assay (IGRA)
ACTIVE INFECTION/TB
DISEASE If the immune system cannot keep the tubercle bacilli under control, the
bacilli begin to multiply rapidly (TB disease). This process can occur in
different areas in the body, such as the lungs, kidneys, brain, or bone.

In some people, the tubercle bacilli overcome the immune system and
multiply, resulting in progression from LTBI to TB disease. Persons who
have TB disease are usually infectious and may spread the bacteria to
other people. The progression from LTBI to TB disease may occur at any
time, from soon to many years later.
 FLOWCHART OF TUBERCULOSIS
INFECTION
Immune system responds to the Immune system controls the
Bacteria enter the body
bacteria bacteria

Bacteria overcome the Bacteria grow and spread throughout Infected person suffers
immune defense parts of the body active TB
 03
TB IN THE
PHILIPPINE
SETTING
 STATISTICAL REPORT OF
TUBERCULOSIS IN THE PHILIPPINES
INCREASE IN TB TREATMENT
IN 2021

18% 50% death rate per 100,000

in 2021
STATISTICAL REPORT OF
TUBERCULOSIS IN THE PHILIPPINES
Females
Age 45-49 Age 50-54
9711
24.9% 26.4%

Total Cases
26,001

Males Age 60-64

22.7% Age 55-59
16290
25.9%

Figure 1: 2022 TB cases report of the Figure 2: 2022 TB cases report of the DOH
DOH by age group (Male cases)
 04
DOH NATIONAL
TUBERCULOSIS
CONTROL
PROGRAM
VISI MISSI
ON ON
To reduce TB burden (TB incidence
and TB mortality)
TB-FREE
To achieve catastrophic cost of TB-
PHILIPPINES affected households

To responsively deliver TB service)

 TARGET AREA OF
POPULATION COVERAGE
Presumptive TB and
TB affected Nationwide
households
 PARTNERSHIP
FDA
INSTITUTIONS DOJ (BuCor)
Bureau of Quarantine PIA
DepEd DOLE
DSWD PhilCAT
DILG WHO
 STRATEGIES, PROGRAM
ACTION POINTS ACCOMPLISHMEN
AND TS AND STATUS
TIMELINE
2017-2022 Philippine 2019 WHO Global TB
Strategic TB Report (Cohort of
Elimination Plan 2018)
CALENDAR OF PROGRAM
ACTIVITIES MANAGER
CONTACT
March 24 - World TB
Day Commemoration
INFORMATION
Dr. Anna Marie
Celina G. Garfin
August - Lung Month Program Manager
Celebration
ntpphilippines.inquiry@doh.gov.ph
 05
TB TREATMENT &
SERVICES IN THE
PHILIPPINES
DIRECTLY-OBSERVED THERAPY
(TB DOTS) DOTS is the acronym for “Directly
Observed Therapy Short Course”,
the only strategy acknowledged and
endorsed by both the World Health
Organization and the Department of
Health as the best strategy for
managing patients with
tuberculosis.

Picture 1. Lavezares TB DOTS Center Municipal Health Office

PHILHEALTH OUTPATIENT TB DOTS
BENEFITS PACKAGE
WHAT IS IT?
It is a health service for members of Philhealth and their qualified dependents with TB
disease and needs first line drugs for Tuberculosis.

WHAT SERVICES ARE COVERED?

The package renders services such as diagnostic exams, consultation, drugs, and health
education during treatment.
PHILHEALTH OUTPATIENT TB DOTS
BENEFITS PACKAGE
INCLUSIO EXCLUSIO
• NS
Cardiopulmonary and • NS
In-patient admissions
Extrapulmonary • Drug-resistant TB
• Adult and Children • Latent TB Infection
• Registration groups:
— New
— Retreatment
PHILHEALTH OUTPATIENT TB DOTS
BENEFITS PACKAGE
ELIGIBILITY
• PhilHealth members and dependents with premium contributions paid at least three
months within the six months prior to the first day of availment
• All TB cases susceptible to first line anti-TB drugs under covered registration
groups
PREVENTIVE TREATMENTS FOR
TUBERCULOSIS
DRUGS USED IN TB PREVENTIVE
TREATMENT

Rifampicin Isoniazid Rifapentine

COMMON SIDE EFFECTS OF
ISONIAZID
Dark urine Nausea or Vomiting Numbness or tingling of
hands & feet

Loss of appetite Unusual tiredness or weakness Skin rash

COMMON SIDE EFFECTS OF
RIFAMPICIN
Itching Confusion or difficulty concentrating Diarrhea

Headache Painful menstrual period Drowsiness

COMMON SIDE EFFECTS OF
RIFAPENTINE
Black stool Lower back pain Fever and Chills

Sore throat Unusual tiredness or weakness Skin rash

PREVENTIVE TREATMENTS FOR
TUBERCULOSIS
TREATMENT CONSIDERATIONS IN SPECIAL
POPULATION
1. PREGNANT
WOMEN
Isoniazid and rifampicin can be used in pregnant or
breastfeeding women. Rifapentine should be avoided due
to lack of data on safety in pregnant or breastfeeding
women.
PREVENTIVE TREATMENTS FOR
TUBERCULOSIS
TREATMENT CONSIDERATIONS IN SPECIAL
POPULATION
2. BREASTFEEDING
Preventive treatment using isoniazid and or rifampicin
can be safely given to breastfeeding women.
Supplemental pyridoxine (i.e. vitamin B6) should be
given to the infant who is taking isoniazid or whose
breastfeeding mother is taking isoniazid.
PREVENTIVE TREATMENTS FOR
TUBERCULOSIS
TREATMENT CONSIDERATIONS IN SPECIAL
POPULATION
3. ORAL
CONTRACEPTIVES
Rifampicin and rifapentine interact with oral contraceptive medications
with a risk of decreased protective efficacy against pregnancy. Advise a
woman receiving oral contraceptives while on rifampicin or rifapentine
that she has the following options:
1) take an oral contraceptive pill containing a higher dose of estrogen
(50μ), following consultation with a clinician; or
2) use another form of contraception.
PREVENTIVE TREATMENTS FOR
TUBERCULOSIS
TREATMENT CONSIDERATIONS IN SPECIAL
POPULATION
4. LIVER DISEASE OR HISTORY OF
LIVER DISEASE
Isoniazid and rifampicin/rifapentine are both associated with
hepatitis. Treatment should not be initiated in individuals whose
baseline liver transaminases is more than three times the upper
limit of normal (ULN). Preventive treatment should not be given
to individuals with end-stage liver disease.
PREVENTIVE TREATMENTS FOR
TUBERCULOSIS
TREATMENT CONSIDERATIONS IN SPECIAL
POPULATION
5. RENAL FAILURE
Isoniazid and rifampicin/rifapentine are eliminated by
biliary excretion. These drugs, therefore, can be given in
normal dosages to patients with renal failure. Patients
with severe renal failure should receive isoniazid with
pyridoxine to prevent peripheral neuropathy.
PREVENTIVE TREATMENTS FOR
TUBERCULOSIS
TREATMENT CONSIDERATIONS IN SPECIAL
POPULATION
6. PEOPLE LIVING
WITH HIV
Rifampicin and rifapentine can be co-administered with
efavirenz without dose adjustment. Rifampicin or
rifapentine cannot be co-administered with protease
inhibitors or nevirapine.
PREVENTIVE TREATMENTS FOR
TUBERCULOSIS
VACCINE AGAINST TUBERCULOSIS:
BCG VACCINE
BCG vaccine protects infants against tuberculosis.
The letters B, C, G stand for Bacillus Calmette-
Guérin. Bacillus describes the shape of a bacterium
while Calmette and Guérin are the names of the
people who developed the vaccine.
PREVENTIVE TREATMENTS FOR
TUBERCULOSIS
VACCINE AGAINST TUBERCULOSIS:
BCG VACCINE
BCG vaccine comes in powder form. BCG vaccine is
freeze-dried, so it must be reconstituted with a diluent
before use. It is essential that only the diluent made
by the same manufacturer as the vaccine be used.
PREVENTIVE TREATMENTS FOR
TUBERCULOSIS
ADMINISTRATIVE SUMMARY OF BCG
VACCINE
TYPE OF VACCINE Live Bacterial

NUMBER OF DOSES 1 Dose

Given preferrably 90 minutes after birth. Areas with high TB infection incidence should routinely
immunize infants with a single dose of BCG at birth. If not given at birth, BCG may be given at the
SCHEDULE infant’s first contact with the health system before turning one year old. BCG immunization of
infants born of mothers positive for TB should be delayed and should be given after one month
after negative PPD Test.
PREVENTIVE TREATMENTS FOR
TUBERCULOSIS
ADMINISTRATIVE SUMMARY OF BCG
VACCINE
CONTRAINDICATIONS Known HIV infection and other immune deficiency.

ADVERSE REACTIONS Local abscess, regional lymphadenitis; rarely, distant spread to osteomyelitis, disseminated disease

DOSAGE 0.05 mL

INJECTION SITE/TYPE Injected intradermally in the outer upper arm or shoulder just below the deltoid
 06
FREQUENTLY
ASKED QUESTIONS
ABOUT
TUBERCOLOSIS
 Tuberculosis (TB) is an infectious disease
caused by a type of bacteria called
Mycobacterium tuberculosis. TB most
commonly affects the lungs, when it is called
pulmonary tuberculosis, but also can involve
WHAT IS any other organ of the body in which case it is
called extra-pulmonary tuberculosis.
TUBERCULO
SIS?
 When a person breathes in the TB bacteria, in
most cases, the body is able to get them to stop
them from growing. The bacteria become
inactive, but do not die. They lie latent, and
can become active later. This state is called TB
infection. People who are infected with TB do
WHAT IS TB not feel sick, do not have any symptoms, and
cannot spread the disease. But they could
INFECTION? develop TB disease at some time in the future.
 Not all people with TB infection get active TB
disease. Only when people infected with the
TB bacteria start showing signs and symptoms
associated with TB are they considered to have
active TB disease. Some people develop TB
disease soon after becoming infected, before
their immune system can ght back. Other
WHAT IS TB people may get sick later, when their immune
system becomes weak for some reason.
DISEASE?
 The most common symptoms of TB are
WHAT ARE chronic cough, fever, especially rising in the
evening, night sweats, chest pain, weight loss,
THE loss of appetite, coughing up blood.

SYMPTOMS
OF
PULMONARY
 The best way to get tested for pulmonary TB is
by getting the sputum examined. The TB-
WHAT TESTS causing germs can be seen through a
microscope. At least two samples of sputum
ARE should be examined for accurate diagnosis.

ADVISED TO
DIAGNOSE
TB?
 The examination is available at public health
facilities, often within easy reach of the
patients. In the facility, the health-care
provider may ask the person suspected of TB
WHAT TESTS to collect two sputum samples and explain
how to produce and collect them. It is
ARE important to carefully follow what the health-
care provider advises to make sure the
ADVISED TO diagnosis is correct.

DIAGNOSE
TB?
 The health-care provider may also advise a
WHAT TESTS chest X-ray if the patient is suspected of
having symptoms of TB and if TB germs are
ARE not seen through the sputum examination.

ADVISED TO
DIAGNOSE
TB?
 ARE THERE In 2010, WHO endorsed Xpert MTB/RIF, a
rapid molecular test that can diagnose TB and
SOME RAPID rifampicin resistance within 90 minutes.

TESTS TO
DIAGNOSE TB
AND DRUG
RESISTANCE?
 Yes. TB can be cured if the full course of the
prescribed drugs is taken regularly, and
without interruption. The WHO-approved
standardized and effective cure for TB, called
CAN DOTS (directly-observed treatment, short-
course) is available in all countries of the
TUBERCULO South-East Asia Region.

SIS BE
CURED?
 It takes at least 6–8 months of medication to
completely treat the disease. It is very
CAN important that the patient takes all the
prescribed drugs for the recommended
TUBERCULO duration.

SIS BE
CURED?
 It is dangerous, both for the patient, family
members and the community, if he/she stops
taking medication before the prescribed course
is completed and without medical advice. The
TB germs that are still alive become even
CAN stronger, or "resistant" to the drugs. Stronger
drugs are then needed to kill these "super" TB
TUBERCULO germs if the treatment is not completed the
first time.
SIS BE
CURED?
THANK
YOU!