Tuberculosis-a threat to Pakistan.

-Tuberculosis (TB) is believed to have been present in humans for thousands of years.

-Skeletal remains show that prehistoric humans (4000 BC) had tuberculosis, and

-tubercular decay has been found in the found in the spines of Egyptian mummiesspines of Egyptian mummies

(3000-2400 BC).

• ROBERT KOCH ON 2424THTH MARCH 1882MARCH 1882 DISCOVERED THE WIDE SPREAD DISEASE CAUSING BACTERIA…

MYCOBACTERIUM MYCOBACTERIUM TUBERCULI.TUBERCULI.

• In 1854, Hermann Brehmer proposed the In 1854, Hermann Brehmer proposed the idea that tuberculosis was indeed a idea that tuberculosis was indeed a curable disease. curable disease.

• The introduction of the sanatorium cure The introduction of the sanatorium cure provided the first big step toward treatment provided the first big step toward treatment for tuberculosis. for tuberculosis.

• Brehmer himself was a TB patientBrehmer himself was a TB patient..

• IN 1993 WORLD HEALTH ORGANIZATION DECLARED T.B AS A GLOBAL EMERGENCY IN DEVELOPING COUNTRIES.

• ITS CAUSING MORE DEATHS THAN ANY OTHER DISEASE…….

TUBERCULOSIS-DEVELOPMENT OF DISEASE

• When the bacillus is inhaled in to the lungs, it sets up a primary tubercle and spreads to the nearest lymph nodes.

• The disease may smoulder for months or years and fluctuate with patients resistance.

• The patients can develop a chronic infection and can transmit the bacillus by coughing and sneezing.

TUBERCULOSIS SYMPTOMS AND SIGNS.

-FEVER

-NIGHT SWEATS

-WEIGHT LOSS

-BLOOD IN SPUTUM

-SEVERE COUGHING

SPREAD OF BACTERIA MAY CAUSE;

• MENINGITIS.

• PERITONITIS.

• POTTS DISEASE.

DIAGNOSIS

• -ESR

• CHEST X-RAY

• SPUTUM AFB

• BIOPSY

• DIRECTLY OBSERVED TREATMENT DIRECTLY OBSERVED TREATMENT STRATEGY (DOTS) is the internationally STRATEGY (DOTS) is the internationally recommended strategy for TB controlrecommended strategy for TB control

• Government of Pakistan endorsed the Government of Pakistan endorsed the DOTS strategy, following WHO’s DOTS strategy, following WHO’s declaration of TB as a global declaration of TB as a global emergency in 1993, The National TB emergency in 1993, The National TB Control Programme (NTP) Pakistan Control Programme (NTP) Pakistan adopted DOTS (Directly Observed adopted DOTS (Directly Observed Treatment, Short course) strategy in Treatment, Short course) strategy in 1995 1995

DIRECTLY OBSERVED DIRECTLY OBSERVED TREATMENT STRATEGY (DOTS).TREATMENT STRATEGY (DOTS).

PREVENTIVE TREATMENT..PREVENTIVE TREATMENT..

• In the United States, healthcare providers try to identify people infected with tuberculosis as early as possible, before they have developed active tuberculosis.

• These people can hen be treated and cured before they become contagious.

• Anyone who has been exposed to a person with TB should be tested for latent tuberculosis.

• This disease is especially dangerous for children and people with HIV infection.

• If infected with TB bacteria, these people need medicine right away to keep from developing an active case.

--TB is closely connected with HIV.

-People living with HIV, representing over 10% of annual TB cases, are up to 37 times more likely to develop TB than people who are HIV-negative.

-In 2009, TB accounted for one in four deaths among HIV-positive people.

TB-HIV RELATION!!

PAKISTAN MOVED UP TWO SPOTS PAKISTAN MOVED UP TWO SPOTS TO 6TH IN THE LIST OF TO 6TH IN THE LIST OF

COUNTRIESCOUNTRIES . .

• “In 2010, after the registration of 0.413 million patients of which 0.3 million are suffering from TB in their lungs.

• Pakistan moved up two spots to 6th in the list of countries with the highest number of TB patients in the world, according to a (WHO) report. TB kills around 48,000 Pakistanis every year.”

• ““Pakistan alone accounts for Pakistan alone accounts for

44%44% of total TB of total TB burden burden in in the Eastern Mediterranean the Eastern Mediterranean Region of the WHO Region of the WHO comprising 23 countriescomprising 23 countries.”.”

-The incidence of sputum positive TB -The incidence of sputum positive TB cases in Pakistan iscases in Pakistan is 80/100,000 80/100,000 per per year and for all types it is year and for all types it is 177/100,000177/100,000..

-TB is responsible for -TB is responsible for 5.1 percent of the 5.1 percent of the total national disease burden in total national disease burden in PakistanPakistan. The impact of TB on socio-. The impact of TB on socio-economic status is substantial.economic status is substantial.

• Source: National Tuberculosis control programe Source: National Tuberculosis control programe

DOTS ENDORCEMENT IN DOTS ENDORCEMENT IN PAKISTAN.PAKISTAN.

• Directly Observed Treatment Strategy Directly Observed Treatment Strategy (DOTS) is the internationally (DOTS) is the internationally recommended strategy for TB control.recommended strategy for TB control.

• NTP NTP Pakistan adopted DOTSPakistan adopted DOTS (Directly (Directly Observed Treatment, Short course) Observed Treatment, Short course) strategy in strategy in 19951995. .

MULTI-DRUG RESISTANT MULTI-DRUG RESISTANT TB.TB.

• “Annually approximately 15,000 patients contract the severe form of tuberculosis, the standard antibiotics do not work anymore.

• It is universally accepted that a partially treated TB patient is worse than an untreated one as the chronic cases are the ones who excrete multi drug resistant organisms and increase the community burden of TB.

• Partial treatment with inappropriate regimens in terms of dosage and duration is probably the most important factor leading to rise in multi-drug resistant (MDR) TB in Pakistan”

MOST OF THESE PATIENTS GO TO

QUACKS WHO GIVE THEM MEDICINES

THAT WORSEN THE DISEASE • In Pakistan, where TB is endemic and has

assumed large proportions, the diagnosis would be considered and correctly treated by only a small percentage of PPs.

• A study recently conducted by the authors in Karachi showed that only 66% PPs ordered sputum microscopy as the preferred method for diagnosing TB. Only 50% thought themselves as capable enough to treat patients with pulmonary TB. Only 21% doctors prescribed a correct regimen in accordance with NTP or WHO guidelines. In such circumstances, if the PPs are treating 80% of patients presenting to them with tuberculosis1, one can imagine how worse the situation can get.

• More than one million people have TB in Pakistan.

• ONE PERSON IS INFECTED EVERY TWO MINUTES AND ONE DIES EVERY EIGHT MINUTES.

• The marginalization and poverty of sick people has fuelled another trend.

-W.H.O.

DELAYED TREATMENT AND DELAYED TREATMENT AND ISOLATION OF PATIENTS.ISOLATION OF PATIENTS.

• Another important aspect noted in this study was that more than half of TB patients in Pakistan first presented to their general practitioners in private sector

• Up to 10% delayed seeking treatment for more than six months after the onset of illness.

• A majority of patients and their relatives feel that the dishes of TB patients should be kept separate from rest of the family members thus isolating them further from their families.

A PROJECT BY STUDENTS OF MBBS 1ST YEAR

SHAHEED MOHTARMA BENAZIR BHUTTO MEDICAL COLLEGE,KARACHI.