Description
Tuberculosis (TB) management involves a comprehensive approach, from diagnosis to treatment, aimed at controlling and curing the infection. Early diagnosis is critical and is often done using sputum tests, chest X-rays, and molecular tests like GeneXpert. Once diagnosed, TB patients are typically treated with a standard regimen of first-line antibiotics, such as isoniazid, rifampicin, pyrazinamide, and ethambutol, over a course of six to nine months. Drug-resistant TB, particularly multidrug-resistant TB (MDR-TB), requires more complex treatment using second-line drugs for longer periods, often up to two years. Adherence to the treatment regimen is crucial, as incomplete treatment can lead to resistance.
Résumé
- The global burden of tuberculosis (TB) remains significant, with 1.3 million deaths and 10.6 million people falling ill in 2022. TB affects all countries and age groups but is curable and preventable. Multidrug-resistant TB (MDR-TB) poses a public health crisis, with only two in five affected individuals accessing treatment.
- Global efforts to combat TB have saved approximately 75 million lives since 2000. Achieving global targets requires an annual investment of around $13 billion for prevention, diagnosis, treatment, and care.
- In India, there are an estimated 2.78 million TB cases, with 20.55 million reported cases and 8.4 million reported from the private sector. The percentage of cases from the private sector is 32.9, while estimated mortality stands at 320,000.
- TB is caused by *Mycobacterium tuberculosis*, primarily affecting the lungs but potentially involving any body part except hair and nails. Pulmonary TB is the infectious form of the disease, transmissible from person to person. Common symptoms include a cough lasting more than two weeks, fever, weight loss, and night sweats.
- Pulmonary TB accounts for 80-85% of cases, followed by extra-pulmonary TB, with lymph node involvement being most common. Infection occurs through inhaling aerosol droplets, leading to primary infection and potentially progressing to pulmonary disease, lymph node involvement, or hematogenous dissemination to various organs.
- Recent guidelines classify TB into drug-sensitive and drug-resistant types. Diagnosing drug-sensitive TB involves x-rays, sputum microscopy, and rapid molecular tests like CBNAAT and Line Probe Assay (LPA).
- The diagnostic algorithm involves smear examination. If the patient is positive then they have a CBNAAT done. If CBNAAT is positive for MTB that means that it is detected and then must be tested for resistance to compycin. The patient's sputum can also be cultured. If CBNAAT is negative for MTB that means it is undetected and an alternate diagnosis must be searched for.
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