Spot specimen during second visit
9
Three sputum smears
are optimal
100%
81%
93%
100%
50%
Cumulative Positivity
0%
First
Second
Third
10
Reporting on AFB Microscopy
Effective Diagnosis, Treatment, and Control of
Tuberculosis
World Health Organization
Regional Office for South-East Asia New Delhi
South-East Asia accounts for nearly 40% of all tuberculosis cases
538,000
605,000
48,000
Tropical Diseases
101,000 STD
Maternal Mortality
Malaria
TB
4
Tuberculosis
A Global Emergency
TB kills 5,000 people a day – 2-3 million each year One third of the world’s population is infected with TB TB kills more young women than any other disease More than 100,000 children will die needlessly from TB this year Hundreds of thousands of children will become TB orphans this year
98% 100
80 60 40 20
0
AFB Microscopy
Inter-observer agreement
70%
X-ray
13
Microscopy is a more specific test than X-ray for TB diagnosis
If 2/3 positive: Anti-TB Rx
Broad-spectrum antibiotic 10-14 days
If symptoms persist, repeat AFB smears, X-ray
If consistent with TB
Anti-TB Treatment
12
Microscopy is more objective and reliable than X-ray
Number of bacilli seen None per 100 oil immersion fields
Result reported Negative
1-9 per 100 oil immersion fields 10-99 per 100 oil immersion fields
Scanty, report exact number
8
Diagnosis of Pulmonary Tuberculosis
Three specimens optimal
Spot specimen on first visit; sputum container given to patient Early morning collection by patient on next day
5
TB and AIDS
Lifetime Risk
70%
of TB
60%
50%
40%
30%
20% 10%
10%
0%
PPD+/HIV-negative
60%
PPD+/HIV+
6
TB Control: The 5 components of DOTS
Political commitment Diagnosis by microscopy Adequate supply of SCC drugs Directly observed treatment Accountability
EUR AMR EMR 6% 5% 8%
AFR 18%
SEAR 38%
WPR 25%
2
TB is the leading single infectious cause of death in South-East Asia
800
Number of deaths (1000s)
700
600
Deaths from infectious
agents in South-East
500
Asia
400
300
200
100
0 Tuberculosis HIV
Measles
STD
Malaria Tropical Diseases
3
TB is a Leading Killer of Women
Deaths among women
493,000
1+
1-10 per oil immersion field
2+
> 10 per oil immersion field
3+
11
Diagnosis of Pulmonary TB
Cough 3 weeks
ቤተ መጻሕፍቲ ባይዱ
If 1 positive, X-ray and evaluation
AFB X 3 If negative:
TB Register
7
Diagnosis of pulmonary tuberculosis
Patients with TB feel ill and seek care promptly Active case finding is unnecessary and unproductive Microscopy is appropriate technology, indicating infectiousness, risk of death, and priority for treatment X-ray is non-specific for TB diagnosis Serological and amplification technologies (PCR, etc.) currently of no proven value in TB control