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  • Symptoms of TB Disease

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    Active TB disease has 4 major symptoms (the 4 Symptom complex). Presence of any one of these symptoms without any other reason warrants evaluation for TB. These are:

    Figure: Signs and Symptoms of TB

    People affected with TB may experience other symptoms as well. These may be based on the site that is affected with TB or other more non-specific symptoms of an infection. The physician or doctor would evaluate these symptoms in view of diagnosis of TB.

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  • Presumptive TB

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    Presumptive TB case refers to a patient who presents with symptoms or signs suggestive of TB disease (previously known as a TB suspect) and where further diagnostic workup including bacteriological investigation is required.

     Presumptive TB can be categorized into

    1. Presumptive Pulmonary TB (P TB) - Symptoms are directly related to lungs (Cough, hemoptysis)

    2. Presumptive Extra Pulmonary TB (EP TB) - Symptoms/ signs are specific to an extra pulmonary site (example: Lymph node swelling)

    3. Presumptive Pediatric TB - Symptoms of TB in young children are more difficult to identify and can be more general (fever, weight loss) 

     

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  • Presumptive Pulmonary TB

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    Pulmonary TB(PTB) is primarily involves lungs. Screening should be done for the following symptoms:

    Figure: Signs and Symptoms of active TB

     

    Regular screening of Presumptive TB cases with unexplained cough of any duration should be done and checked for:

    • History of close contact with known active TB case 

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    • Whether the patient has developed Presumptive/confirmed extrapulmonary TB(EPTB)

    Extrapulmonary Tuberculosis Objectives

    • High-risk groups: PL HIV, Diabetics, Malnourished, Cancer patients, patients on immunosuppressive therapy or steroids

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  • Testing for TB diagnosis

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    National Tuberculosis Elimination Programme (NTEP) strives for all presumptive TB patients to be microbiologically confirmed. Under NTEP, the acceptable methods for microbiological diagnosis of TB are: 

    Sputum Smear Microscopy (for Acid Fast Bacilli - AFB): Sputum Smear microscopy is the primary tool which is reliable, inexpensive, easily accessible and rapid method of diagnosing PTB, where in the bacilli are demonstrated in the sputum. Two types:

    • Ziehl-Neelsen Staining

    • Fluorescence staining

    Rapid diagnostic molecular test: Rapid molecular tests that use techniques like NAAT are very specific. They amplify the genomic material in the patient sample and hence enhances detection

    • Nucleic Acid Amplification Test (NAAT) e.g., GeneXpert, TrueNat

      GeneXpert

      Figure: Genxpert Machine for CBNAAT

      Truenat

      Figure:  Truenat Machine

    • Line Probe Assay

     

    Culture and DST: A culture test involves studying bacteria by growing the bacteria on different substances. This is to find out if particular bacteria are present. In the case of the TB culture test, the test is to see if the TB bacteria Mycobacterium tuberculosis, are present. 

    Two types:

    • Solid (Lowenstein Jensen) media

    • Liquid media (Middlebrook) e.g., Bactec MGIT etc.

  • Biological Specimen for Diagnosis of TB

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    For laboratory diagnosis of TB, different biological specimens are used.

    Pulmonary TB: Sputum sample is used. Sputum is a thick fluid produced in the lungs and in the adjacent airways. Normally, a spot sample and a fresh morning sample is preferred for the bacteriological examination of sputum.

    Extra Pulmonary TB:

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  • Approaches to TB Case Finding

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    People who have been exposed to patients with infectious TB are known as TB contacts; they constitute a high-risk group for TB. Case finding investigation contributes to the early detection of TB cases, and results in identifying a significant number of additional patients.

    Figure: Approaches to Tuberculosis Case Finding

     

    Active case-finding requires systematic screening and clinical evaluation of populations who are at high risk of developing TB, such as people living in slums, tribal areas, congregate settings, persons who are household contacts of TB cases

     

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  • Prevention of TB

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    As TB is an airborne infection, TB bacteria are released into the air when someone with infectious TB coughs or sneezes. The risk of infection can be reduced by taking simple precautions:

    Figure: Measures for control and prevention of tuberculosis

    TB Preventive Treatment(TPT) also has a very important role in prevention of TB. Presently, household contacts of sputum-positive TB patients are given TPT upon confirmation of TB infection and ruling our active Tuberculosis.

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