2025
DR.A K M MOHIUDDIN
Assistant Professor
Respiratory Medicine
Chattagram Medical College.
WorldonTBMarch
World TB day is observed day24 each year to
raise public awareness and understanding about
one of the world’s deadliest infectious killers-TB
and it’s devastating health,social and economic
impact on people around the world.
It marks the day of discovery of Mycobacterium
Tuberculosis by [Link] Koch.
TRIBUTE TO ROBERT KOCH
DISCOVERY OF MYCOBACTERIUM TUBERCULOSIS IN 1882
World Tuberculosis Day 2025 Theme
Why this theme
Tuberculosis
Basic facts about TB
TB is an old disease
About a quarter of world’s
population has TB
affecting humans for
infection but 5 to 10 % will
thousands of years.
develop TB disease.
Can also affect other parts
TB typically affects the
of body# extra-pulmonary
lungs# pulmonary TB.
TB.
No vaccine available for adults
No new vaccine till date
Vaccine BCG only for children,discovered 100
years ago
Every 10 second 3 people fall sick
Every minute 3 people die
Basic facts about TB
Over 4100 daily deaths from TB
How TB spreads
TB spreads through the air
TB is NOT spread by
TB Infection vs TB Disease
Latent TB TB Disease
TB lives but doesn’t grow in the body TB is active and grown in the body
Doesn’t make a person feel sick or have Makes a person feel sick and have symptoms
symptoms
Can spread from person to person
Can’t spread from person to person
Can advance to TB disease Can cause death if not treated
Not Everyone Infected With TB Becomes
Sick
PLHIV
When to treat latent TB infection
Positive contacts# age <5 and >60 years
Positive contacts# age 5> to <60 years with risk factors#
DM,CKD,Anti-TNF treatment,
Transplantation,Silicosis,smoking,substance abuse.
Positive contacts# age 5> to <60 years Without risk
factor# needs positive TST/IGRA.
Diagnostic tool #Latent TB treatment
TST(MT) QuantiFERON TB Gold
• Skin test • Simple blood test
• Requires two visits • Single visit
• Specificity & Sensitivity • High
is low • It doesnt interferes
• False positive due to with BCG vaccine or
BCG vaccine & NTM NTM
• Cost effective • Costly
Possible TB Disease Symptoms
• Night Sweats • Fever
• Chills
• Weakness • No appetite
• Weight loss
or fatigue
Cough lasting • Coughing up
• Pain in
longer than blood or
the chest
2 weeks sputum (phlegm
from inside the lung
Extra-Pulmonary TB#
Diagnostic Tools of TB
Pulmonary TB#
• Gene Xpert & Xpert XDR of
body fluids, pus, aspirate,
tissue, bone marrow & stool
• AFB culture & DST
XDR,LPA CXR PAV
Ultra,Xpert
• Histo / cytopatholgy
GeneXpert
• Imaging : Xray,CT,MRI,USG
• Biochemistry,cytology,TST,IGRA
AFB culture&DST
Rapid Molecular Test Facilities In BD
• Gene Xpert Sites: 1170 including UHC & CDC
[only sputum]
• RTRL:5 centres. Gene Xpert [MTB/RIF],LPA &
Xpert XDR [To detect MDR&XDR TB]
. NTRL: Gene Xpert,LPA,Xpert XDR &
Next Generation Sequencing.
Treatment of TB
Disease
Type of Patient Treatment regimen
TB diagnostic
category Intensive Continuation Phase
phase (Daily) (Daily)
New Cases (never Bacteriologically positive PTB
been treated for TB patients
or have taken ATT
for < 1 month) Bacteriologically negative PTB
patients
Extra-pulmonary TB*
TB/HIV co-infected
2 (HRZE) 4 (HR)
If no resistance to TB drugs (both
H and R sensitive P and EP TB 6 HRZE
Cases)
Clinically diagnosed PTB 6 HRZE
Previously
Treated Cases
(received >1 month Complicated EP cases (TB 12 HRZE-Lfx
of ATT meningitis, Neurological TB, Bone
in the past) ** TB, nonresolving lymph node)
If Rif susceptible and INH resistant 6 (H)REZ- Lfx
or unknown in bacteriologically
confirmed PTB & EP-TB
TB in special
situation
Full course
treatment with
TB in pregnancy
BCG vaccination
andHREZ
lactation
Fluoroquinolones
after completion like Lfx to be
of IPT. avoided.
IPT to breastfed Vit.K to be given
infant if no to both mother &
active TB Breast-feeding to neonate
be
continued,mother
to practice cough
hygeine & wearing
face mask.
TB in liver disorders
• Acute viral hepatitis:
Anti-TB to be stopped.
Once hepatitis resolves & LFT returns to normal same drugs to be
restarted.
If hepatitis persists,8 months of HRE
• Chronic liver disease:
no Pyrazinamide.
9 months course(2HRE/7HR)
• Drug induced hepatitis:
If Pyrazinamide is involved>9HRE
If INH>9RZE,if RIF>9Lfx-HZE,IF PZA&RIF>10 Lfx-HE
TB and renal insufficiency
•INH & RIF >
# No dose reduction
ETHAMBUTAL & PZA>
# if Cr. Clearance is > 30ml/min.
No dose reduction
# if Cr. Clearance is < 30 ml/min
thrice wkly dose
Drug resistant TB
Types of DR-TB
Drug resistant (DR) TB Refers to active tuberculosis disease caused by
Mycobacterium tuberculosis bacilli that are resistant to
one or more anti-TB medicines.
Mono-resistance Refers to resistance to one first line anti-TB drug only.
Poly resistance Refers to resistance to more than one first-line anti-TB drug,
other than isoniazid and rifampicin together.
Rifampicin-resistant TB (RR-TB): Refers to resistance to rifampicin detected using phenotypic
or genotypic methods. C
Isoniazid-resistant TB (Hr-TB) Refers to Mycobacterium tuberculosis strains in which
resistance to isoniazid and susceptibility to rifampicin has
been confirmed in vitro
Multidrug resistance (MDR) Refers to resistance to at least isoniazid and rifampicin, the
two most potent anti-TB agents, with or without resistance
to other first line drugs.
MDR TB with Refers to MDR TB with additional resistance to moxifloxacin
Quinolone resistance or levofloxacin.
Extensive drugresistance (XDR) Refers to MDR TB with additional resistance to moxifloxacin
or levofloxacin and to one of two other group A drugs
(BDQ, LZD).
Treatment of Hr-TB
6 months LfxHREZ
regimen.
Treatment of RR/MDR-TB
• STR: Intial phase = 4-6 months=7 drugs
Bdq(6m)-Lfx-Eto-Cfz-Z-E-H(high dose)
Continuation phase= 5 months=4 drugs
Lfx-Cfz-Z-E
• Eigibiity of STR: No resistance to above
drugs
No exposure to above drugs >1 month
Not pregnant,child> 6 years.
Treatment of DR-TB
• LTR: For Quinolone susceptible: 6(Bdq-Lzd-
Lfx-Cfz-Z)/14(Lzd-Lfx-Cfz-Z)
For Quinolone resistant: 6(Bdq-Dlm-
Lzd-Cfz-Z-Cs)/14(Lzd-Cfz-Z-Cs)
• Eligibility: Extensive/severe TB disease
Resistance to STR drugs/Quinolones
Exposure to STR drugs >1month
Child of any age.
Treatment of X-DR TB
• BPaL regimen: 6–9 Bdq- Pa-Lzd
Still under operational research conditions
Nix-TB study showed its efficacy in
Pre-XDR TB
XDR-TB .
Non-responsive MDR
Key Takeaways
Anyone can get
Latent TB
infection needs
TB Rx in certain
conditions
WHO
All anti-TB
recommended
(DS&DR) are now
RMDTs are
in oral form
available in BD
