Rntcp

1. Scientific Basis of Diagnosis and Treatment in RNTCP Dr Awadhesh Kumar Sharma , MD Senior resident Department of Medicine, M.L.B. Medical College, Jhansi, UP

3. India is the highest TB burden country globally accounting for one fifth of the global incidence Source: WHO Geneva; WHO Report 2006: Global Tuberculosis Control; Surveillance, Planning and Financing Globally ~9 million new TB cases occur annually Non-HBCs 20% Ethiopia 3% Philippines 3% South Africa 4% Bangladesh 4% Pakistan 3% Nigeria 4% Indonesia 6% China 15% India 20% Other 13 HBCs 18%

5. Estimated Incidence of TB in India* (No. of New Smear Positive Cases per 100,000 population, per year) North West East South National 75 North Zone 95 East Zone 75 West Zone 80 South Zone 75

10. Diagnosis

12. DIAGNOSTIC ALGORITHM FOR PULMONARY TB

15. Acid Fast Stain Tubercle Bacilli

17. X-rays of an Dubai based NRI engineer who complaints of cough with expectoration alongwith haemoptysis for 3 months, diagnosed there as case of pulmonary tuberculosis & antituberculosis Rx started. When he did not get relief, he visited India, here on investigation his eosinophillic count and IGE level found to be elevated & diagnosed as case of Allegric Bronchopulomonary Aspergillosis and got relief by antifungal and steroids .

21. Three sputum Samples collected - SPOT – Early Morning – SPOT

22. Three sputum smears are optimal

23. Diagnosis of tuberculosis Tools Merits Demerits Tuberculin test Can identify infection Good epidemiological tool Cannot differentiate infection & disease X-ray Sensitive Not specific Sputum Sm. Microscopy Definitive diagnosis Easy to perform at the periphery Replicability Less costly Sensitivity 60-80% Culture for MTB Highly sensitive & specific Costly, not freely available long waiting period

24. Treatment

35. Treatment Regimens 2H 3 R 3 Z 3 / 4H 3 R 3 New smear negative and extra-pulmonary, not seriously ill Cat III 2H 3 R 3 Z 3 E 3 S 3 / 1H 3 R 3 Z 3 E 3 / 5H 3 R 3 E 3 Previously treated smear positive (relapse, failure, treatment after default) Cat II 2H 3 R 3 Z 3 E 3 / 4H 3 R 3 New smear positive; seriously ill smear negative; seriously ill extra-pulmonary Cat I

36. Side Effect of Anti-TB Drugs Symptom Drug Action to be taken Gastrointestinal upset Any oral medication Reassure patient Give drugs with less water Do not give drugs on empty stomach. Itching Burning in the hands and feet Isoniazid Give pyridoxine 100 mg/day until symptoms subside Joint pains Pyrazinamide evaluate Impaired vision Ethambutol STOP ethambutol and evaluate Ringing in the ears Loss of hearing Streptomycin STOP streptomycin and evaluate Jaundice Isoniazid, Rifampicin, Pyrazinamide STOP if liver enzymes elevated 5 times of normal.

42. Patients swallows drugs in presence of observer

54. Diagnostic Algorithm for Pediatric Tuberculosis

56. Algorithm for clinical monitoring

61. Thank You