NTA Level 4 • Semester 1 • PST04102

Identification of Patients with Tuberculosis

Disease Control and Prevention • Source Session/Topic 28

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Session 28: Identification of Patients with Tuberculosis

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe Causes of Tuberculosis

• Describe mode of Transmission of Tuberculosis

• Describe Major Signs and Symptoms of Tuberculosis

• Explain Treatment of Tuberculosis

• Explain Prevention and Control of Tuberculosis

Resources Needed

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Tuberculosis (10 minutes)

|Activity: Buzzing (10 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What causes tuberculosis? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Definition

• Tuberculosis (TB) is a chronic infectious disease caused mainly by

mycobacterium tuberculosis (M. tuberculosis) and occasionally by

mycobacterium bovis or mycobacterium africanum.

Tuberculosis can be grouped into two main types:

Pulmonary tuberculosis (PTB)

• Affects the lungs

• Most common and accounts for 80% of all cases of TB

Extra-pulmonary (EPTB)

• Affects organs other than the lungs

• Non-infectious

• Accounts for 20% of all cases of TB

• The most common types of extra-pulmonary tuberculosis are:

o TB lymphadenitis

o TB of the bones and joints

o TB meningitis

• Tuberculosis is on the increase, especially in countries with high

prevalence of HIV

• Tuberculosis can kill or render the patient disabled for life if

untreated or inadequately treated

STEP 3: Mode of Transmission of Tuberculosis (30 minutes)

|Activity: Group discussion (30 minutes) |

| |

|DIVIDEstudents into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What is the mode of transmission of tuberculosis? |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• The transmission of tubercle bacilli occurs by airborne spread of

infectious droplets

• TB is transmitted from one person to another through inhalation of

droplets during:

o Coughing

o Laughing

o Talking

o Sneezing

o Spitting

o Singing

• Coughing is the common means of transmission

• The risk of acquiring the infection is higher for individuals close to

the patient

• Direct sunlight kills tubercle bacilli within minutes, but they can

survive in the dark for many hours (24-48 hours)

Note: The majority (90%) of people without HIV infected with

mycobacterium tuberculosis do not develop tuberculosis because their

immune system is strong enough to prevent the development of

tuberculosis

STEP 4: Signs and Symptoms of Tuberculosis (10 minutes)

The most common symptoms of pulmonary tuberculosis are:

• Persistent cough for 2 weeks or more

• Blood stained sputum (haemoptysis)

• Shortness of breath

• Chest pain

• Fatigue (tiredness)

• General malaise

• Loss of appetite

• Loss of weight

• Night sweats

• Fever

The symptoms for extra-pulmonary tuberculosis depend on the organs

involved, for example:

• Chest pain in Tb pleurisy

• Swelling of lymph nodes in Tb lymphadenitis

• Pain and swelling of joints in Tb arthritis

• Deformity of the spine (Pott’s disease)

• Headache, fever, stiffness of the neck and mental confusion in Tb

meningitis

STEP 5: Treatment of Tuberculosis (10 minutes)

Treatment is divided into three groups:

• New patients who have no history of TB treatment or who have received

less than one month of anti-TB drugs regardless of their smear or culture

results

• Previously treated patients who have received anti-TB drugs for one month

or more in the past with a second episode

• Drug-resistant patients with tubercle bacilli that are resistant to

rifampicin and isoniazid

Direct observation treatment (DOT) strategy

• Direct observation treatment means that a trained health care provider or

other designated individual, including family members, observe the

patient swallow all tablets

• Ensures that a TB patient takes the right drugs, in the right doses, at

the right intervals and finishes treatment within the required duration,

There are five essential first-line anti-TB drugs for adults and children

in Tanzania, as recommended by the MOHSW and WHO.

• Drugs are formulated in fixed drug combinations (FDCs)

o Isoniazid (H)

o Rifampicin (R)

o Pyrazinamide (Z)

o Ethambutol (E)

o Streptomycin (S)

• Treatment of TB requires multiple drugs for effectiveness

o This is called Multi-Drug Treatment (MDT)

o If one or two drugs are used alone, other organisms will not be killed

and resistance will develop

• Treatment of TB is divided into two phases as described below;

Initial (intensive) phase

• At least 4 drugs are used in this phase:

o Isoniazid

o Rifampicin

o Pyrazinamide

o Ethambutol

• Majority of TB bacilli are rapidly killed and patients become non-

infectious within two weeks

• The duration of treatment for initial phase is at least two (2) months

Continuation phase

• There are always bacilli that remain metabolic inactive, hiding in tissue

or macrophages even after the initial phase of treatment

• These are called persisters or semi-dormant and they need much longer

treatment before they are killed

• Two drugs are used

o Isoniazid

o Rifampicin

• The duration for this phase is at least four (4) months to make a total

duration of at least six (6) months to complete treatment

[pic][pic]Handout 28.1: Mode of Action, Potency and Recommended dose of

Anti-TB drugs for further reading

• [pic] Handout 28.1: Adverse Reactions of Anti-TB Drugs for further

reading

STEP 6: Prevention and Control of Tuberculosis (40 minutes)

|Activity: Group discussion (30 minutes) |

| |

|DIVIDEstudents into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What are the preventive prevention and control measures of |

|tuberculosis? |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• The control of TB depends on success of treatment of registered TB

patients and contact tracing.

o Emphasis must be placed on those who are sputum smear-positive (open

TB) to make them smear-negative

o All patients with open TB must be put on treatment as early as

possible to prevent them from infecting others

o Early case finding is an important aspect of TB control

▪ Passive case finding – all health care workers should know the

early symptoms of TB and diagnose it whenever patients reports to

facilities

▪ Active contact tracing/case finding – community health workers to

visit the homes of all TB cases to look for other cases

• Appropriate health education should be given to patients and relatives so

that symptomatic contacts can be brought to the health facility for

investigation

• Case holding – those who are put on treatment, should be maintained on

treatment until they finish the whole course of treatment

• Strengthen the efficiency and reliability of the health services

o Advertise the routine methods of TB treatment in health facility

o Having special day in a week/month where TB patients are seen

• The role of BCG immunization

o Provides partial active immunity against TB

• Other important measures are:

o TB patients should be advised not to spit anywhere carelessly

o A sputum mug should be provided in which to spit and disposed

carefully

o Overcrowding and poor ventilation at homes should be avoided

o Patients should cough into a piece of cloth to reduce distribution of

particles b in the air

o Hand washing after coughing

STEP 7: Key Points (5minutes)

• TB is transmitted from one person to another through inhalation of

droplets

• Treatment of TB requires multiple drugs for effectiveness

• Majority of TB bacilli are rapidly killed and infectious patients become

non- infectious within two weeks

• There are five essential, first-line anti-TB drugs which are Isoniazid,

Rifampicin, Pyrazinamide, Ethambutol and Streptomycin

• The control of TB depends on successful treatment of registered TB

patients and contact tracing

• Early case finding is an important aspect of TB control

STEP 8: Evaluation (5 minutes)

• What causes of tuberculosis?

• What is the mode of transmission of tuberculosis?

• What are major signs and symptoms of tuberculosis?

• What is the treatment of tuberculosis?

• What are the preventive prevention and control measures of tuberculosis?

STEP 9: Assignment (5 minutes)

|Activity: Take Home Assignment (5 minutes) |

| |

|ASK the students to work individually on the following Assignment |

|Explain preventive measures that you will take to control Tuberculosis |

|in your area |

|ALLOCATE time for students to do the assignments and submit |

|REFER students to recommended references |

References

Cook, G. Zumla, A. (2003). Manson’s Tropical Diseases. (21st ed.). London:

Saunders Ltd.

Eshuis, J. Manschot, P. (1992). Communicable diseases, (1st ed). Nairobi:

AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for

Healthcare Workers. Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines

List (4thed). Dar es Salaam: MOHSW

GoT (2013) National Tuberculosis and Leprosy Programme: Manual for the

management of tuberculosis and leprosy (6thed) Dar es Salaam: MOHSW

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in

Sub-Saharan Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable

Diseases. (4thed.). Nairobi: AMREF

|[pic] |Handout 28.1: Mode of Action, Potency and Recommended dose |

| |of Anti-TB drugs |

[pic]

|[pic] |Handout 28.2: Adverse Reactions of Anti-TB Drugs |

[pic]

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