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Communicable Diseases & Prevention


Tuberculosis( 2017-01-01 )



Background

1. Tuberculosis caused by various strains of mycobacteria, usually mycobacterium tuberculosis.

2. Tuberculosis typically attacks the lungs, but can also affect other organs and tissues of the body, such as lymph nodes, meninges, pleura, kidney, bone, skin, gastrointestinal tract, urogenital tract, etc.

3. The pathogen is spread through the air when people who have an active TB infection cough, sneeze, speak, sing, spit or otherwise transmit respiratory fluids through the air.

4. The people who are exposed to mycobacterium tuberculosis may not necessarily develop the disease. Most people are able to fight the infection by immune system. In fact, healthy people who are infected with tuberculosis have a 5-10% chance of converting to active disease over their lifetime. This is often described as Latent TB Infection (LTBI). LTBI may develop into active tuberculosis someday, often when the persons immune system becomes weakened.

5. Risk factors for tuberculosis are including

(1)diabetes mellitus;

(2) silicosis;

(3) had undergone gastrectomy;

(4) malnutrition;

(5) immunosuppressive drugs (e.g., medical steroids);

(6) immunodeficiency disease;

(7) end stage renal disease (ESRD);

(8) living at mountains area in Taiwan;

(9) aging population.

6. Case Definition

(1) Tuberculosis

Clinical case definition:

a. symptoms or signs compatible with tuberculosis, ie. chronic cough, weight loss, fever, or abnormal chest radiography

b. clinical symptoms or signs were improved after anti-tuberculosis treatment

Lab criteria:

a. Isolation of Mycobacterium tuberculosis complex(except Mycobacterium bovis BCG) from a clinical specimen(eg. sputum, pleural fluid, gastric juice, bronchial lavage, tissue culture) OR

b. Demonstration of acid-fast bacilli in a clinical specimen OR

c. a nucleic acid amplification test positive for Mycobacterium tuberculosis complex in the acid-fast stain positive clinical specimen

d. pathological findings compatible with tuberculosis

Case classification:

-possible:

a case meets the clinical case definition a.

-confirmed:

a. a case meets both clinical case definitions a and b , OR

b. a case meets the lab. criteria a or d , OR

c. a possible case that meets lab. criteria b or c

 

(2) MDR-TB (multidrug-resistant tuberculosis)

Clinical case definition:

a. symptoms or signs compatible with tuberculosis, ie. chronic cough, weight loss, fever, or abnormal chest radiography

b. clinical symptoms or signs were not significantly improved after anti-tuberculosis treatment, and was MDR-TB suspected

Lab criteria:

a. Isolation of Mycobacterium tuberculosis complex(except Mycobacterium bovis BCG) from a clinical specimen(eg. sputum, pleural fluid, gastric juice, bronchial lavage, tissue culture) and drug-resistance test revealed both were resistant to Isoniazid and Rifampincin

b. a rapid molecular diagnostic test revealed both Isoniazid and Rifampincin resistance in a acid-fast stain positive sputum specimen

Epi. criteria:

a. a case who had a contact history of a confirmed MDR case OR

b. a case who was a relapse tuberculosis case or treatment failure after anti-tuberculosis therapy

Case classification:

-possible:

a. a case meets both clinical case definitions a and b, OR

b. a case meets the clinical case definition a and any one of epi criteria

c. a case who meets any one of the clinical case definition and any one of lab criteria

-confirmed:

a possible case who was confirmed by reference lab of Taiwan CDC

 

*** A MDRTB case who had treatment failure or any isolate which drug susceptibility test revealed all resistant to Isoniazide, Rifampincin, Fluoquinolone, and any injectable drug of Kanamycin, Amikacin or Capreomycin, the isolate should be sent to Taiwan CDC for confirmation of XDRTB

 

Epidemiology

Tuberculosis is one of the most widespread communicable diseases in the world. In 2013, the World Health Organization (WHO) estimates that there were 9.0 million incident TB cases, 1.5 million TB deaths, 13% of new TB cases were HIV-positive. An estimated 480,000 people developed MDR-TB and there were an estimated 210,000 deaths from MDR-TB. In 2016, there were 10,328 tuberculosis cases (43 cases per 100,000 population) and 547 tuberculosis-related deaths (2.3 cases per 100,000 population) in Taiwan. The incidence rate fell 4% as compared to 2015. Overall, the incidence rate has been showing a continuous downward trend.

TB Incidence

Goal:

1. To detect infected persons as early as possible by implementing active strategies and improving contact investigation.

2. To prevent individuals with latent TB infection (LTBI) from developing active TB and halve the number of TB cases by providing comprehensive medical treatment for TB and LTBI patients.

3. To increase the completion of treatment and cure rates by implementing DOTS and DOPT.

 

Prevention and Control

Taiwan CDC had promoted“Mobilization Plan to Halve Tuberculosis Incidence in Ten Years” since 2006.

Fifteen strategies of “Mobilization Plan to Halve Tuberculosis Incidence in Ten Years”:

1. Case finding campaign

2. Laboratory capacity improvement

3. Direct Observe Treatment (DOTs)

4. Hospital Care Enhancement & infection control

5. MDR-TB project (DOTS-Plus)

6. Air Travel control

7. Surveillance and database

8. National Health Insurance related issues

9. Local government evaluation

10. LTBI treatment program

11. Contact tracing plus pilot project

12. Foreign Worker program

13. BCG evaluation

14. IC and R&D

15. Mandatory isolation implementation

 

FAQ

1. What is TB?

Tuberculosis is a disease that usually attacks the lungs but can affect almost any part of the body. A person infected with TB does not necessarily feel ill – and such cases are known as silent or “latent” infections. When the lung disease becomes “active”, the symptoms include cough that last for more than two or three weeks, weight loss, loss of appetite, fever, night sweats and coughing up blood.

2. What causes TB?

TB is caused by the bacterium Mycobacterium tuberculosis. The bacterium can cause disease in any part of the body, but it normally enters the body though the lungs and resides there.

3. Is TB treatable?

Yes. TB can be cured, even in people living with HIV. DOTS is the internationally recommended strategy for TB control.

4. What is multidrug-resistant tuberculosis (MDR-TB)?

MDR-TB is a specific form of drug-resistant TB due to a bacillus resistant to at least isoniazid and rifampicin, the two most powerful anti-TB drugs. The treatment for MDR-TB is longer conjugated with injectable anti-TB medications for up to 18 months.

5. How does drug-susceptible TB become drug-resistant TB?

Drug resistance arises due to the improper use of antibiotics in chemotherapy of drug-susceptible TB patients. This improper use is a result of a number of actions, including administration of improper treatment regimens by health care workers and failure to ensure that patients complete the whole course of treatment. Essentially, drug-resistance arises in areas with poor TB control programmes.

  

More Information

International Union Against Tuberculosis and Lung DiseaseIUATLD

The Global Fund to Fight AIDS, Tuberculosis and Malaria

CDC-Division of Tuberculosis Elimination

WHO-Stop TB Department

Stop TB Partnership

 

 

 

 

 

 

 

 

 

 

 

 

 


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  • Last modified at 2018-03-12
  • Data from Division of Chronic Infectious Diseases