Eradication of Tuberculosis

Eradication of Mycobacterium Tuberculosis

Introduction to Mycobacterium Tuberculosis:

Mycobacterium tuberculosis is a bacterial species also known as acid-fast bacilli (AFB). Mycobacterium tuberculosis can be gram-positive or gram-negative. Mycobacterium tuberculosis is a pathogenic organism that commonly causes Tuberculosis. It measurably affects the lungs or lower respiratory tract but may also cause infection in the brain, bones, glands, and other body parts.

Robert Koch firstly discovered mycobacterium tuberculosis in the year 1882. Mycobacterium tuberculosis has a unique character; it contains a waxy layer on its cell wall made up of mycolic acid & teichoic acid. Because of mycolic acid & teichoic acid, gram stain cannot penetrate inside the cell wall of Mycobacterium tuberculosis. Therefore M.tuberculosis is stained with Ziehl Neelsen Stain or Acid Fast Stain as ZN stain can penetrate the cell wall of Acid Fast Bacilli. M.tuberculosis is a highly aerobic strain, and this is the reason it causes diseases majorly in the lungs.

History of Mycobacterium Tuberculosis:

In ancient times Mycobacterium tuberculosis was known as tubercle bacillus. Three million years ago, M.tuberculosis originated in East Africa. In 1993 WHO declared Tuberculosis as a world emergency.

Robert Koch firstly discovered tubercle bacillus on 24th March 1882. Therefore, this bacterium is also known as Koch’s bacillus.

Structure of Mycobacterium tuberculosis: M.tuberculosis is a rod-shaped bacterium, nearly 2-4mm in length and 0.2-0.5um in width. Tubercle bacillus is an obligate aerobe.

And these bacteria are facultative intracellular parasites.

Their generation time is 15-20 hours. They can quickly be grown on Lowenstein Jensen Medium. LJ Medium is a unique medium of M.tuberculosis.

Pathogenicity of M.tuberculosis:

Tubercle bacilli can only cause infection in human beings. This disease or illness can only spread infection from one person to another through air droplets during coughing, sneezing and speaking. They can not be spread by handshaking or sharing food.

Mycobacterium tuberculosis firstly enters the respiratory tract by the medium of air droplets and reaches the lungs. After reaching the lungs, alveolar macrophages engulf the bacteria for phagocytosis. But due to the unique characteristics of the bacterial cell wall, macrophages cannot lyse the bacteria. Because of aerobic conditions of the lungs, tuberculin bacilli starts multiplying inside the macrophages. And are released from alveolar macrophages after the cell dies/lyses or bursts. Granulomatous lesions were formed in the lungs and caused infection in the lungs. Tubercle bacilli can also cause infection in other body parts other than the lungs by moving through lymphatic vessels to other sites known as extrapulmonary Tuberculosis.

Lymph node TB is commonly seen in HIV infected patients. Tubercle bacilli may also penetrate inside pleural fluid and may cause pleural TB. It is very much common after Primary Tuberculosis. Mycobacterium tuberculosis may cause:–

• Skeletal TB
• Genitourinary TB
• Gastrointestinal TB
• TB meningitis
• TB pericarditis
• Miliary TB or disseminated TB

When a person is infected with Tuberculosis for the first time in life, the condition is known as Primary Tuberculosis. If a person has infection after primary infection, that condition is known as secondary infection, reinfection or chronic infection. A person may also develop latent Tuberculosis; that is, one may carry the infection but do not develop symptoms of Tuberculosis. Such a kind of infection is called Latent Tuberculosis. Latent tuberculosis patients are capable of infecting other persons.

People at risk:

As per study all age groups are at risk because of tuberculosis but adults are mostly affected by tuberculosis for a few years.

People suffering with HIV are 18 times at higher risk in comparison to healthy people. However, people whose immunity is compromised because of any other disease or we can say a patient suffering from an immunocompromised condition are also at high risk.

Malnutrition is also a major cause of tuberculosis, as we all know the immunity or immune system of malnutrition people is very much compromised; they are more susceptible to the disease tuberculosis caused by Mycobacterium tuberculosis.

As per study, if a person is in a starvation state, the energy of the patient will get low which will automatically lead to lower immunity level. And one will get susceptible to tuberculosisAs per earlier studies, all age groups are at equal risk of getting infected with Tuberculosis, but adults are affected mainly by tuberculosis infection.

People who have HIV are 18 times at higher risk in comparison to healthy people. However, people whose immunity is compromised because of any other disease or a patient suffering from an immunocompromised condition are also at high risk.

Malnutrition is also a significant cause of Tuberculosis; as we all know, malnutrition people’s immunity or immune system is very much compromised; they are more susceptible to the disease tuberculosis caused by Mycobacterium tuberculosis.

As per a study, if a person is in a starvation state, the patient’s energy will get low, automatically leading to a lower immunity level. And one will get susceptible to tuberculosis disease. Overall conditions we may consider starvation regularly will increase the chance of occurring disease because of weakness or compromising immunity. So, it is said one should always have their meal on time. Must have a healthy meal at the start of the day.

disease. Overall conditions we may consider starvation on a regular basis will increase the chance of occurring disease because of weakness, or compromising immunity. So, it is said one should always have their meal on time. Must have a healthy meal at the start of the day.

Facts about Tuberculosis:

In 2020, 43% of new tuberculosis cases were registered in the southeast Asian region, 25% new cases in the African region and 18% new cases in the pacific region.

Tuberculosis is the 13th leading cause of death worldwide.  1.5 million people died in 2020 due to tuberculosis disease. 86% of new tuberculosis diseases were registered in 2020 within the 30 most infected countries. Tuberculosis is a curable and preventable disease. Society is suffering much from Tuberculosis because of multi-resistant TB (MDR-TB).

The primary symptom of lung tuberculosis is a cough with sputum, and sometimes patients may have sputum with blood, weakness, weight loss, fever, night sweat and chest pain.

Coughing is a significant symptom of Tuberculosis. People should go for a checkup of Tuberculosis if they have been suffering from a cough for more than two or three weeks. A person will suffer from fever, as body temperature increases during bacterial infection as a symptom of inflammation. One may also suffer from chest pain or may have breathing difficulties.

Diagnosis of Tuberculosis:

Physical examination of Tuberculosis is the diagnosis of lymph nodes or listening to the sound of breathing from lungs with a stethoscope.  We may also go for a skin test/tuberculin test/ Mantoux test. 1um of tuberculin is injected at the subcutaneous layer of skin at the forearm. Then it is observed after 48 hours to 72 hours for reaction. Tuberculosis may also be diagnosed with the TB-Gold test (ELISA Test). TB-Gold is a qualitative as well as quantitative test

Tuberculosis may also be diagnosed with ZN stain. Mycobacterium tuberculosis is an acid-fast bacillus. Therefore, it is stained with acid-fast stain.

Mycobacterium tuberculosis is cultured on a specialized medium, known as Lowenstein Jensen Medium (LJ). The incubation period of tubercle bacilli in LJ Medium is 7 to 14 days.

Chest X-Ray is performed for diagnosis of Tuberculosis. Ghon’s complex forms lesion in lungs, and it is observed in chest X-Ray.

Treatment of Tuberculosis:

Tuberculosis is a treatable disease; multiple types of  are available to treat Tuberculosis.

Commonly used medicines for Tuberculosis are Isoniazid, Rifampin, Ethambutol and Pyrazinamide.

If a person is suffering from multiple resistant Tuberculosis, a combination of antibiotics called fluoroquinolones and injectable medicines, such as amikacin or capreomycin, is generally used for 20 to 30 months.

There are multiple side effects of medications like nausea, loss of appetite, yellow colour to your skin, dark urine, easy bruising or bleeding, blurred vision.

Complete treatment of Tuberculosis is very much necessary. If an individual does not complete their treatment, the disease will develop resistance against the , leading to multi resistance TB.

will develop resistance against the . Leading to multi resistance TB.

Best way of preventing tuberculosis is by being vaccinated. Bacillus calmette guerin  (BCG) is a live vaccine against tuberculosis. BCG has been used worldwide for prevention of tuberculosis since 1921. This vaccine is 80% effective to prevent tuberculosis till 15 years of vaccination.

Tuberculosis is spread in droplets, therefore good ventilation is very much necessary to prevent spread of disease.

UV light is a method of sterilization for prevention of disease, therefore UV light is used for sterilization of M.tuberculosis.

Because tuberculosis is spread with droplets, it is very much necessary to cover the mouth and nose while sneezing to prevent tuberculosis. It is also prevented with use of protective masks, ventilations systems and regular screening of healthcare workers of Tuberculosis.

As per study 60% of adults can prevent disease with a healthy immune system.

Eradication of Tuberculosis:

Eradication of Tuberculosis:

United Nations Sustainable Development Goals (SDGs) are trying to eradicate the tuberculosis epidemic worldwide by 2030. 13 billion is needed to treat, prevent, and cure tuberculosis disease. On 26th September 2018, United Nations arranged a meeting for discussion of prevention and eradication of Tuberculosis.

After that, in the year 2017, the first global ministerial conference on TB occurred by WHO and the Russian government. After the conference, it was mutually decided, and UN members made a political declaration to eradicate Tuberculosis.

The political declaration of the UN high-level meeting included four new global targets:

• treat 40 million people for TB disease in the five years 2018–2022;
• reach at least 30 million people with TB preventive treatment for a latent TB infection in the five years 2018–2022;
• mobilize at least US$ 13 billion annually for universal access to TB diagnosis, treatment and care by 2022;
• mobilize at least US$ 2 billion annually for TB research.

As requested in the political declaration:

• WHO finalized and published a Multisectoral Accountability Framework for TB (MAF-TB) in 2019. WHO is supporting countries to adapt and use the framework to translate commitments into actions and monitor, report, and review progress, with high-level leadership, all relevant sectors, civil society, and other stakeholders.
• In 2020, a progress report from the UN Secretary-General to the General Assembly was developed. It was released with the support of WHO.
• Examples of high-level leadership on multisectoral accountabilityinclude Presidential or Head of State End TB initiatives and formalized mechanisms for the engagement and accountability of stakeholders in India, Indonesia, Pakistan, Philippines and VietNam, and national campaigns to drive progress the Race to End TB.

WHO is working closely with countries, partners and civil society in scaling up the TB response. Six core functions are being pursued by WHO to contribute to achieving the targets of the UN high-level meeting political declaration, SDGs, End TB Strategy and WHO strategic priorities:

• Providing global leadership to end TB through strategy development, political and multisectoral engagement, strengthening review and accountability, advocacy, and partnerships, including with civil society;
• Shaping the TB research and innovation agenda and stimulating the generation, translation and dissemination of knowledge;
• Setting norms and standards on TB prevention and care and promoting and facilitating their implementation;
• Developing and promoting ethical and evidence-based policy options for TB prevention and care;
• Ensuring the provision of specialized technical support to the Member States and partners jointly with WHO regional and country offices, catalyzing change, and building sustainable capacity;
• Monitoring and reporting on the status of the TB epidemic. And reporting progress in financing and implementation of the response at global, regional and country levels.

This is blog has been submitted by the faculty of IMPACT PARAMEDICAL & HEALTH INSTITUTE (IPHI).

Impact Paramedical & Health Institute (IPHI) is one of the top paramedical institutions in Delhi. It offers its students an opportunity to learn from an industry leading faculty of Doctors.