- Tuberculosis (TB) has been present in humans for thousands of years and has been found in skeletal remains from 4000 BC as well as Egyptian mummies from 3000-2400 BC. - Robert Koch discovered the bacteria that causes TB, Mycobacterium tuberculosis, in 1882. - Infants in areas where TB is common should receive the BCG vaccine to prevent tuberculosis. - Directly Observed Treatment Strategy (DOTS) was endorsed by Pakistan in 1995 as the strategy to control TB according to WHO guidelines. - Pakistan has a high burden of TB and ranks 6th in the world for number of TB cases, accounting for 44% of the Eastern Mediterranean region's cases.

3. -Tuberculosis (TB) is believed to have been
present in humans for thousands of years.
-Skeletal remains show that prehistoric
humans (4000 BC) had tuberculosis, and
-tubercular decay has been found in the
spines of Egyptian mummies
(3000-2400 BC).

4. • ROBERT KOCH ON 24TH
MARCH 1882 DISCOVERED
THE WIDE SPREAD
DISEASE CAUSING
BACTERIA…
MYCOBACTERIUM
TUBERCULI.

5. In those parts of the world where
tuberculosis is common, infants
should receive a vaccine called BCG
(Bacille Calmette Guerin) to
prevent tuberculosis..

6. • In 1854, Hermann Brehmer proposed the
idea that tuberculosis was indeed a
curable disease.
• The introduction of the sanatorium cure
provided the first big step toward
treatment for tuberculosis.
• Brehmer himself was a TB patient.

7. • IN 1993 WORLD HEALTH
ORGANIZATION DECLARED
T.B AS A GLOBAL
EMERGENCY IN DEVELOPING
COUNTRIES.
• ITS CAUSING MORE DEATHS
THAN ANY OTHER
DISEASE…….

8. TUBERCULOSIS-DEVELOPMENT
OF DISEASE
• When the bacillus is inhaled in to the
lungs, it sets up a primary tubercle and
spreads to the nearest lymph nodes.
• The disease may smoulder for months
or years and fluctuate with patients
resistance.
• The patients can develop a chronic
infection and can transmit the bacillus
by coughing and sneezing.

9. TUBERCULOSIS SYMPTOMS
AND SIGNS.
-FEVER
-NIGHT SWEATS
-WEIGHT LOSS
-BLOOD IN SPUTUM
-SEVERE COUGHING

10. SPREAD OF BACTERIA MAY
CAUSE;
• MENINGITIS.
• PERITONITIS.
• POTTS DISEASE.

11. DIAGNOSIS
• -ESR
• CHEST X-RAY
• SPUTUM AFB
• BIOPSY

12. DIRECTLY OBSERVED
TREATMENT STRATEGY (DOTS).
• DIRECTLY OBSERVED TREATMENT
STRATEGY (DOTS) is the internationally
recommended strategy for TB control
• Government of Pakistan endorsed the DOTS
strategy, following WHO’s declaration of
TB as a global emergency in 1993, The
National TB Control Programme (NTP)
Pakistan adopted DOTS (Directly Observed
Treatment, Short course) strategy in 1995

13. PREVENTIVE TREATMENT..
• In the United States, healthcare providers try to identify
people infected with tuberculosis as early as possible,
before they have developed active tuberculosis.
• These people can hen be treated and cured before they
become contagious.
• Anyone who has been exposed to a person with TB
should be tested for latent tuberculosis.
• This disease is especially dangerous for children and
people with HIV infection.
• If infected with TB bacteria, these people need medicine
right away to keep from developing an active case.

14. TB-HIV RELATION!!
-TB is closely connected with HIV.
-People living with HIV, representing over
10% of annual TB cases, are up to 37 times
more likely to develop TB than people who
are HIV-negative.
-In 2009, TB accounted for one in four
deaths among HIV-positive people.

16. PAKISTAN MOVED UP TWO SPOTS
TO 6TH IN THE LIST OF
COUNTRIES .
• “In 2010, after the registration of 0.413
million patients of which 0.3 million are
suffering from TB in their lungs.
• Pakistan moved up two spots to 6th in the
list of countries with the highest number of
TB patients in the world, according to a
(WHO) report. TB kills around 48,000
Pakistanis every year.”

17. • “Pakistan alone accounts for
44% of total TB burden in the
Eastern Mediterranean Region
of the WHO comprising 23
countries.”

18. -The incidence of sputum positive TB
cases in Pakistan is 80/100,000 per
year and for all types it is 177/100,000.
-TB is responsible for 5.1 percent of the
total national disease burden in
Pakistan. The impact of TB on socio-
economic status is substantial.
• Source: National Tuberculosis control programe

19. DOTS ENDORCEMENT IN
PAKISTAN.
• Directly Observed Treatment Strategy
(DOTS) is the internationally
recommended strategy for TB control.
• NTP Pakistan adopted DOTS (Directly
Observed Treatment, Short course)
strategy in 1995.

22. MULTI-DRUG RESISTANT
TB.
• “Annually approximately 15,000 patients contract
the severe form of tuberculosis, the standard
antibiotics do not work anymore.
• It is universally accepted that a partially treated
TB patient is worse than an untreated one as the
chronic cases are the ones who excrete multi
drug resistant organisms and increase the
community burden of TB.
• Partial treatment with inappropriate regimens in
terms of dosage and duration is probably the
most important factor leading to rise in multi-
drug resistant (MDR) TB in Pakistan”

23. MOST OF THESE PATIENTS GO TO
QUACKS WHO GIVE THEM MEDICINES
THAT WORSEN THE DISEASE
• In Pakistan, where TB is endemic and has
assumed large proportions, the diagnosis
would be considered and correctly treated
by only a small percentage of PPs.
• A study recently conducted by the authors
in Karachi showed that only 66% PPs
ordered sputum microscopy as the
preferred method for diagnosing TB. Only
50% thought themselves as capable enough
to treat patients with pulmonary TB. Only
21% doctors prescribed a correct regimen in
accordance with NTP or WHO guidelines. In
such circumstances, if the PPs are treating
80% of patients presenting to them with
tuberculosis1, one can imagine how worse
the situation can get.

24. • More than one million people have TB
in Pakistan.
• ONE PERSON IS INFECTED EVERY
TWO MINUTES AND ONE DIES
EVERY EIGHT MINUTES.
• The marginalization and poverty of sick
people has fuelled another trend.
-W.H.O.

25. DELAYED TREATMENT AND
ISOLATION OF PATIENTS.
• Another important aspect noted in this study was
that more than half of TB patients in Pakistan first
presented to their general practitioners in private
sector
• Up to 10% delayed seeking treatment for more than
six months after the onset of illness.
• A majority of patients and their relatives feel that the
dishes of TB patients should be kept separate from
rest of the family members thus isolating them
further from their families.

26. A PROJECT BY STUDENTS OF
MBBS 1ST YEAR
SHAHEED MOHTARMA BENAZIR
BHUTTO MEDICAL
COLLEGE,KARACHI.