What is TB? How is it treated? Ask the expert Updated October 2013 Q: What is TB? How does it spread?

How is it treated? A: Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs. Tuberculosis is curable and preventable. TB is spread from person to person through the air. When people with lung TB cough, sneeze or spit, they propel the TB germs into the air. A person needs to inhale only a few of these germs to become infected. In healthy people, infection with Mycobacterium tuberculosis often causes no symptoms, since the person'simmune system acts to wall off the bacteria. The symptoms of active TB of the lung are coughing, sometimes with sputum or blood, chest pains, weakness, weight loss, fever and night sweats. Tuberculosis is treatable with a six-month course of antibiotics. About one-third of the world's population has latent TB, which means people have been infected by TB bacteria but are not (yet) ill with disease and cannot transmit the disease. People infected with TB bacteria have a lifetime risk of falling ill with TB of 10%. However persons with compromised immune systems, such as people living with HIV, malnutrition or diabetes, or people who use tobacco, have a much higher risk of falling ill. When a person develops active TB (disease), the symptoms (cough, fever, night sweats, weight loss etc.) may be mild for many months. This can lead to delays in seeking care, and results in transmission of the bacteria to others. People ill with TB can infect up to 10-15 other people through close contact over the course of a year. Without proper treatment up to two thirds of people ill with TB will die. Since 1995 more than 22 million lives have been saved and 56 million people cured by WHOrecommended treatment and care. Active, drug-sensitive TB disease is treated with a standard 6month course of four antimicrobial drugs that are provided with information, supervision and support to the patient by a health worker or trained volunteer. The vast majority of TB cases can be cured when medicines are provided and taken properly.

What is multidrug-resistant tuberculosis and how do we control it? Online Q&A Updated October 2013 Q: What is multidrug-resistant tuberculosis and how do we control it? A: The bacteria that cause tuberculosis (TB) can develop resistance to the antimicrobial drugs used to cure the disease. Multidrug-resistant tuberculosis (MDR-TB) is TB that does not respond to at least isoniazid and rifampicin, the two most powerful anti-TB drugs. The primary causes of multidrug resistance are mismanagement of TB treatment and person-toperson spread. Most people with tuberculosis are cured by a strictly followed, six-month drug regimen that is provided to patients with support and supervision. Inappropriate or incorrect use of antimicrobial drugs, or use of ineffective formulations of drugs, and premature treatment interruption can cause drug resistance, which can then be transmitted, especially in crowded settings such as prisons and hospitals. In some countries, it is becoming increasingly difficult to treat MDR-TB. Treatment options are limited and expensive, recommended medicines are not always available, and patients experience many adverse effects from the drugs. In some cases even more severe drug-resistant tuberculosis may develop. Extensively drug-resistant TB, XDR-TB, is a form of multi-drug resistant tuberculosis that responds to even fewer available medicines. It has been reported in 92 countries worldwide. Solutions to control drug-resistant TB are to:

cure the TB patient the first time around; ensure adequate infection control in facilities where patients are treated; ensure the appropriate use of recommended second-line drugs to treat this form of TB. In 2012, an estimated 450 000 people developed MDR-TB in the world. It is estimated that about 9.6% of these cases were XDR-TB.

Tuberculosis

Fact sheet N104 Updated October 2013

Key facts

Tuberculosis (TB) is second only to HIV/AIDS as the greatest killer worldwide due to a single infectious agent.

In 2012, 8.6 million people fell ill with TB and 1.3 million died from TB. Over 95% of TB deaths occur in low- and middle-income countries, and it is among the top three causes of death for women aged 15 to 44.

In 2012, an estimated 530 000 children became ill with TB and 74 000 HIV-negative children died of TB.

TB is a leading killer of people living with HIV causing one quarter of all deaths. Multi-drug resistant TB (MDR-TB) is present in virtually all countries surveyed. The estimated number of people falling ill with tuberculosis each year is declining, although very slowly, which means that the world is on track to achieve the Millennium Development Goal to reverse the spread of TB by 2015.

The TB death rate dropped 45% between 1990 and 2012. An estimated 22 million lives saved through use of DOTS and the Stop TB Strategy recommended by WHO.

About one-third of the world's population has latent TB, which means people have been infected by TB bacteria but are not (yet) ill with disease and cannot transmit the disease. People infected with TB bacteria have a lifetime risk of falling ill with TB of 10%. However persons with compromised immune systems, such as people living with HIV, malnutrition or diabetes, or people who use tobacco, have a much higher risk of falling ill. When a person develops active TB (disease), the symptoms (cough, fever, night sweats, weight loss etc.) may be mild for many months. This can lead to delays in seeking care, and results in transmission of the bacteria to others. People ill with TB can infect up to 10-15 other people through close contact over the course of a year. Without proper treatment up to two thirds of people ill with TB will die.

Who is most at risk? Tuberculosis mostly affects young adults, in their most productive years. However, all age groups are at risk. Over 95% of cases and deaths are in developing countries. People who are co-infected with HIV and TB are 21 to 34 times more likely to become sick with TB (see TB and HIV section). Risk of active TB is also greater in persons suffering from other conditions that impair the immune system. About half a million children (0-14 years) fell ill with TB, and 74 000 HIV-negative children died from the disease in 2012. Tobacco use greatly increases the risk of TB disease and death. More than 20% of TB cases worldwide are attributable to smoking. Global impact of TB TB occurs in every part of the world. In 2012, the largest number of new TB cases occurred in Asia, accounting for 60% of new cases globally. However, sub-Saharan Africa carried the greatest proportion of new cases per population with over 255 cases per 100 000 population in 2012. In 2012, about 80% of reported TB cases occurred in 22 countries. Some countries are experiencing a major decline in cases, while cases are dropping very slowly in others. Brazil and China for example, are among the 22 countries that showed a sustained decline in TB cases over the past 20 years. In the last decade, the TB prevalence in Cambodia fell by almost 45%. Symptoms and diagnosis Common symptoms of active lung TB are cough with sputum and blood at times, chest pains, weakness, weight loss, fever and night sweats. Many countries still rely on a long-used method called sputum smear microscopy to diagnose TB. Trained laboratory technicians look at sputum samples under a microscope to see if TB bacteria are present. With three such tests, diagnosis can be made within a day, but this test does not detect numerous cases of less infectious forms of TB. Diagnosing MDR-TB (see Multidrug-resistant TB section below) and HIV-associated TB can be more complex. A new two-hour test that has proven highly effective in diagnosing TB and the presence of drug resistance is now being rolled-out in many countries. Tuberculosis is particularly difficult to diagnose in children.

Treatment TB is a treatable and curable disease. Active, drug-sensitive TB disease is treated with a standard six-month course of four antimicrobial drugs that are provided with information, supervision and support to the patient by a health worker or trained volunteer. Without such supervision and support, treatment adherence can be difficult and the disease can spread. The vast majority of TB cases can be cured when medicines are provided and taken properly. Since 1995, over 56 million people have been successfully treated and an estimated 22 million lives saved through use of DOTS and the Stop TB Strategy recommended by WHO and described below. TB and HIV At least one-third of people living with HIV worldwide in 2012 are infected with TB bacteria, although not yet ill with active TB. People living with HIV and infected with TB are 30 times more likely to develop active TB disease than people without HIV. HIV and TB form a lethal combination, each speeding the other's progress. Someone who is infected with HIV and TB is much more likely to become sick with active TB. In 2012 about 320 000 people died of HIV-associated TB. Almost 25% of deaths among people with HIV are due to TB. In 2012 there were an estimated 1.1 million new cases of HIV-positive new TB cases, 75% of whom were living in Africa. As noted below, WHO recommends a 12-component approach to integrated TB-HIV services, including actions for prevention and treatment of infection and disease, to reduce deaths. Multidrug-resistant TB Standard anti-TB drugs have been used for decades, and resistance to the medicines is growing. Disease strains that are resistant to a single anti-TB drug have been documented in every country surveyed. Multidrug-resistant tuberculosis (MDR-TB) is a form of TB caused by bacteria that do not respond to, at least, isoniazid and rifampicin, the two most powerful, first-line (or standard) antiTB drugs. The primary cause of MDR-TB is inappropriate treatment. Inappropriate or incorrect use of antiTB drugs, or use of poor quality medicines, can all cause drug resistance.

Disease caused by resistant bacteria fails to respond to conventional, first-line treatment. MDRTB is treatable and curable by using second-line drugs. However second-line treatment options are limited and recommended medicines are not always available. The extensive chemotherapy required (up to two years of treatment) is more costly and can produce severe adverse drug reactions in patients. In some cases more severe drug resistance can develop. Extensively drug-resistant TB, XDR-TB, is a form of multi-drug resistant tuberculosis that responds to even fewer available medicines, including the most effective second-line anti-TB drugs. About 450 000 people developed MDR-TB in the world in 2012. More than half of these cases were in India, China and the Russian Federation. It is estimated that about 9.6% of MDR-TB cases had XDR-TB. WHO response WHO's pursues six core functions in addressing TB. 1. Provide global leadership on matters critical to TB. 2. Develop evidence-based policies, strategies and standards for TB prevention, care and control, and monitor their implementation. 3. Provide technical support to Member States, catalyze change, and build sustainable capacity. 4. Monitor the global TB situation, and measure progress in TB care, control, and financing. 5. Shape the TB research agenda and stimulate the production, translation and dissemination of valuable knowledge. 6. Facilitate and engage in partnerships for TB action. The WHOs Stop TB Strategy, which is recommended for implementation by all countries and partners, aims to dramatically reduce TB by public and private actions at national and local levels such as: 1. pursue high-quality DOTS expansion and enhancement. DOTS is a five-point package to: a. secure political commitment, with adequate and sustained financing b. ensure early case detection, and diagnosis through quality-assured bacteriology c. provide standardized treatment with supervision and patient support d. ensure effective drug supply and management and e. monitor and evaluate performance and impact; 2. address TB-HIV, MDR-TB, and the needs of poor and vulnerable populations;

3. contribute to health system strengthening based on primary health care; 4. engage all care providers; 5. empower people with TB, and communities through partnership; 6. enable and promote research.

Facts About TB

In 2012 8.6 million people fell ill with TB

But tuberculosis is curable and preventable.

A total of 1.3 million people died from TB in 2012 (including 320 000 people with HIV)
TB remains one of the world's top infectious killers. About 95% of TB deaths occur in low- and middleincome countries and it is among the top three causes of death among women aged 15 to 44.

TB is the leading killer of people living with HIV

About one in four deaths among people with HIV is due to TB. But about 1.3 million lives were saved over seven years (2005 to 2011) through coordinated TB and HIV services to detect, prevent and treat the dual infections.

Multidrug-resistant TB (MDR-TB) does not respond to standard treatments and is difficult and costly to treat
MDR-TB is a form of TB that is present in virtually all countries surveyed by WHO. The primary cause of multi-drug resistance is the inappropriate or incorrect use of anti-TB drugs.

An estimated 450 000 people developed MDR-TB in 2012

In some cases an even more severe form of multi-drug resistant TB may develop with bad treatment. Extensively drug-resistant TB (XDR-TB) is a form of TB that responds to even fewer available medicines.

An estimated 450 000 people developed MDR-TB in 2012

In some cases an even more severe form of multi-drug resistant TB may develop with bad treatment. Extensively drug-resistant TB (XDR-TB) is a form of TB that responds to even fewer available medicines.

The world is on track to achieve two global TB targets set for 2015: Europe and Africa are not on track

The Millennium Development Goal, which aims to halt and reverse global incidence; and The Stop TB Partnership target of halving deaths from TB (in comparison with 1990).

PENGAWAS MENELAN OBAT (PMO)

Pengobatan TB memerlukan jumlah obat yang cukup banyak (minimal 4 obat/hari pada fase awal dan 2 obat/hari pada fase lanjutan) dan lama pengobatan yang panjang (minimal 6 bulan). Bila ada penyakit lain maka jumlah obat menjadi lebih banyak lagi dan pada beberapa jenis TB memerlukan masa pengobatan yang lebih panjang. Masalah lain adalah masyarakat sering menghindari kontak dengan penderita TB, mengisolasi, memisahkan peralatan makan, kebersihan, pakaian dan lainlain. Keadaan tersebut membuat penderita TB merasa malu, rendah diri dan bahkan bisa depresi, sehingga ada kemungkinan pasien tidak mau konsultasi ke petugas kesehatan,malas minum obat, atau menghentikan pengobatan.

Penderita TB paru yang tidak berobat atau minum obat tapi tidak sesuai pedoman akan berisiko penyakitnya makin parah dan menulari orang di sekitarnya saat yang bersangkutan batuk atau bersin. Akibatnya jumlah penderita TB makin banyak dan program pemberantasan TB jadi semakin berat. Salah satu usaha untuk menjamin pasien tetap semangat menelan obat sampai sembuh adalah menyiapkan seseorang untuk mendampingi pasien TB, disebut PMO (Pengawas Menelan Obat).

Siapa yang menjadi PMO? PMO sebaiknya sudah ditetapkan sebelum pengobatan TB dimulai. Bila pasien mampu datang berobat teratur maka paramedic atau petugas sosial dapat berfungsi sebagai PMO, namun bila sulit datang berobat rutin maka PMO sebaiknya seseorang yang tinggal serumah atau dekat rumah pasien. Beberapa pilihan yang dapat menjadi PMO adalah

Petugas kesehatan Orang lain (kader, tokoh masyarakat, dll) Suami, istri, keluarga, orang serumah Selama perawatan di rumah sakit yang bertindak sebagai PMO adalah petugas rumah sakit.

Syarat PMO

Bersedia dengan sukarela membantu pasien TB sampai sembuh selama pengobatan dengan obat anti TB (OAT) dan menjaga kerahasiaan bila penderita juga HIV/AIDS Diutamakan petugas kesehatan, pilihan lain adalah kader kesehatan, kader dasawisma, kader PPTI , kader PKK atau anggota keluarga yang disegani pasien

Tugas PMO

Bersedia mendapat penjelasan di poliklinik Melakukan pengawasan terhadap pasien dalam hal minum obat Mengingatkan pasien untuk pemeriksaan ulang dahak sesuai jadwal yang telah ditentukan Memberikan dorongan terhadap pasien untuk berobat secara teratus sampai selesai Mengenali efek samping ringan obat dan menasehati pasien agar tetap mau menelan Merujuk pasien bila efek samping semakin berat Melalkukan kunjungan rumah Menganjurkan anggota keluarga untuk memeriksa dahak bila ditemui gejala TB

obat

Tindakan pencegahan TBC paru oleh orang yang belum terinfeksi

1. Selalu berusaha mengurangi kontak dengan penderita TBC paru aktif. 2. Selalu menjaga standar hidup yang baik, caranya bisa dengan mengkonsumsi nakanan yang bernilai gizi tinggi, menjaga lingkungan selalu sehat baik itu di rumah maupun di tempat kerja (kantor), dan menjaga kebugaran tubuh dengan cara menyempatkan dan meluangkan waktu untuk berolah raga. 3. Pemberian vaksin BCG, tujuannya untuk mencegah terjadinya kasus infeksi TBC yang lebih berat. Vaksin BCG secara rutin diberikan kepada semua balita.

Tindakan pencegahan TBC paru oleh penderita agar tidak menular

Bagi mereka yang sudah terlanjur menjadi penederita TBC aktif tindakan yang bisa dilakukan adalah menjaga kuman (bakteri) dari diri sendiri. Hal ini biasanya membutuhkan waktu lama sampai beberapa minggu untuk masa pengobatan dengan obat TBC hingga penyakit TBC sudah tidak bersifat menular lagi. Berikut ini adalah beberapa tips dan cara untuk membantu menjaga pencegahan TBC agar infeksi bakteri tidak menular kepada orang-orang di sekitar anda baik itu teman atau keluarga di rumah. 1. Selama beberapa minggu menjalani pengobatan sebaiknya tidak berpergian ke mana pun baik itu sekolah, tidak melakukan aktifitas di tempat kerja (ngantor), dan tidak tidur sekamar dengan orang lain meskipun keluarga sendiri sebagai usaha pencegahan TBC agar tidak menular. 2. Sifat dari kuman (bakteri) TBC adalah memiliki kemampuan menyebar lebih mudah di dalam ruangan yang tertutup di mana udara tidak bergerak. Jika ventilasi ruangan untuk sirkulasi udara kurang, bukalah jendela dan nyalakan kipas angin untuk meniupkan udalah dari dalam ke luar ruangan.

3. Selalu menggunakan masker untuk menutup mulut kapan saja ketika didiagnosis TBC. Hal ini merupakan langkah pencegahan TBC secara efektif dan jangan membuang masker yang sudah tidak dipakai lagi pada tempat yang tepat dan aman dari kemungkinan terjadinya penularan TBC ke lingkungan sekitar. 4. Jangan meludah di sembarangan tempat, meludah hendaknya pada wadah atau tempat tertentu yang sudah diberi desinfektan atau air sabun. 5. Menghindari udara dingin dan selalu mengusahakan agar pancaran sinar matahari dan udara segar dapat masuk secukupnya ke ruangan tempat tidur. Usahakan selalu menjemur kasur, bantal, dan tempat tidur terutama di pagi dan di tempat yang tepat. 6. Tidak melakukan kebiasaan sharing penggunaan barang atau alat. Semua barang yang digunakan penderita TBC harus terpisah dan tidak boleh digunakan oleh orang lain bai itu teman bahkan anak, istri dan keluarga. Perlu dingat dan diperhatikan bahwa meraka yang sudah mengalami terkena penyakit infeksi TBC dan menjadi penderita kemudian diobati dan sembuh kemungkinan bisa terserang infeksi kembali jika tidak melalukan pencegahan TBC dan menjaga kesehatan tubuh. 7. Mengkonsumsi makanan yang mengandung banyak kadar karbohidrat dan protein tinggi.