Notes on clinical findings, mode of transmission and prevention of Tuberculosis

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Tuberculosis is a specific communicable disease caused by Mycobacterium tuberculosis. It is other­wise known as Phthisis which means “to dry up”. It affects both the pulmonary and non-pulmonary tissues. The disease may be acute or chronic, general or local. It is a disease that is found almost everywhere.

Mode of Transmission:

Tuberculosis is transmitted by “droplet nuclei”, less than 10 microns in diameter, containing one or more tuber­cle bacilli, by an ‘ open” case. Coughing generates larger number of droplets of all sizes than speaking. It is not trans­mitted by vomits, e.g. dishes and other articles used by the patient.

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Incubation Period:

The period of time from infec­tion to onset of progressive disease may be weeks or years depending upon the virulence of the organisms and resis­tance of the person.

Clinical Features:

(i) Persistent chronic cough lasting for more than tour weeks is usually an early and important manifestation.

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(ii) Continuous fever having rise of temperature in evening and the night with drenching sweats during sleep;

(iii) Feeling of general weakness and personating after slight exertion;

(iv) Gradual loss of weight and appetite;

(v) There is disinclination to play having difficulty in breathing;

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(vi) Pain in the chest;

(vii) In severe cases there is presence of blood will the cough.

Protection:

The best approach at the present time lies in pro­phylactic immunization by B.C.G. vaccine. Recognition of the value of BCG came in 1943 when it was accepted by tuberculosis workers from the entire world as a safe preven­tive.

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There are two types of BCG vaccine—the Liquid vaccine, and the Freeze dried vaccine. The liquid vaccine has a short life of 2 weeks from the date of production and it has to be kept under refrigeration in order to maintain its potency. Freeze—dried vaccine is a more stable preparation than liquid vaccine and under refrigeration it can be kept for one year. So the BCG vaccination teams in India are now using freeze—dried vaccine.

BCG vaccination early in life provides a high level of protection against tuberculosis during infancy. So it is routinely given soon after birth. It is given intradermal by a special tuberculin syringe in the dose of 0.05 ml. to 0.1 ml. according to the age of the child. 2 to 3 weeks after successful vaccination, a papule develops which slowly increases in size.

In about 5 weeks it subsides or breaks in to a shallow ulcer which heals spontaneously leaving a tiny permanent scar. BCG affords 80 percent pro­tection for 15 years.

Prevention:

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The modern methods of tuberculosis prevention are based on the following principle early detection of cases:

The most of the cases of pulmonary tuberculosis had one or more of the symptoms referable to chest—pseudo- indignantly persistent cough. Sputum examination may posi­tive for tubercle bacilli. In other sputum negative cases mass miniature radiography shows suggestive shadows in chest but it is very expensive.

2. Chemotherapy:

The ant tubercular drugs play in important role for the prevention as it is potent in clinical cases; easy to administer, free from toxicity and reasonably cheap. Patient can take the drugs at home without hospitalization.

3 BCG Vaccines:

BCG vaccine can be given to the infants as well as to the children up to the age 13 years who have not develop­ed immunity.

4 Preventive treatment:

The drug Ionized has been tried in the preventive treatment of tuberculosis. But in a country such as India, where more than half the population is infected it is unre­alistic to try the administration of drug for preventive treatment. So prevention with BCG gets priority over the drug in India.

5. Rehabilitation:

In recent years, there has been a good deal of fresh thinking on the subject of rehabilitation, because of the success achieved in treating patients on domiciliary lines without interfering with their normal life and work It is needed for those who are chronically ill to suit their physi­cal, mental abilities. Non-Pulmonary Tuberculosis:

Though the tubercle bacillus may attack almost any organ or tissue in the body, the most commonly affected are the peripheral limerick glands mainly the glands of the nice which drain the tonsils and nose-pharynx, the bones and joints mainly the spine, hip, knee and ankle.

Clinical Features:

In case of tuberculosis of the lymphatic glands, the blends become enlarged and painful, there may be irre­gular fever, there is formation of pus inside the gland and at last it bursts which heals up leaving a scar. In case of the affection of joints there is usually some inflammation, intermittent pain and restriction of movement in that particular joint.

Protection and prevention are the same as in case of pulmonary tuberculosis.

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