Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. Until now, tuberculosis is still the most dangerous infectious disease in the world. The World Health Organization (WHO) reports that as many as 1.5 million people died of TB (1.1 million with HIV negative results and 400,000 people with HIV positive) with details of 89,000 men, 480,000 women and 140,000 children. In 2015, the number of TB case finding was 330,910 cases. This number increased from 2014, which was 324,539 cases.
The number of new TB cases in Indonesia was 420,994 cases in 2017 (data as of May 17, 2018). Based on gender, the number of new TB cases in 2017 was 1.4 times greater for men than in women, as was the case in other countries. This may be because men are more exposed to TB risk factors, such as smoking and lack of medication adherence in patients who have been diagnosed with TB.
Most TB disease (active TB) occurs in the lungs. However, in a person with HIV infection, nearly half of TB cases have disease in another part of the body. In contrast to latent TB (asymptomatic TB disease) a person with TB disease in the lungs usually has a cough and sometimes coughs up blood. Common symptoms of TB disease or also known as active TB include fever, night sweats, loss of appetite, weight loss, and fatigue. TB disease can be cured with standard therapy, even in patients with HIV infection. Untreated tuberculosis is often fatal, especially in patients with HIV infection. Sputum smears are often negative in patients with TB and HIV.
Currently, active TB disease is treated with combination therapy consisting of three or more drugs (usually four). The duration of therapy for new TB cases is six months, consisting of the first two months of the intensive phase, followed by four months of the follow-up phase to destroy remaining bacteria that have entered a dormant state (sleep). Currently, standard therapy for drug-sensitive TB infection is highly effective in bacterial clearance. Monitoring the progress of treatment outcomes in adults is carried out by microscopic re-examination of sputum. Microscopic examination of sputum is better than radiological examination in monitoring the progress of treatment. To monitor the progress of treatment, sputum examination was carried out 2 times (during and in the morning). The results of the examination were declared negative if both sputum specimens were negative. If one or both specimens are positive, the results of the sputum examination are positive.
Patient discovery activities consist of screening of suspects, diagnosis, determination of disease classification, and type of patient. The discovery of patients is the first step in the activities of the TB control program. The discovery and cure of infectious TB patients will significantly reduce TB morbidity and mortality, TB transmission in the community and at the same time be the most effective TB transmission prevention activity in the community. The main focus of DOTS (Directly Observed Treatment Shortcourse) is the discovery and cure of patients, priority is given to patients with infectious types of TB. This strategy will stop the transmission of TB and thereby reduce the incidence of TB in the community. Finding and curing patients is the best way to prevent TB transmission.
Pulmonary tuberculosis is caused when the body's immune system decreases. In an epidemiological perspective that sees disease incidence as a result of interactions between the three components of the host (host), agent (agent), and the environment (environment) the risk factors of these nodes can be studied. On the host side, susceptibility to Mycobacterium tuberculosis infection is strongly influenced by a person's immune system at that time. People with HIV AIDS or people with poor nutritional status are more easily infected and contracted TB.
Steps to prevent transmission and prevent TB disease are to always apply cough etiquette, namely;
1. When you are coughing, wear a mask
2. When not wearing a mask and coughing, cover your mouth with your elbows and then wash the exposed area with soap and running water or cover it with a tissue and throw it in the trash.
3. If you want to expel phlegm, throw the phlegm in the toilet
In addition to these 3 steps, which can reduce the risk of transmission of pulmonary TB disease is to pay attention to the supporting infrastructure at home such as lighting the entry of sunlight into the house, ventilation and preventing the house from being humid. Then so that we do not contract TB disease, namely by increasing our immunity by getting enough sleep, eating according to appropriate nutritional needs, diligently exercising and avoiding other risk factors that can trigger TB infection.
Created by : dr. Ghifary AL Ashafaahary Gumelar
Reviewed by : dr.Hery Irawan,Sp.P
Reference:
World Health Organization, 2015, WHO Global Tuberculosis Report 2015
CDC, 2016, Transmission and Pathogenesis of Tuberculosis