TUBERCULOSIS

Background Mycobacterium tuberculosis (TB) has infected a third of the world's population, according to the WHO about 8 million people worldwide were attacked TB with 3 million deaths per year (WHO, 1993). In developing countries these deaths account for 25% of deaths that could have held disease prevention. An estimated 95% of TB sufferers are in developing countries With the advent of HIV / AIDS epidemic in the world will increase the number of TB patients. Female mortality due to TB are more than the deaths due to pregnancy, childbirth and childbirth (WHO). WHO declared a global emergency for TB disease in 1993 due to a third of the world's population is estimated to have been infected with TB germs. 

In Indonesia, tuberculosis re-emerged as a leading cause of death after heart disease and respiratory tract. Pulmonary TB disease, remains a public health problem. Household health survey results (SKRT) in 1995 showed that tuberculosis is the number 3 cause of death after cardiovascular disease and respiratory disease in all age groups and number of class I of the infection. Between 1979? 1982 prevalence survey has been conducted in 15 provinces with the results of 200-400 patients per 100,000 population. It is estimated that every year 450,000 new cases of TB in which approximately 1 / 3 patients there were around health centers, 1 / 3 is found in service hospitals / clinics pemerintahd the private sector, private practice and the rest have not terjangku health care units. While deaths due to TB is estimated to 175,000 per year. TB disease attacks the most productive working age group, most TB patients from lower socioeconomic groups. From 1995-1998, the range of pulmonary TB patients with DOTS strategy (Directly Observed Treatment Shortcourse Chemotherapy)-or swallowing the direct supervision of short-term drug / every day-just reached 36% with 87% cure rate. Before the DOTS strategy (1969-1994) of coverage by 56% with cure rates can be achieved only 40-60%. Because the treatment of irregular and inadequate drug combinations in the past may have TB germs arise immunity against TB (anti tuberculosis drugs) in a widespread or multi-drug resistance (MDR). 

Definition:  
Tuberculosis: is directly infectious disease caused by the TB germ (Mycobacterium Tuberculosis), most of the TB germs attack the lungs, but can also on other organs. Tuberculosis Germs: Rod-shaped bacteria, have special properties of the acid in the staining Taha, therefore referred to as a Resistant Acid Bacillus (AFB), the TB germs die quickly in direct sunlight, but can survive a few hours a dark and humid place. In this germ tissue can Dormant, slept for a few years old. 

Mode of transmission:  
Source penularana are smear positive TB patients. At the time of coughing or sneezing, people spread germs keudara in the form of droplets. Droplets containing the bacteria can survive in the air at room temperature for several hours. People can become infected if the droplets are inhaled into the respiratory tract. During the TB germs enter the body through breathing, these TB germs can spread from the lungs other body gets, through the circulatory system, the system linfe tract, respiratory tract, or the spread of direct-nagian goto the other body. Power transmission from a patient is determined by the number of bacteria released from the lungs. The higher the degree of positive results of sputum examination, the patient is contagious. When the results of sputum examination is negative (no visible germ), then the patient is considered not contagious. The possibility of someone infected with TB is determined by the concentration of droplets in the air and the length of breathing air. 

Risk of Transmission:  
The risk of transmission of each year (Annual Risk of Tuberculosis Infection = ARTI) in Indonesia is considered quite high and berfariasi between 1? 2%. In regions with ARTI of 1%, means that every year between 1000 population, 10 (ten) people will be infected. Most of the people who will not become infected TB patients, only 10% of which will become infected TB patients. From the above description, it can be expected that regions with ARTI of 1%, then among the 100,000 people on average 100 (hundred) people with tuberculosis every year, of which 50% of patients are smear positive. Factors affecting the likelihood of someone to be patient endurance of TB is low, such as malnutrition or HIV / AIDS. 

History of Tuberculosis
Primary Infection:  
Primary infection occurs when a person was first exposed to TB germs. Are inhaled very small droplet size, so it can pass defense system mukosillier bronchus, and kept walking so until the alveolus and remained there. Infection begins when the TB germs to breed successfully by splitting themselves in the lungs, causing inflammation in the lung, the channel will bring crocus TB linfe to linfe glands around the lung hilum, and is called primary complex. The time between the occurrence of infection to primary complex formation is 4? 6 weeks. The presence of infection can be proved by the tuberculin reaction changes from negative to positive. Continuation after primary infection depends on the amount of germs that enter and immune responses (cellular immunity). In general, immune reactions can stop the progression of TB germs. Nevertheless, there are some germs will stay as germ persister or dormant (sleeping). Sometimes the immune system is unable mengehentikan germ development, resulting in a few months, the concerned will be patient Tuberculosis. The incubation period, the time needed from infected to become ill, it is estimated about 6 months. 

Post-Primary Tuberculosis (TB Post Primary):  
Post-primary tuberculosis usually occurs after several months or years after primary infection, such as decreased immune system due to HIV infection or poor nutritional status. Characteristic of the post-primary tuberculosis is extensive lung damage with the cavity or pleural effusion. 

Complications in Patients with Tuberculosis:  
The following complications often occur in patients with advanced stage:
Severe hemoptysis (bleeding from the lower respiratory tract), which can result in death due to hypovolemic shock or blockage of the airway. Collapse of the lobe due to bronchial retraction. Bronkiectasis and Fibrosis in the lung. Spontaneous pneumothorax: a spontaneous collapse because of damage to lung tissue. The spread of infection to other organs such as brain, bones, joints, kidneys and so forth. Cardio pulmonary insufficiency (Cardio Pulmonary insufficiency). Patients who experience severe complications should be hospitalized in the hospital. Pulmonary tuberculosis patients with extensive tissue damage that has been cured (smear negative) can still be experienced coughing up blood. This situation is often confused with cases of relapse. In such cases, treatment with OAT is not required, but adequate given symptomatic treatment. If heavy bleeding, patients should be referred to specialist units. 

Natural Journey TB Not Treated:  
Without treatment, after five years, 50% of TB patients will die, 25% will heal itself with high endurance, and 25% as? Cases of chronic? which remain infectious (WHO 1996). 

Effect of HIV Infection:  
HIV infection resulted in extensive damage to the immune system of mobile (Cellular Immunity), so if there is an opportunistic infection, like tuberculosis, it is concerned will become seriously ill and even cause death. When the number of people infected with HIV increases, the number of TB patients will increase, thus the transmission of TB in the community will increase as well. 

Symptoms of Tuberculosis  
General Symptoms:  
Persistent cough and phlegm for 3 (three) weeks or more. Other symptoms of Frequently Found: Sputum mixed with blood. Coughing up blood. Shortness of breath and chest pain. Body weakness, decreased appetite, weight loss, body discomfort (malaise), night sweats, although no activity, fever, fever more than a month. 

Discovery  Tuberculosis (TB) Patient
The discovery of Tuberculosis in Adult Patients.  
The discovery of the TB patients conducted in Passive, meaning crawl suspects held in those patients who come to visit the health care units. The discovery of these passively supported by extension actively, both by health workers and the community, to increase coverage suspected invention. This method is commonly known as the Passive Case Finding Promotive In addition, all contacts of smear positive pulmonary tuberculosis patients with similar symptoms, should be examined sputum. A health worker is expected to find a suspected case as early as possible, considering that tuberculosis is a contagious disease that can lead to kematian.Semua suspect patient should be examined three sputum specimens within 2 days in a row, both when? morning? while (SPS). The discovery of Tuberculosis Patients in Children. The discovery of tuberculosis in children is difficult. Most of the child's diagnosis of tuberculosis was based on clinical, radiological images and tuberculin test. 

Diagnosis of Tuberculosis (TB)  
Diagnosis of Tuberculosis in Adults.  
The diagnosis of pulmonary tuberculosis in adults can be enforced with the finding by sputum smear on microscopic examination. Examination results declared positive when at least two of the three SPS smear results are positive. If only 1 positive specimens need to hold further examination of chest x-rays or SPS specimen examination was repeated. If the results of x-rays support the TB, then the patient diidagnosis as smear positive TB patients. If the results of X-rays did not support the TB, then other tests, such as culture. If facilities allow, then it can be done other tests, such as culture. When the three negative sputum specimens, are given broad-spectrum antibiotics (eg co-trimoxazole or Amoxicillin) for 1? 2 weeks. If nothing changes, but remains suspicious clinical symptoms of TB, repeat sputum examination SPS: If positive results of the SPS, were diagnosed as smear positive TB patients. If results remain negative SPS, do pemriksaan chest x-rays, to support the diagnosis of TB. - When the results of x-rays support the TB, TB patients diagnosed as X-rays negative smear positive. - If the results do not support ropntgen TB, the patient is not TB.
UPK who do not have X-ray facility, patients can be referred for chest X-ray photographed. 

THREADS DIAGNOSIS OF TUBERCULOSIS IN ADULT LUNG 
In Indonesia, at present, tuberculin test has no meaning in determining a diagnosis of TB in adults, because most people already infected with Mycobacterium Tuberculosis Due to the high prevalence of TB. A positive tuberculin test indicates that the person concerned only been exposed to Mycobacterium tuberculosis. On the other hand, the results of tuberculin test can be negative even if the person is suffering from tuberculosis. For example, in people with HIV / AIDS, severe malnutrition, TB and morbili out military. 

Reflections on World TB Day  
Every March 24 is celebrated as a day of Tuberculosis (TB) worldwide. This year the commemoration day of TB worldwide theme of "Every Breath Counts-Stop TB Now!". This theme emphasizes the word "breath" which means not only breathing, but also the center of all human activity. Thus, damage to "breath" of tuberculosis will lead to the destruction of all human activity. This theme is once again remind us of the dangers of TB and the urgency of the eradication. In order to celebrate the TBC is also done "2nd Stop TB Partners', the forum and the Stop TB campaign for 2004-2005 which was held in New Delhi. 

Mass murderer
It is no exaggeration to say that the bacterium mycobacterium tuberculosis that causes TB is bekteri mass murderer. WHO estimates that this bacteria kills about 2 million people each year. Between the years 2002-2020 is estimated around 1 billion people will become infected. In other words the number of infections for more than 56 million each year. Typically 5-10 percent of the infection developing into disease, and 40 percent of which develop into the disease ended in death. If counted, the number of TB patients will be increased by about 2.8 to 5.6 million every year, and 1.1 to 2.2 million people die each year from TB. WHO estimates, namely, 2 million people die each year, is based on this calculation. This number is a number that large, because 2-4 people are infected every second, and nearly 4 people die of TB every minute of this. The speed of the spread of tuberculosis could increase again in accordance with the increasing spread of HIV / AIDS and the emergence of TB bacteria that are resistant to the drug. In addition, human migration also accelerate the spread of TB. In the United States, nearly 40 percent of TB patients are people born overseas. Their immigration to America and become a source of spread of TB. So also with the increasing number of refugees from the war with an unhealthy environment to facilitate the spread of TB. An estimated 50 percent of refugees in the world likely infected with TB. In Southeast Asia, WHO data (http:www.whosea.org) indicated that tuberculosis kills about 2,000 people every day. And about 40 percent of the world's TB cases are in Southeast Asia. Two of the three countries with the largest number of TB sufferers in the world, namely India and Indonesia, is in the region. Indonesia is under India, with the number of people in the world, followed by China in second place. Compared with other infectious diseases, tuberculosis is also the number one killer in this region, where the amount is 2-3 times the number of deaths caused by HIV / AIDS which is ranked second. Meanwhile, tropical diseases such as dengue hemorrhagic fever (DHF), not until the tenth. We can imagine how serious a problem this TB. Therefore, we need to realize again that TB is a disease that desperately need attention to be addressed. Because the bacterium Mycobacterium very easily transmitted through airborne droplets when coughing or sneezing TB patients, even while spitting and talking. One person can spread TB bacteria to 10-15 people in one year. Based on data from Hospital "Prof Dr Sulianti Saroso" (http:www.infeksi.com), in Indonesia every year there are 583 thousand cases and 140 thousand of them died. If counted, every day 425 people died from tuberculosis in Indonesia. If 1 patient could infect 10 people, in the following year the number of infected is 5.8 million people. Thus it is clear that tuberculosis is a mass murderer who should be eradicated. 

TB Therapy  
 Because the source of the spread of TB is TB patients themselves, effectively control TB is to reduce TB patients. There are two ways of being made to reduce the TB patients at this time, the therapy and immunization. For therapy, the WHO recommended TB treatment strategy with short-term direct supervision or known as DOTS (Directly Observed Treatment Shortcourse Chemotherapy). In this strategy there are three important stages, namely detection of patients, conduct treatment, and perform direct supervision. Detection or diagnosis of patients is very important because patients who escape from detection will be the next source of spread of TB. A person who is coughing for more than 3 weeks can be suspected tuberculosis. This person must then be diagnosed and confirmed infected with TB germs or not. Until now, accurate diagnosis is to use a microscope. X-ray diagnosis by less specific, while the molecular diagnostics such as Polymerase Chain Reaction (PCR) can not be applied. If the patient has been identified have TB, your doctor will give medicine to the composition and the dosage according to the condition of the patient. As for TB drugs are normally used are isoniazid, rifampicin, pyrazinamide, streptomycin, and Ethambutol. To avoid the emergence of resistant tuberculosis bacteria, are usually given drugs that consist of a combination of 3-4 this drug. Your doctor or health worker and then oversee the process of drugs and drinking patient's progress. This is very important because there is a tendency of patients stop taking the medication because their symptoms have disappeared. After taking TB drugs TB symptoms usually disappear within 2-4 weeks. However, to fully recover from tuberculosis are required to take the drug for at least 6 months. The negative effects that arise if we stop taking the drugs is the emergence of TB germs are resistant to the drug. If this happens, and germs are spread, TB control will be increasingly difficult. DOTS is the most effective strategy for dealing with current TB patients, with cure rates even to 95 percent. DOTS was introduced since 1991 and about 10 million patients have received DOTS treatment of this. In Indonesia, DOTS was introduced in 1995 with a cure rate of 87 percent in 2000 (http:www.who.int). This figure exceeds the WHO target, namely 85 percent, but it is very unfortunate that the level of detection of new cases in Indonesia is still low. Based on WHO data, for 2001, only 21 percent detection rate, far below the WHO target, 70 per cent. Therefore, efforts to medeteksi new cases should be improved. 


Immunization  
Control of TB is the second immunization. Immunization will provide active immunity against TB penyaki. TB vaccine, known as BCG is made from the bacterium M. tuberculosis strains of Bacillus Calmette-Guerin (BCG). This bacterium causes tuberculosis in cattle, but not in humans. This vaccine was developed in 1950 from the bacteria that live M. tuberculosis (live vaccine), and therefore can reproduce in the body and is expected to mengindus antibodies lifetime. In addition, the provision of two or three times had no effect. Therefore, BCG vaccination is required only once in a lifetime. In Indonesia, given before the age of two months. TB immunization is not entirely protect us from attack tuberculosis. Rate the effectiveness of these vaccines ranged between 70-80 percent. Therefore, despite having received the vaccine, we still must be vigilant against attack this TB. Because the effectiveness of this vaccine is not perfect, globally there are two opinions about this TB immunization. The first opinion is not necessary immunizations. United States is one of them. United States did not perform BCG vaccination, but they keep tight against persons or groups who are at high risk and to diagnose them. Patients who are detected will be immediately treated. Detection and diagnosis system that tidy is the key pengontorlan TB in the U.S.. A second opinion is a need for immunization. Because 70-80 percent effectiveness rate, most people can be protected from infection with TB germs. European countries and Japan is a country that considers the need for immunization. Even Japan has decided to perform BCG vaccination of all babies born without Tuberculin test, tests conducted to detect the presence or absence of antibodies that dihasikan by infection with TB germs. If the positive test results, deemed to have been infected with TB and will not be given the vaccine. Because rare cases of tuberculosis in Japan, considered all children not infected with TB germs, so it was decided that the Tuberculin test no longer need to be implemented. What about Indonesia? Because Indonesia is a big country with a population of many, apparently still need to implement this BCG vaccination. By implementing this vaccination, the number of cases of suspected (suspected cases) is much reduced, making it easier for us to detect TB patients, to further DOTS therapy for patients who are detected. Both approaches, ie vaccination and therapy needs to be done to eradicate tuberculosis from Indonesia. : Andi Utama (Research Center for Biotechnology-LIPI and Observer Health Issues)

Fight TB:  

10 THINGS ABOUT tuberculosis and for their handling.  
10 IMPORTANT FACTS ABOUT TB SITUATION IN INDONESIA
Each year there were 583,000 cases of TB in Indonesia Nationally, the TB? Kill? approximately 140,000 people each year Every day 425 people died from tuberculosis in Indonesia. Indonesia is? Contributor? TB cases to-3 in the World, after China and India. The level of risk for developing TB in Indonesia ranges from 1.7% - 4.4% (according to data from 1972 to 1987). Approximately ¾ of tuberculosis patients in Indonesia is categorized in the productive age. In 1995, the Indonesian government began to adopt starategi DOTS (Directly Observed Short-Course Tratment) to tackle tuberculosis. In 1996, TB drugs in health centers is given in the form Kombipak. In 1999 an important era in the response to tuberculosis in Indonesia, since the establishment of GERDUNAS-tuberculosis (TB Prevention National Integrated Movement) which is a real wujut partnership with various sectors involved in TB control in Indonesia. Health economics research in Indonesia found that if treatment can be applied early, every U.S. $ ¬ ¬ 1 that for TB control programs, it will be able to save U.S. $ ¬ ¬ 55 in 20 years.


10 IMPORTANT FACTS ABOUT TB  
Each year there is always an increasing number of TB patients are higher than the previous year. TB kills more youth and women than any other infectious disease. There are about 2 to 3 million people die from tuberculosis every year. Surely every death due to TB can be avoided. Every second, there is 1 person who died as a result of contracting TB. Every 4 seconds, someone is sick due to contracting tuberculosis. Every year. 1% of the population worldwide infected by the disease TB. One third of the world's population is already infected by TB germs (although) not infected by the disease. People with TB are not treated can transmit pentakit to about 10? 15 people in a period of 1 year. Like the flu, TB germs spread through the air when a person suffering from tuberculosis coughing and sneezing, spitting or speaking. TB germs usually attack the lungs. 

10 IMPORTANT FACTS ABOUT TB & TRANSFER OF POPULATION
About 50% of the number of refugees around the world may have been infected with TB, each year, more than 17,000 displaced people suffering from illness due to tuberculosis. Refugee populations face increasing problems due to tuberculosis, the number of IDPs and refugees worldwide has doubled 9 times during the last 20 years. Patients with untreated TB disease can spread rapidly, especially in the camps and the refugee camp environment, It is very difficult to provide TB treatment for people moving. WHO recommends that TB should be a priority, as soon as possible after the emergency phase for the refugees pass. Tourism, travel and migration between countries to support the spread of TB germs. In many industrialized countries, at least half of the number of cases of tuberculosis, was found in people who were born in another country. In the United States, one third of the total cases of tuberculosis, was found in people who are not in the U.S. birthplace The number of TB cases in the U.S. among people yanglahirnya not in the U.S., continues to increase every year. The homeless people in developed countries is the group that his risk of contracting tuberculosis is increasing. In 1995, it was reported that nearly 30% of the population of homeless people in San Francisco (USA) and approximately 25% of the population of homeless people in London (UK) have been infected by TB germs? much higher than the national average in both countries. 

10 IMPORTANT FACTS ABOUT TB & WOMEN  
Tuberculosis is a contagious disease that attacks the most violent and killing women. More than 900 million women around the world infected with TB germs. 1 million of them will die and 2.5 million will soon suffer from the disease this year, Women who suffer from TB are aged between 15? 44 years. Tuberculosis is the most deadly killer disease for young women age. TBC has a share of around 9% of deaths aged 15-44 years, compared to other causes of death (due to the war: 4%, HIV: 3%, and heart disease: 3%). Women in reproductive age are more susceptible to TB and more likely to be infected by TB disease than men of the same age group. Women in the reproductive age group are also at greater risk of HIV penuaran. In some African countries, the number of women who contracted tuberculosis is greater than the number of male sufferers. Tuberculosis causes a greater number of deaths for women than deaths from childbirth. In some parts of the world, stigma or embarrassment due to tuberculosis caused the isolation, ostracism and divorce for women. In some parts of the world, women's movement is pushing the effort to better control TB disease. 

WHAT IS DOTS?  
DOTS stands for Directly Observed or Treatment, Short-course TB treatment is short-term strategy with direct supervision. By using the DOTS strategy, then the healing process can be quick TB. Emphasized the importance of supervision of DOTS TB patients to swallow the medicine on a regular basis as required until declared cured. DOTS strategy provides a high cure rate, can be up to 95%. DOTS strategy recommended by WHO globally to tackle tuberculosis. 

DOTS strategy consists of five components, namely:  
o The political commitment of governments to genuinely tackle tuberculosis.
o The diagnosis of TB disease through microscopic examination of sputum  
o Treatment of tuberculosis with anti-tuberculosis drug combination of short-term, supervised directly by the PMO (observer treatment).  
o Availability of anti-tuberculosis drug combination of short-term consistently. o Recording and reporting of TB patients according to the standard. 

World Bank declared the DOTS strategy is a strategy that most health? Cost effective?. Bangladesh: With the strategy of DOTS, cure rate can reach about 80%. Maldives: cure rate reached about 85% thanks to the DOTS strategy. Nepal: After using DOTS, cure rates reach 85% - previously only reached 50%. PRC: achieve 90% cure rate with DOTS.