Int. J. Life. Sci. Scienti. Res.,
3(6):
1471-1475,
November 2017
Prevalence
of Tuberculosis: Present Status and Overview of Its Control System in
Bangladesh
Md. Samiul Islam1, Razia
Sultana1, Md. Amit Hasan1, Md.
Abu Horaira2, Md. Azizul Islam3,4*
1Department
of Genetic Engineering and Biotechnology, Faculty of Life and Earth Science,
University of Rajshahi, Bangladesh
2Department
of Statistics, University of Rajshahi, Bangladesh
3Department
of Biotechnology and Genetic Engineering, Faculty of Applied Science and
Technology, Islamic University, Kushtia-7003, Bangladesh
4
State Key Laboratory of Plant Genomics, Institute of Microbiology, University
of Chinese Academy of Sciences, China
*Address for
Correspondence: Md. Azizul Islam, PhD
research fellow, State Key Laboratory of Plant
Genomics, Institute
of Microbiology, University of Chinese Academy of Sciences, No.
1 Beichen West Road, Chaoyang
District, Beijing 100101, P. R. China
ABSTRACT- Tuberculosis (TB) is one of the major prevalent disease, which is
caused by Mycobacterium tuberculosis
and among all the diseases it exists in harmful condition. The long term cough with blood sputum and fever is the major
symptom of tuberculosis. In 2014, 1.5 million TB patients were dead from the 9.6
million active TB patients. Every second someone in the world affected by M. tuberculosis and 10% of the affected
people will be infected in their later period of life. The global scenario in
terms of TB infection is varies from one country to another. Developing country
like Bangladesh stands on much more harmful condition. According to WHO Global
TB Report 2016, Bangladesh is one of the world’s 30 high TB burden countries
and near about 73, 000 people die annually due to Tuberculosis. In addition,
Multi Drug Resistance Tuberculosis (MDR-TB) is increasingly affected the people
and it is now a major concern for disease prevention. The infection chances of
a HIV affected people are much higher than a healthy people in case of
tuberculosis. Although, the infection rate of tuberculosis is increasing over
the last few decades, but new anti-Tb drugs show greater audacity to eradicate
critical situation of tuberculosis. Through the molecular analysis, researchers
pointed out the M. tuberculosis resistance,
which will give us effective result in the improvement of drug development.
This review summarized the novel drugs, treatment phenomenon and overall condition
of tuberculosis in Bangladesh.
Keywords- Mycobacterium tuberculosis, Multi
Drug Resistance Tuberculosis, HIV, TB infection
INTRODUCTION- Tuberculosis (TB) is one of the most
virulent disease, which caused by Mycobacterium tuberculosis (MTB) bacterium. From the ancient
period, this disease has played troublesome preface of mankind [1].
It has been estimated that about one-third of world’s population to be affected
with TB and more than 95% patients died in developing countries [2].
Generally TB affects the lungs, but other parts of the body can also be
affected [3]. The true sign of active TB are a long term cough with
blood-containing sputum, fever, night sweats, and weight loss [4].
Robert Koch was discovered the causal agent M.
tuberculosis, and awarded Nobel Prize in physiology or medicine in 1905 [5].
Tuberculosis germs transmitted from person to person through the air when they
have active TB in their lungs cough, spit, speak, or sneeze [6].
Active TB is diagnosed by chest X-rays, as well as microscopic examination and
culture of body fluids whereas tuberculin skin test (TST) or blood tests done
in latent TB patient [7]. TB prevention comprises screening of those
are at high infection risk, early detection and vaccination with the bacillus Calmette-Guérin vaccine [8-9]. Over a long
period of time multiple antibiotics required for TB treatment. After the Second
World War the first anti-tuberculosis drugs were introduced and then more
effective drugs following in the early 1950s.
During this time very worthy observational studies were conducted. This
information provided details elaboration of disease progression without the
influence of chemotherapy or human immunodeficiency virus (HIV) infection. TB
subsequently collision the income bankrupt into poverty, the food deprived into
a condition of further malnutrition [10]. Now M. tuberculosis can showed resistency
against antimicrobial drugs. The two most widely used TB drugs such as rifampicin and isoniazid cannot
respond their efficacy against Multidrug-resistant tuberculosis (MDR-TB) [11]. In Bangladesh TB
has been a major public health concern for last few decades. According to the
World Health Organization (WHO), Bangladesh ranks seventh among the 30 highest
TB-burdened countries [12]. Bangladesh made a remarkable progress in
Directly Observed Treatment Short course (DOTS) implementation since it’s been
running in 1993. The country achieved a 100% DOTS coverage in 2003, the
treatment success rate is persistently above 90% from 2000, and case detection
rate for new smear positive pulmonary TB above 70% since 2006 [13].
The aims of this review were looked into the overall situation of TB disease in
Bangladesh and highlight the present status of this disease, pathogenesis,
treatment and control of TB, in order to better understand the disease.
Global epidemiology- TB is generally affected the humans from the beginning of their
history and remains it’s one of the leading causes of death worldwide contempt
the spotting of fruitful and affordable chemotherapy more than 50 to 60 year
ago [14-15]. According to WHO, TB is pandemic and among the fifteen
countries where 13 are Africans, while half of the new cases are in six Asian
countries with highest estimated TB incidence rates [16]. In 2007
there was an estimate 13.7 million chronic active cases [17], and
8.8 million new cases in 2010 and 1.45 million deaths mostly occur in
developing countries [18]. Among these 0.35 million deaths
occur in those co-infected with HIV [19]. In 2015, 1.8 million
people out of 10.4 were affected and died by these diseases [20].
Histrionic progress was achieved Russia in its mortality rate from 61.9 per 0.1
million in 1965 to 2.7 per 0.1 million in 1993 [21]; however these
rate increased to 24 per 0.1 million in 2015 and then rebound to 11 per 0.1
million by 2015 [22]. Across
the globe TB distribution is not uniform; about 80% of the Africans, Caribbean,
south Asian and Eastern Europe populations were tuberculin test positive, while
only 5-10% of the U.S. population test positive [23]. In India, every year 0.5 million patients
died due to pulmonary TB. The scientists try to find out the associated causes
such oxidative stress, degenerative disease, and antioxidant status [24]. According to (WHO), during 2000-2015, India's estimated
mortality rate dropped down from 55 to 36 per 0.1 million population per year
with estimated 480 thousand people died of TB in 2015 [25]. In
developed countries, TB is less common. In Europe, TB death fell from 500 out
of 0.1 million in 1850 to 50 out of 0.1 million by 1950. When related
antibiotics were come than these disease was reduced, although its remains a
significant threat to public health, such that when the Medical Research
Council was formed in Britain in 1913 [26]. In Canada, tuberculosis
is still endemic in some rural areas [27].
Bangladesh status- In Bangladesh, the population migration is high and these
population faces poverty, densely living and poorly living and working
situation, all of these facts are allow TB spread. Beside these, many parts of
the Bangladesh population has a general lack of consciousness about TB infection.
Urban areas in Bangladesh are densely populated and about one third of the
populations are slum dwellers, creating conditions where a high transmission
can occur [28]. In case of
Bangladesh, tuberculosis services were started in 1965 under numerous TB
clinics and hospitals. In the first half of 80’s TB treatment expanded 20%
areas of the country, during the second health and population plan (1980-1986).
Then, during the period of third health and population Plan (1986-1991) under
the Mycobacterial Disease Control (MBDC) Directorate of the
Directorate-General of Health Services (DGHS), TB services were operationally
integrated with leprosy.
.jpg)
Fig. 1: Current situation of Tuberculosis (TB)
in Bangladesh
National tuberculosis control program (NTP) adopted the Directly Observed Chemotherapy, Short Course (or DOTS) strategy during the
fourth population and health plan (1992-98) under the project of “Further
Development of TB and Leprosy Control Services”. In the mid-90’s NTP initiated
its field implementation and gradually expanded to cover most part of the
country. In 2002, DOTS was expanded to Dhaka Metropolitan City and by 2003, 99%
of the country’s population was brought under DOTS services. However, the government
of Bangladesh committed to intensify the DOTS program and linked up this
program to the Millennium development Goals (MDGs) [29]. In
addition, Bangladesh has a five-year National Strategic Plan for TB control
(2015-2020) which reduce the prevalence of TB and increases the treatment
success rate of at least 90% for all forms of TB. Noteworthy, this plan will be
ensure the treatment of all multi drug resistant (MDR)-TB cases and aligned all
private and public health providers [30].
Kinds of Tuberculosis
(TB)- Mainly
tuberculosis divided into two classes. One is pulmonary TB and another is
extra-pulmonary TB. Pulmonary TB is categorized into some sub-classes. The M. tuberculosis, when developed on the
edge of the lung rupture into space of pleura, it is tuberculosis pleurisy. In
other cases, when bacteria destroy the progressive lung by cavity formation, it
is cavitary TB. In case of miliary
TB, bacteria
affect the bloodstream. This form of TB can be rapidly fatal. In contrast to
extra-pulmonary TB, it is mainly occurred in immuno-compromised
patients [31]. Most of the cases kidney is affected by
extra-pulmonary TB disease and renal tube is the most common organ for
extra-pulmonary TB infection [32].
Diagnosis
of Tuberculosis (TB)- The
diagnosis system of TB can be done by different tests. In microbiological
diagnosis section, it includes sputum, laryngeal swab, gastric
washing, bronchoscopy, and PCR analysis. In
radiography diagnosis section, it includes chest x-ray, CT scan, and FDG PET/CT
tests. In immunological diagnosis part, it includes ALS assay, Transdermal patch, Tuberculin skin test, Mantoux skin test, and Heaf
tests. In recent years, adenosine deaminase test,
Nucleic acid amplification tests (NAAT), and Interferon-γ
release assays is more effective for the diagnosis of TB. But these advanced diagnosis tests of TB is costly for developing
country like Bangladesh [33].
Tuberculosis (TB) drugs and its present
situation in Bangladesh- More than 20 drugs used
for the treatment of tuberculosis disease.
Among them most of the drugs developed more than 40 years ago. A very recent
review by Islam et al. summarized some new anti-TB drugs target in M. tuberculosis [34]. Initial
treatment of TB disease start with 4-drug regimen: isoniazid,
rifampicin, pyrazinamide,
and either ethambutol or streptomycin. After
isolating susceptible TB, ethambutol or streptomycin
can be discontinued [35].
.jpg)
Fig. 2: X-ray
report of TB patient before and after treatment
Table 1: WHO recommended doses of the First line anti-TB drugs
|
Drugs |
Daily doses (mg/kg) |
Route |
Thrice weekly dosage (mg/kg/dose) |
|
Isoniazid (H) |
5 (4-6) |
Oral |
10 (8-12) |
|
Rifampin (R) |
10 (8-12) |
Oral |
10 (8-12) |
|
Ethambutol (E) |
15 (15-20) |
Oral |
30 (25-35) |
|
Pyrazinamide (Z) |
25 (25-30) |
Oral |
35 (30-40) |
|
Streptomycin (S) |
15 (12-18) |
Oral |
15 (12-18) |
Table 2: WHO recommended doses of the Second line anti-TB drugs
|
Drugs |
Daily doses (mg/kg) |
Route |
Maximum daily dose |
|
Kanamycin (K) |
15 |
IM |
Up to 1 gm |
|
Amikacin (A) |
15 |
IM |
Up to 1 gm |
|
Ethionamide (Eto) |
10-15 |
Oral |
Up to 1 gm |
|
Cycloserine (Cs) |
10 |
Oral |
Up to 1 gm |
|
Para amino salicylic acid (PAS) |
250 |
Oral |
Up to 1 gm |
|
Ofloxacin (Ofx) |
15-20 |
Oral |
800-10000 mg |
|
Levofloxacin |
7.5-10 |
Oral |
750-1000 mg |
|
Moxifloxacin |
7.5-10 |
Oral |
400 mg |
After two month of
treatment, pyrazinamide can be stopped. Then, isoniazid plus rifampicin are continued
for 4 more months. If isoniazid resistance is
appeared stopped isoniazid and continue treatment
with rifampicin, pyrazinamide,
and ethambutol for the next 6 months. In case of
Bangladesh, 9 to 12 month regimen marked to be effective for treating MDR-TB
cases. It includes a primary phase of kanamycin, moxifloxacine, pyrazinamide,
high-doses isoniazid, and ethambutol.
Then, 5 months treatment of moxifloxacine, pyrazinamide, and ethambutol
should be continued [36].
HIV related Tuberculosis- Human immunodeficiency virus (HIV) is one of the most
threatening viruses for developing the AIDS [37]. Generally
the virus affects our immune systems, particularly in T lymphocytes and
macrophages, which operating cell mediated immunity in human body [38]. Infection with TB pathogen can occur when an individual’s
exposed to an infectious case of TB inhales particles containing the tubercle
bacilli [39]. In HIV infection, macrophage abnormally functions in
response to TB infection, which may increase the susceptibility of TB disease [40].
Immuno competent individuals infected with M. tuberculosis have approximately a 10% lifetime risk
of developing TB [41], with half of the risk occurring in the first
1-2 years after infection. In contrast, HIV-infected individuals with latent TB
are approximately 20-30 times more likely to develop TB disease than those who
are HIV uninfected, at a rate of 8-10% per year. [42]
CONCLUSIONS- Tuberculosis disease
has still prevalent in many countries like Bangladesh. But developing country
faces many troubles to tackling tuberculosis disease, such as lower diagnostic
opportunity, lesser quality of treatment and unavailability of advanced drugs.
The national TB prevalence survey is considered to be another success of
Bangladesh’s against TB disease. Although, successful treatment rate against
normal tuberculosis much lower than multi-drug resistance tuberculosis. So new
era of drug lines shown complaisant respond against tuberculosis and prevent
epidemic condition. In future, better technology, advanced diagnosis systems,
skilled full manpower, enough funds, and well equipped laboratory will help us
to achieve desired control and management systems against TB disease.
ACKNOWLEDGEMENTS- The authors
like to thanks National Tuberculosis Programme (NTP)
of Bangladesh for their informative support. The authors did not receive any
funding for this review.
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