Medical and social aspects of tuberculosis chandankumar nittur bhaktaprakash

nature of tuberculosis is known for a long time. After

revolution in Russia considerable successes in struggle against tuberculosis have been reached. Tuberculosis morbidity and mortality of the population steadily decreased. In Russia the lowest indices of primary disease incidence with tuberculosis have been noted in 1991: 34,0 persons per 100 thousand, and the lowest indices of death rates – in 1989: 7,4 per 100 thousand. However, in the early nineties tuberculosis morbidity and death rate in the majority of countries of the world began to increase rapidly.

planet is infected with Mycobacterium of tuberculosis. In 1995 about

9 million persons fallen ill (for the first time) in the world, and about 3 million patients have died because of this illness. Mycobacteria of tuberculosis kill more people, than any other contagium.

INDIA
India accounts for nearly one-third of global burden of tuberculosis. Every year, approximately 1.8 million persons develop tuberculosis of which about 0.8 million are new smear positive highly infectious cases and 4.17 lakh people die of TB every year, one person dies every minute, and about 1000 people die every day.

and death rate of the population have increased at average

by 2,5 times and have made in 2005: primary disease incidence has made 68 persons per 100 thousand, and death rate – 20,0 per 100 thousand population. In 2000 the highest levels of tuberculosis morbidity and death rate have been registered for the last decades: morbidity – 90,4, and death rate – 20,6 per 100 thousand population. Among the dead 75 % were the persons of able-bodied age. In total in 2005 more than 2200 thousand patients were registered in TB dispensaries of the country.

there are three links of a complex epidemic chain: a

source of disease, ways of transmission of infection and a susceptible collective.

Ways of transfer of tuberculosis are the following: aerogenic (droplet or air-dust infection), alimentary, contact and pre-natal (from mother to a fetus through placenta). 95 % of all cases of infection fall to aerosol way. Mycobacteria of tuberculosis are very stable in the environment – they easily stand low temperatures (-273 °С), boiling (1-2 mines), survive in sputum at direct sun rays (15-20 min), they long keep viability and can cause disease long time intervals later after discharging them by patients. Alimentary infection is connected with insufficient thermal processing of the foodstuff received from sick animals (meat, milk and dairy products, eggs). Children can also be infected alimentary with mother milk. At a contact way tuberculosis is transmitted through the infected towels, linen, bedding, and ware.

cattle). Those who discharge mycobacteria of tuberculosis into environment are

the most dangerous.

The third link of the epidemic chain is a susceptible collective, which can significantly influence on tuberculosis prevalence. Here the important role belongs both to the general reactance of an organism of each person, and specific antituberculous immunity.

connected with all three links of the epidemic chain. So,

a growth of the revealed for the first time patients discharging mycobacteria of tuberculosis is characteristic for the modern period. Annually in Russia about 60 thousand of such patients come to light, even more than 60 thousand of patients with chronic forms of disease have discharged mycobacteria of tuberculosis for a long time already. Thus, in the country there is a huge reservoir of tubercular infection. Meanwhile one bacillary patient can contaminate 5-10 persons within a year on the average, and under certain conditions there can be epidemic eruptions with infection of 100 persons and more.

bacillary patients from hostels and densely populated apartments. However within

1990s this index was reduced from 53,0 to 15,0 %. Eliminators of bacilli should observe the certain rules, allowing to reduce risk of infection of associates. However, according to our data, only less than a half of the patients (48,8 %) observe these rules. The control of tuberculosis

The important role in tuberculosis preventive maintenance is played by its timely revealing. Fluorographic examination, bacteriological investigation of diagnostic material, routine inspections have great importance. However during the period from 1986 till 1997 the number of fluorographically examined was reduced to 30 million persons, coverage by tuberculosis routine inspections has decreased from 75 to 59%,

attention of phthisiatricians and therapists is claimed by persons who

can be referred to a group of high risk of tuberculosis morbidity. Alcndoholics, the glue sniffers acoemned nd recently released from places of imprisonment are also referred to them, as well as suffering from chronic nonspecific diseases of lungs, diabetes, mental frustration, stomach ulcer, etc. These groups should be revealed and registered by doctors.

necessary to pay essential attention to increase of resistance of

the population to infection. Here the important role belongs to creation of specific antitubercular immunity as a result of immunization by vaccines BCG and BCG-M.

The important role belongs to social preventive maintenance in increase of general reactivity of the organism, decrease in macroorganism susceptibility to tuberculous infection. Improvement of conditions and a way of life,

general increase of protective forces of the person and tuberculosis

susceptibility decrease. Today growth of tuberculosis morbidity is promoted by the whole complex of social factors: defective food of the greater part of the population of the country, growth of alcoholism, narcotism, HIV-infection, deterioration of living conditions, etc.

it is characteristic that it is caused by mycobacterium of

tuberculosis, having high stability to antitubercular preparations. At present, more than 10 % of revealed for the first time patients with the "open" form of tuberculosis discharge drug-resistant mycobacteria. That’s why today the WHO has developed special strategy of treatment tubercular patients – strategy DOTS - Directly Observed Treatment, Short-course (treatment by short-term courses under direct supervision of medical workers) which, according to experts, is economically effective and allowing to reach high results at treatment of patients. To 1995 80 countries of the world (including Russia) have introduced or have started to introduce this strategy.

CHANDANKUMAR NITTUR BHAKTAPRAKASH

LA2-CO-161A