NATIONAL TB ELIMINATION PROGRAMME l Presumptive TB, Recurrent TB, CBNAAT l SPM Malayalam

നാഷണൽ ട്യൂബർകുലോസിസ് എലിമിനേഷൻ പ്രോഗ്രാം (NTEP): Presumptive TB, Recurrent TB, CBNAAT, കുട്ടികളിലെ TB നിർണ്ണയം: മലയാളത്തിൽ ലളിതമായി. NEET PG, NExT, AIAPGET, UPSC, Kerala PSC, MD എൻട്രൻസ്, MPH പരീക്ഷകൾക്ക്. This lecture covers the key case definitions and diagnostic approach under the National TB Elimination Programme (NTEP): who counts as presumptive TB, what recurrent TB means, how TB is diagnosed, how CBNAAT works, and how presumptive paediatric TB is identified and confirmed. These definitions are asked again and again in NEET PG, NExT, AIAPGET, UPSC CMS, Kerala PSC and MD entrance exams, and they are essential for MPH and public health students and for anyone working in the programme. Related videos • NTEP Part 2: Strategy and Organisation: [paste link] • TB Epidemiology and Diagnostic Tests: [paste link] TOPICS COVERED 1. Presumptive TB (pulmonary) • Cough for 2 weeks or more • Fever, significant weight loss, night sweats, haemoptysis • Any abnormality on chest X-ray • In high-risk groups (people living with HIV, contacts of TB patients, diabetics, the malnourished and other vulnerable groups), symptoms of any duration are enough • Presumptive extrapulmonary TB: organ-specific symptoms such as lymph node swelling, back pain or pleural effusion • Presumptive drug-resistant (DR) TB: treatment failure, contacts of DR-TB patients, previously treated patients and others at risk 2. Diagnosis of TB under NTEP • Microbiologically confirmed TB: positive smear, culture or a WHO-approved rapid molecular test (NAAT) • Clinically diagnosed TB: no microbiological confirmation, but diagnosed by a clinician on the basis of X-ray, histopathology or clinical findings, and started on treatment • The shift to NAAT (CBNAAT/TrueNat) as the preferred first test where available • Universal Drug Susceptibility Testing (UDST) for every diagnosed patient 3. Case types by treatment history • New case: never treated, or treated for less than 1 month • Recurrent TB: previously declared successfully treated (cured or treatment completed) and now diagnosed again with microbiologically confirmed TB; this may be relapse or reinfection • Treatment after loss to follow-up • Treatment after failure • Other previously treated patients 4. CBNAAT (Cartridge-Based Nucleic Acid Amplification Test) • Platform: GeneXpert MTB/RIF • Detects Mycobacterium tuberculosis DNA and rifampicin resistance at the same time • Rifampicin resistance is detected through mutations in the rpoB gene • Results in about 2 hours • More sensitive than smear microscopy, especially in children, people living with HIV and paucibacillary disease • Rifampicin resistance is taken as a marker of MDR-TB • TrueNat: an indigenous, chip-based, battery-operated NAAT suitable for peripheral laboratories 5. Presumptive paediatric TB • Persistent fever and/or cough for more than 2 weeks • Loss of weight or no weight gain (failure to thrive) • History of contact with an infectious TB patient • Specimens: gastric aspirate, induced sputum, and others as appropriate • Tests: NAAT (preferred), chest X-ray, tuberculin skin test as supportive evidence • Contact tracing and TB Preventive Treatment (TPT) for child contacts QUICK EXAM POINTS • Presumptive pulmonary TB: cough for 2 weeks or more (any duration in high-risk groups) • Recurrent TB = previously cured or treatment completed, now microbiologically confirmed again (relapse or reinfection) • CBNAAT detects MTB plus rifampicin resistance (rpoB gene) in about 2 hours • Rifampicin resistance on CBNAAT is used as a surrogate marker for MDR-TB • Commonest specimen for diagnosing TB in young children who cannot cough up sputum: gastric aspirate • Microbiologically confirmed vs clinically diagnosed: the key difference is laboratory confirmation • New case: never treated, or treated for less than 1 month WHO IS THIS FOR? MBBS, BHMS, BAMS and other AYUSH students, interns and graduates preparing for university exams, NEET PG, NExT, AIAPGET, UPSC CMS, Kerala PSC and MD entrance exams. Also useful for MPH, BPH, Social Medicine and Public Health students, and for health workers involved in TB care. ABOUT THE INSTRUCTOR Dr. Shary Krishna B.S., MD (Homoeopathy), PhD (Public Health, Jawaharlal Nehru University, New Delhi). UGC-NET qualified in Social Medicine & Community Health. About three years of teaching experience in medical colleges. Subscribe and turn on notifications for more Community Medicine and National Health Programme lectures. Share with batchmates preparing for PG entrance and PSC exams. TB is curable. Diagnosis and treatment are free at government health facilities in India. If you or someone you know has a cough for 2 weeks or more, please get tested. Disclaimer: This content is for educational and exam-preparation purposes only. It is not medical advice. Please consult a doctor for any health concern. #NTEP #PresumptiveTB #CBNAAT #PaediatricTB #CommunityMedicine #NEETPG #AIAPGET #KeralaPSC