Clinical tuberculosis problems and management

Tuberculosis (TB) is a chronic disease caused by M. tuberculosis. WHO (World Health Organization) 1993 has estimated that one third of world population has been infected by M. tuberculosis bacillus. It is also estimated that 8 million people contract the disease annually and two to three million deaths occur every year due to TB. Major factors that have aggravated the spread of TB are: 1) ineffective TB control programs, leading to the development of multi drug resistant bacilli, 2) co infection with HIV (human immunodeficiency virus) where TB progress rapidly and deadly,3) existence of other co-morbid that need higher expert (Internist etc). Vaccination with BCG does not seem to protect the adult population consistently and effectively from developing pulmonary TB, and has had no significant impact on the global TB epidemiology. Tuberculosis in Indonesia results in high death rate because it is the second highest infection with national prevalence rate of 0.24%. Effective medicine standard of anti-tuberculosis is available, but many obstacles in the program from lack of knowledge among health officers, low consciousness and compliances of person with tuberculosis to carry out the treatment schedule and so on make the success of TB eradication unsatisfied. Clinical appearances of TB are multiple with non-specific symptoms, the cases that are exposed to similar source of infection but will show different clinical consequence from mild to severe. Nevertheless, with the rise of multi drug resistance strains of M. tuberculosis, the spread of HIV infection and the variation of BCG efficacy, the search for more powerful drugs, more effective vaccines, better diagnostics and other intervention strategies have become an urgent goal worldwide. Also written here how to diagnose, choose of category of treatment, cocktail anti TB according the category and some clue in handling problems during treatment.