Introduction


Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. Tuberculosis typically attacks the lungs, but can also affect other parts of the body. The disease has become rare in high income countries, but is still a major public health problem in low- and middle-income countries.

It is estimated that between the years 2000 and 2010, eight to nine million new cases emerged each year. Approximately 1.5 million people die from the disease each year. In adults, tuberculosis is the second leading cause of death due to an infectious disease (after AIDS), with 95% of deaths occurring in low-income countries. Tuberculosis is a major problem of children in poor countries where it kills over 100,000 children each year.

The treatment of tuberculosis remains a constraint for patients and a heavy burden for the healthcare system. Drug-susceptible tuberculosis requires at least six months of therapy under close supervision. A treatment for multidrug-resistant tuberculosis requires nearly two years of treatment with poorly tolerated and less effective drugs. In most places the diagnosis still relies mainly on direct microscopy that is unable to detect a large proportion of patients. The BCG vaccine, developed almost a century ago, confers only partial protection.

After 40 years of minimal progress in the tools to fight tuberculosis there are some reasons for hope. A few new drugs are reaching the final phase of development; a new molecular test that can be decentralized to some extent and allows the rapid diagnosis of tuberculosis and of resistance to rifampicin has been introduced. Though this is undeniable progress, much will be needed to bring the new tools and drugs to the patients in need. Furthermore, a true “point of care” diagnostic test still does not exist and little progress has been made in research for a more effective vaccine.

Case management of patients does not necessarily have to involve a major, vertical programme. It should be incorporated into the framework of other medical activities in order to offer comprehensive and integrated treatment even if the number of patients being treated is relatively small.

This guide has been developed jointly by Médecins Sans Frontières and Partners In Health. It aims at providing useful information to the clinicians and health staff for the comprehensive management of tuberculosis. Forms of susceptible and resistant tuberculosis, tuberculosis in children, and HIV co-infection are all fully addressed.

As treatment protocols are constantly changing, medical staff are encouraged to check this website for updates.