Tuberculosis (TB) and leprosy (Hansen disease) are chronic mycobacterial infections that are curable with free multidrug therapy, carry strong stigma, and are controlled by finding cases early, treating them completely, and protecting contacts.

Tuberculosis in the Philippines

• One of the highest TB burdens in the world — in the WHO Global Tuberculosis Report 2025 the country ranked third, with about 6.8% of global cases (2024 data).
• Caused by Mycobacterium tuberculosis, spread by airborne droplet nuclei from people with infectious pulmonary or laryngeal TB. Crowding, poor ventilation, malnutrition, diabetes, HIV, smoking, and alcohol raise the risk.
• Comprehensive Tuberculosis Elimination Plan Act (RA 10767, 2016) — requires a national TB elimination plan, case notification, and expanded PhilHealth benefits.
• The DOH National TB Control Program (NTP) delivers free diagnosis and treatment through public and private TB-DOTS facilities under the Philippine Strategic TB Elimination Plan, Phase 2 (PhilSTEP2, 2025–2030), aligned with the WHO End TB Strategy. PhilSTEP2 aims to cut TB incidence to 300 and TB deaths to 5 per 100,000 population by 2030.

Leprosy

• Caused by Mycobacterium leprae; affects the skin and peripheral nerves. Spread mainly by droplets from the nose and mouth of untreated people during prolonged close contact; most exposed people never develop disease. It is not spread by casual touch.
• Incubation is long (years). Nerve damage causes loss of sensation, weakness, and deformity of hands, feet, and eyes.
• The Philippines reached the WHO target of eliminating leprosy as a public health problem (prevalence below 1 per 10,000) in 1998, but new cases, including in children, still occur. The DOH Leprosy Control Program now aims to interrupt transmission and prevent disability.
• RA 4073 ended compulsory segregation: people with leprosy are treated as outpatients in rural health units and skin clinics, and are confined only when the Secretary of Health certifies that their condition requires it.

TB program strategy

1. Case finding — active screening of high-risk groups (household contacts, people with HIV or diabetes, older adults, prisoners, urban poor) with symptom screening and chest X-ray, including AI-assisted reading, plus passive case finding at health facilities.
2. Diagnosis — rapid molecular tests (NAAT, such as Xpert MTB/RIF) as the preferred initial test; they also detect rifampicin resistance. Sputum smear microscopy is used for monitoring. A presumptive TB client typically has cough for 2 weeks or more or other TB symptoms (fever, night sweats, weight loss, hemoptysis) or a suggestive chest X-ray.
3. Treatment — standardized, weight-banded fixed-dose combination tablets with treatment support (DOTS):

1. Treatment support — each client has a treatment supporter (health worker, BHW, trained family or community member); support includes adherence counseling, food and transport help, and PhilHealth benefits.
2. Monitoring and recording — sputum follow-up, weight, adverse effects, and treatment outcomes (cured, treatment completed, treatment failed, died, lost to follow-up, not evaluated) recorded in the NTP information system; every case must be notified (RA 10767).
3. Prevention — BCG at birth (protects young children against severe forms such as TB meningitis and miliary TB), TB preventive treatment, infection control, and addressing social determinants.

First-line drug safety (consistent with the pharmacology and TB chapters)

Baseline liver tests and HIV testing are done for everyone starting TB treatment; if jaundice, dark urine, anorexia, vomiting, or right upper abdominal pain appears, withhold the drugs and refer at once (usual stop rule: ALT more than 3 times the upper limit of normal with symptoms, or more than 5 times without symptoms).

BPaLM/BPaL safety: bedaquiline and moxifloxacin prolong the QT interval — baseline and periodic ECG with potassium and magnesium; hold and report QTc above 500 ms, palpitations, or fainting. Linezolid causes myelosuppression (monitor CBC) and peripheral and optic neuropathy (ask about numbness and tingling; check vision) and can cause serotonin syndrome with serotonergic drugs. Monitor liver function for the whole regimen.

Leprosy — diagnosis (cardinal signs; one is enough)

1. Hypopigmented or reddish skin patch with definite loss of sensation
2. Thickened or enlarged peripheral nerve with loss of sensation or muscle weakness
3. Acid-fast bacilli in a slit-skin smear

Classification for treatment (WHO)

• Paucibacillary (PB): 1–5 skin lesions, no demonstrated bacilli
• Multibacillary (MB): more than 5 lesions, or nerve involvement, or positive smear

Multidrug therapy (MDT) — the DOH uses the WHO three-drug regimen of rifampicin, clofazimine, and dapsone for all leprosy cases: PB = 6 monthly blister packs, MB = 12 monthly blister packs, supplied free. Rifampicin and a higher clofazimine dose are taken once a month under supervision; dapsone and low-dose clofazimine are taken daily at home.

Leprosy reactions (immune flares that can occur before, during, or after MDT and damage nerves quickly):

• Type 1 (reversal) reaction — existing lesions become red, swollen, painful; new nerve pain or weakness
• Type 2 reaction (erythema nodosum leprosum) — crops of painful red nodules, fever, joint pain, eye inflammation (MB clients)
• Management: continue MDT, refer for corticosteroids (prednisolone) and nerve protection; reactions are not a sign that treatment has failed.

Contacts: household and other close contacts (neighbors, social contacts) are examined; the DOH (AO 2021-0004) provides single-dose rifampicin post-exposure prophylaxis (SDR-PEP) to household and other close contacts aged 2 years and older after active leprosy and TB are excluded.

TB — at the rural health unit

1. Screen and identify presumptive TB; collect sputum properly (early morning, deep cough, outdoors or in a well-ventilated area).
2. Register the client, notify, and start treatment promptly; teach the regimen and adverse effects.
3. Arrange the treatment supporter and follow-up schedule; trace absent clients within days.
4. Screen all household contacts; give TB preventive treatment to eligible contacts after excluding active TB.
5. Home infection control: cover coughs, open windows, sleep in a separate well-ventilated room when possible, and limit contact with young children and immunocompromised people until the doctor says the client is no longer infectious.

Leprosy — at the community

1. Recognize suspicious patches (numb, hypopigmented) during skin checks and school or household examinations; refer for confirmation.
2. Start MDT and give monthly supervised doses; check adherence and completion within the allowed time.
3. Disability prevention (POD): at each visit test sensation and muscle strength in hands, feet, and eyes, and grade disability.
4. Self-care teaching: inspect hands and feet daily; soak dry skin and apply oil; wear protective footwear and gloves when cooking; protect the eyes (blink often, cover at night if eyelids do not close).

• Case finder: active and passive screening; contact investigation.
• Treatment manager and supporter: directly observed or supported dosing, adherence counseling, early tracing of interrupters.
• Monitor for adverse effects and reactions; refer promptly.
• Health educator: cure is possible; stigma reduction; family involvement.
• Record keeper: registers, treatment cards, notification, outcome reporting.
• Coordinator: links with PhilHealth, social welfare, and nutrition programs; trains BHWs as treatment supporters.
• Infection control in facilities: triage coughing clients, masks for clients, ventilation, and N95 respirators for staff in high-risk procedures.

• RA 10767 mandates TB case notification by public and private providers and provides for PhilHealth benefits.
• Confidentiality: TB and leprosy diagnoses and HIV results are protected (Data Privacy Act, RA 10173); disclose only to those involved in care and public health follow-up.
• Non-discrimination: do not isolate, dismiss, or shame people with TB or leprosy; RA 4073 abolished compulsory segregation for leprosy.
• Autonomy vs. public health: respect choices while explaining the community risk of untreated TB; involve the family and document counseling for treatment refusal or interruption.
• Justice: free, accessible services for the poor and those in isolated areas.
• Duty to protect staff: proper respiratory protection is part of occupational safety.

Case 1. A 45-year-old tricycle driver has cough for 3 weeks, night sweats, and weight loss.

• Action: presumptive TB — collect sputum for a rapid molecular test, request chest X-ray, give a surgical mask, and screen household contacts.
• Why: early diagnosis and contact screening break transmission.

Case 2. A woman on 2HRZE who uses combined oral contraceptives asks why she must change methods.

• Action: explain that rifampicin lowers hormone levels; advise a copper IUD, DMPA, or condoms during treatment.
• Why: rifampicin enzyme induction causes contraceptive failure.

Case 3. A man on MB-MDT develops painful red nodules and fever in the 5th month and wants to stop the drugs.

• Action: type 2 reaction — continue MDT, refer urgently for corticosteroid treatment and nerve assessment, reassure him.
• Why: reactions are immune flares, not treatment failure; stopping MDT risks relapse.

Case 4. A child in a household with a newly diagnosed leprosy case has no skin lesions.

• Action: examine all household and other close contacts; give single-dose rifampicin post-exposure prophylaxis to eligible contacts (age 2 years and older, no active leprosy or TB).
• Why: household contacts have much higher risk; SDR-PEP reduces it.

• Thinking leprosy spreads by touching skin or that clients must be isolated in leprosaria.
• Stopping MDT because of a reaction.
• Forgetting G6PD deficiency with dapsone.
• Stopping TB drugs once symptoms improve (causes relapse and resistance).
• Alarm over orange-red urine — it is expected with rifampicin.
• Missing ethambutol visual checks or isoniazid neuropathy prevention.
• Using 18–24-month injectable regimens for drug-resistant TB — current regimens are 6-month all-oral.
• Not screening household contacts.

• Philippines: third in the world for TB cases (WHO 2025 report); RA 10767 is the TB elimination law; PhilSTEP2 runs 2025–2030.
• Presumptive TB: cough 2 weeks or more or other symptoms; rapid molecular test is the preferred diagnostic.
• Drug-susceptible TB: 2HRZE/4HR (6 months); non-severe childhood TB: 4 months; drug-resistant TB: 6-month BPaLM/BPaL (age 14 and older).
• INH: hepatotoxicity, neuropathy (pyridoxine); RIF: orange fluids, contraceptive failure; PZA: hyperuricemia; EMB: optic neuritis.
• BCG at birth protects against severe childhood TB.
• Leprosy cardinal signs: anesthetic patch, thickened nerve, positive slit-skin smear.
• PB = 1–5 lesions; MB = more than 5 lesions, nerve involvement, or positive smear.
• MDT (rifampicin, clofazimine, dapsone): PB 6 packs, MB 12 packs.
• Dapsone → hemolysis in G6PD deficiency; clofazimine → reddish-brown skin.
• Reactions: continue MDT, refer for steroids.
• SDR-PEP for household and other close contacts aged 2 years and older.
• BPaLM/BPaL: ECG for QT (bedaquiline, moxifloxacin); CBC and neuropathy checks (linezolid).
• RA 4073 ended compulsory segregation of people with leprosy.