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Tuberculosis
 

Tuberculosis

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Tuberculosis.

Tuberculosis.

Rosemberg Galeano Barbosa

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    Tuberculosis Tuberculosis Presentation Transcript

    • ROSEMBERG GALEANO
    • DESCRIPCION
      • Es una enfermedad infectocontagiosa causada por el grupo de bacterias del complejo M. tuberculosis; se adquiere principalmente por vía aérea o digestiva.
    • FUENTE Y CADENAS DE TRASMISION Fuente: Animales y personas infectadas Afecta principalmente los sistemas respiratorios, linfático, renal, digestivo y el SNC Cadena de trasmisión: Agente causal Un reservorio o fuente de infección Mecanismo de transmisión Un huésped susceptible de enfermar.
    • FUENTE Y CADENA DE TRASMISION
    • EPIDEMIOLOGIA La organización mundial de la salud (OMS) señala que un tercio de la población mundial esta infectada por M. tuberculosis; cada año ocurre 8 millones de casos nuevos y tres millones de funciones por TBC. Clasificándola como una enfermedad re emergente y en algunas regiones del mundo considerándole una enfermedad persistente. INDICADORES EPIDEMIOLOGICOS BASICOS: Incidencia Prevalecía Mortalidad Riesgo de infección
    •  
    • SIGNOS Y SINTOMAS
      • PRIMARIOS
      • El diagnostico de la tuberculosis primaria progresiva puede ser difícil. Contrariamente el cuadro habitual del tipo adulto (o reactivación) de la tuberculosis (enfermedad apical con cavitación), la tuberculosis primaria progresiva se asemeja, mas a menudo, a una neumonía bacteriana aguda, con consolidación en los lóbulos medio e inferior, adenopatía hiliar y derrame pleural; la cavitacion es rara, especialmente en pacientes con inmunosupresiòn intensa.
      • SECUNDARIOS
      • La tuberculosis secundaria es el patrón de enfermedad que surge en un huésped previamente sensibilizado puede seguir al poco tiempo de una tuberculosis primaria y sus síntomas son:
      • Malestar
      • Anorexia
      • Perdida de peso
      • Fiebre
      • fatiga
    • APARIENCIA FISICA
    • ESPECTRO NATURAL DE LA TUBERCULOSIS
    • PATOGENIA
      • La patogenia de la tuberculosis en una persona previamente no expuesta, inmunocompetente, depende del desarrollo de una inmunidad celular antimicobacteriana, la cual confiere resistencia a las bacterias y que da lugar al desarrollo de hipersensibilidad frente a los antígenos tuberculosos.
      • Las manifestaciones patológicas de la tuberculosis, tales como granulomas caseosos y la formación de cavernas, son el resultado de la hipersensibilidad, que es una parte esencial de la respuesta inmunitaria del huésped. Como las células afectadas que median en la inmunidad también median en la hipersensibilidad y la destrucción tisular, la aparición de hipersensibilidad también señala la adquisición de inmunidad frente al organismo.
      • Los macrófagos son las células primarias infectadas por M. tuberculosis. Al principio de la infección, el bacilo tuberculoso se replica esencialmente de una manera incontrolada.
      • Una vez dentro del macrófago, se replica dentro del fagosoma con el liposoma; este es un proceso activo ya que las microbacterias vivas, pero no las muertas, bloquean la formación del fago lisosoma. M tuberculosis tiene varios mecanismos para bloquear la formación del fago lisosoma, incluyendo la inhibición de las señales de Ca2 y el bloqueo del reclutamiento y de la organización de proteínas que median en la fusión fagosoma-lisosoma.
      • Así pues, el estadio más precoz de la tuberculosis primaria ( ‹ 3 semanas), en el individuo no sensibilizado, se caracteriza por la proliferación de las bacterias en los macrófagos alveolares pulmonares y en los espacios aéreos, con la siguiente bacteriemia y la siembra en localizaciones múltiples.
    •  
    • ARTICULOS CIENTIFICOS
      • ARTICULO Nº 1
      • Tuberculin-specific T cells are reduced in active pulmonary tuberculosis compared to LTBI or status post BCG vaccination.
      • Streitz M , Fuhrmann S , Powell F , Quassem A , Nomura L , Maecker H , Martus P , Volk HD , Kern F .
      • Abstract
      • Functional characteristics of tuberculosis (TB)-specific CD4 T cells were studied in clinically active pulmonary TB (n = 21) and high TB exposure including LTBI (n = 17). Following tuberculin stimulation, activated CD4 T cells were identified by flow-cytometry (CD154 up-regulation, degranulation, interferon γ [IFN-γ], tumor necrosis factor α [TNF-α], and interleukin 2 [IL-2 production). Interestingly, CD154 up-regulation accounted for ∼80% of activated CD4 T cells in the active TB group but just 40% in the controls, whereas IFN-γ accounted for only ∼50% of activated cells in each group. The frequencies of CD4 T cells displaying at least 1 activation marker discriminated better between the groups than those displaying degranulation or IFN-γ production alone
      • “ En este documento destacamos la función que tiene la parte molecular ante la tuberculosis y la acción del INF gamma de actuar solo ante la enfermedad”
      • ARTICULO Nº2
      • Mycobacterium tuberculosis causing infection of an implantable biventricular defibrillator.
      • Luckie M , Zaidi A , Woodhead M , Garratt C .
      • Manchester Heart Centre, Manchester Royal Infirmary, UK. mluckie@doctors.net.uk
      • Abstract
      • Mycobacterial infection of implantable cardiac devices is rare, and infection of pacing system components with M. tuberculosis has been reported on only three previous occasions, involving epicardial pacing systems in two cases. We report here a pocket infection with M. tuberculosis in a transvenous biventricular defibrillator.
      • “ El articulo trata de los implantes de dispositivos cardiacos y sus complicaciones de los cuales solo se han reportado 3 casos expuesto en el articulo”
      • ARTICULO Nº 3
      • Smoking prolongs the infectivity of patients with tuberculosis.
      • Siddiqui UA , O'Toole M , Kabir Z , Qureshi S , Gibbons N , Kane M , Keane J .
      • Trinity College Dublin, Centre for Global Health, 3-5 Foster Place, Dublin 2. siddiquu@tcd.ie
      • Abstract
      • We sought to establish if smokers on anti-tuberculosis treatment are more likely to have a prolonged period of infectivity, compared to non-smoking tuberculosis patients, in a low tuberculosis prevalence country. We conducted a cross-sectional, retrospective study in Ireland that recruited 53 microbiologically confirmed cases of pulmonary tuberculosis (PTB). The age-sex adjusted odds ratios (AOR) suggest that the infectivity status of PTB on treatment was four times more likely to be prolonged beyond 6-8 weeks, if the cases had a smoking history (AOR: 4.42; 95% CI: 1.23; 15.9). Smoking was associated with delayed sputum smear conversion in PTB patients on treatment.
      • “ El articulo muestra un experimento hecho en Irlanda con 53 personas las cuales estan diagnosticadas con tuberculosis pulmonar, se trata de mostrar un cuadro comparativo entre las personas con tuberculosis no fumadoras con respecto a las fumadoras con tuberculosis y asi se demostro la incidencia de infectividad de los fumadores en un pais en el cual los casos de tuberculosis son muy bajos”
      • ARTICULO Nº 4
      • Zinc and vitamin A supplementation fails to reduce sputum conversion time in severely malnourished pulmonary tuberculosis patients in Indonesia.
      • Pakasi TA , Karyadi E , Suratih NM , Salean M , Darmawidjaja N , Bor H , van der Velden K , Dolmans WM , van der Meer JW .
      • South East Asia Minister of Education Organization Tropical Medicine, Regional Center for Community Nutrition, University of Indonesia, Jl, Salemba Raya no 6, Jakarta Pusat 10420, Indonesia. tpakasi_commed@fk.ui.ac.id
      • Abstract
      • BACKGROUND: A previous study showed that combination of zinc and vitamin A reduced sputum conversion time in pulmonary tuberculosis (TB) patients.
      • OBJECTIVE: We studied the efficacy of which single micronutrient contributed more to the sputum conversion time.
      • METHODS: In a double-blind randomized community trial, newly sputum smear positive pulmonary TB patients were assigned randomly to receive zinc, vitamin A, zinc + vitamin A or placebo on top of TB treatment. Patients were asked to deliver their sputum on weekly basis to measure positivity of the bacteria. Nutritional status, chest x-ray, hemoglobin, C-reactive protein (CRP), retinol and zinc level were examined prior to, after 2 and 6 months of treatment.
      • RESULTS: Initially, 300 patients were enrolled, and 255 finished the treatment. Most patients were severely malnourished (mean BMI 16.5 ± 2.2 Kg/m2). Patients in the zinc + vitamin A group showed earlier sputum conversion time (mean 1.9 weeks) compared with that in the other groups; however the difference was not significant. Also, no benefit could be demonstrated of any of the used supplementations on clinical, nutritional, chest x-ray, or laboratory findings.
      • CONCLUSIONS: This study among severely malnourished TB patients, did not confirm that single or combined supplementation of zinc and vitamin A significantly reduced sputum conversion time or had other significant benefit.
      • “ el abstracto me parece muy bueno ya que muestra los beneficios con una terapia de la conbinacion del zinc y las vitaminas en tratamientos tales como la tuberculosis, reduciendo la expectoracion en esta enfermedad.”
      • ARTICULO Nº 5
      • Rapid molecular detection of tuberculosis and rifampin resistance.
      • Boehme CC , Nabeta P , Hillemann D , Nicol MP , Shenai S , Krapp F , Allen J , Tahirli R , Blakemore R , Rustomjee R , Milovic A , Jones M , O'Brien SM , Persing DH , Ruesch - Gerdes S , Gotuzzo E , Rodrigues C , Alland D , Perkins MD .
      • Abstract
      • BACKGROUND: Global control of tuberculosis is hampered by slow, insensitive diagnostic methods, particularly for the detection of drug-resistant forms and in patients with human immunodeficiency virus infection. Early detection is essential to reduce the death rate and interrupt transmission, but the complexity and infrastructure needs of sensitive methods limit their accessibility and effect.
      • METHODS: We assessed the performance of Xpert MTB/RIF, an automated molecular test for Mycobacterium tuberculosis (MTB) and resistance to rifampin (RIF), with fully integrated sample processing in 1730 patients with suspected drug-sensitive or multidrug-resistant pulmonary tuberculosis. Eligible patients in Peru, Azerbaijan, South Africa, and India provided three sputum specimens each. Two specimens were processed with N-acetyl-L-cysteine and sodium hydroxide before microscopy, solid and liquid culture, and the MTB/RIF test, and one specimen was used for direct testing with microscopy and the MTB/RIF test.
      • RESULTS: Among culture-positive patients, a single, direct MTB/RIF test identified 551 of 561 patients with smear-positive tuberculosis (98.2%) and 124 of 171 with smear-negative tuberculosis (72.5%). The test was specific in 604 of 609 patients without tuberculosis (99.2%). Among patients with smear-negative, culture-positive tuberculosis, the addition of a second MTB/RIF test increased sensitivity by 12.6 percentage points and a third by 5.1 percentage points, to a total of 90.2%. As compared with phenotypic drug-susceptibility testing, MTB/RIF testing correctly identified 200 of 205 patients (97.6%) with rifampin-resistant bacteria and 504 of 514 (98.1%) with rifampin-sensitive bacteria. Sequencing resolved all but two cases in favor of the MTB/RIF assay.
      • CONCLUSIONS: The MTB/RIF test provided sensitive detection of tuberculosis and rifampin resistance directly from untreated sputum in less than 2 hours with minimal hands-on time. (Funded by the Foundation for Innovative New Diagnostics.)
      • “ este estudio hecho con medicamentos tales como la rifanpicina y N- acetil-cisteina nos muestra la evolución de los pacientes con cada uno de los medicamentos”
    • REFERENCIAS
      • ARTICULO Nº 1
      • J Infect Dis. 2011 Feb 1;203(3):378-82. Epub 2010 Dec 24.
      • Tuberculin-specific T cells are reduced in active pulmonary tuberculosis compared to LTBI or status post BCG vaccination.
      • Streitz M , Fuhrmann S , Powell F , Quassem A , Nomura L , Maecker H , Martus P , Volk HD , Kern F .
      • Institut für Medizinische Immunologie, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.
      • http://www.ncbi.nlm.nih.gov/pubmed/21186260
      • ARTICULO Nº 2
      • Indian J Tuberc. 2010 Oct;57(4):213-5.
      • Mycobacterium tuberculosis causing infection of an implantable biventricular defibrillator.
      • Luckie M , Zaidi A , Woodhead M , Garratt C .
      • Manchester Heart Centre, Manchester Royal Infirmary, UK. [email_address]
      • http://www.ncbi.nlm.nih.gov/pubmed/21141340
      • ARTICULO Nº3
      • Ir Med J. 2010 Oct;103(9):278-80.
      • Smoking prolongs the infectivity of patients with tuberculosis.
      • Siddiqui UA , O'Toole M , Kabir Z , Qureshi S , Gibbons N , Kane M , Keane J .
      • Trinity College Dublin, Centre for Global Health, 3-5 Foster Place, Dublin 2. [email_address]
      • http://www.ncbi.nlm.nih.gov/pubmed/21186753
      • ARTICULO Nº 4
      • Zinc and vitamin A supplementation fails to reduce sputum conversion time in severely malnourished pulmonary tuberculosis patients in Indonesia. Pakasi TA , Karyadi E , Suratih NM , Salean M , Darmawidjaja N , Bor H , van der Velden K , Dolmans WM , van der Meer JW .
      • http://www.ncbi.nlm.nih.gov/pubmed/20920186
      • ARTICULO Nº 5
      • Rapid molecular detection of tuberculosis and rifampin resistance. Boehme CC , Nabeta P , Hillemann D , Nicol MP , Shenai S , Krapp F , Allen J , Tahirli R , Blakemore R , Rustomjee R , Milovic A , Jones M , O'Brien SM , Persing DH , Ruesch - Gerdes S , Gotuzzo E , Rodrigues C , Alland D , Perkins MD .
      • http :// www.ncbi.nlm.nih.gov / pubmed /20825313
    • BIBLIOGRAFIA
      • REFERENCIA A LIBROS GRATUITOS EN LINEA
      • http://books.google.com.co/books?id=i2o24JW40wAC&pg=PA385&dq=patogenia+de+la+tuberculosis&hl=es&ei=hTnGTKCDM8OB8gaN-rDvDw&sa=X&oi=book_result&ct=result&resnum=1&ved=0CCoQ6AEwAA#v=onepage&q=patogenia%20de%20la%20tuberculosis&f=false
      • http://books.google.com.co/books?id=fjEPSMLSBMIC&printsec=frontcover&dq=tuberculosis&hl=es&ei=YnVgTbuRCoSWtwfd4L26DA&sa=X&oi=book_result&ct=book-thumbnail&resnum=5&ved=0CEIQ6wEwBA#v=onepage&q&f=false
    •