General Considerations
Tuberculosis is a chronic infection,

potentially of lifelong duration, caused
by two species of m...
General Considerations
The

disease
is
confined to the lungs
in most patients but
may spread to almost
any part of the bo...
Etiology
•

The tubercle bacillus
(M.Tuberculosis) is
aerobic, non-motil,nonspore-forming, high
in lipid content, and
acid...
epidemiology
A key link of epidemic
The source of contagious
The route of spread
Peoples are easily affected
• Tuberculosis is

transmitted by
airborne
droplet
nuclei(containi
ng tubercle
bacilli )
• Many

droplet
nuclei are capable
of floating in the
immediate
environment for
several hours
•
Large particles
may be inh...
The transmission is determined
• The probability of contact with a case of

TB
• The intimacy and duration of that
contact...
Pathogenesis
tubercle
bacillus

Human immunity
Antituberculosis drugs (by group)
Group Description

Drug

Abbreviation

1. First-line oral antituberculosis drugs

isonia...
Antituberculosis drugs
First-line drugs
 Isoniazid,

rifampin, pyrazinamide,
ethambutol and streptomycin

Second-line d...
Isoniazid
1952, the most active drug for the

treatment of tuberculosis
Mechanism of aciton

Inhibit the synthesis of m...
Isoniazid
Pharmacokinetics
Diffuse readily into all body fluids and

tissues
Metabolized by acetylation

Clinical uses...
Isoniazid
Adverse reactions
Peripheral neuropathy
CNS toxicity: memory loss, psychosis,

seizures
 Hepatoxicity: the m...
Rifampicin
Antimicrobial activity
Mycobacteria, some G+ and G- cocci,

chlamydiae and some virus

Mechanism of action
...
Rifampicin
Clinical uses
Tuberculosis and leprosy
Infections caused by stapylococci and other

ripfampicin-susceptible ...
Ethambutol
Mechanism:
 interfering with synthesis of RNAby combination with Mg2+

Used in combination with INH or rifam...
Rationale for the use of
antituberculosis drugs
Use as early as possible
Drug combination
Appropriate doses
Use regula...
LEPROSY:HANSEN’S
DISEASE
(HD)
CAUSE:Mycobacterium leprae:
One of the causative agents
of leprosy. As acid-fast
bacteria, M. leprae appear
red. When a Ze...
Kinds of Anti Leprotic drugs:Sulfone :- Dapsone (DDS),
Phenazine derivative - Clofazimine,
Antitubercular drugs
- Rifam...
Leprosy - one of the few diseases
which can be eliminated
Leprosy meets the demanding criteria for
elimination
practical...
Why integrate leprosy into the
general health services?
Integration means to provide “comprehensive”
essential services f...
How to diagnose leprosy
Examine skin
Check for patches
Test for sensation
Count the number of patches
Look for damage...
Signs of leprosy
Pale or slightly reddish patch
Definite loss of sensation in the patch
Signs of damage to nerves
defi...
Classification of Leprosy:Based on the 2 commonly used classifications, leprosy
is classified into six types based on the...
Borderline
tuberculoid leprosy:-

Characterized by small and numerous skin
lesions The disease goes back to the tuberculo...
Borderline
tuberculoid leprosy:-

Characterized by small and numerous skin
lesions The disease goes back to the tuberculo...
Disease

Clinical features

Multibacillary
Hansen’s disease
(lepromatous leprosy):-

Early symptoms: Several lesions suc...
Treatment:Chaulmoogra oil:Indicated that the oil was the product of a
tree Chaulmoogra odorata, which had been described
i...
Tuberculosis
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Tuberculosis

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  • Tuberculosis

    1. 1. General Considerations Tuberculosis is a chronic infection, potentially of lifelong duration, caused by two species of mycobacteria M.tuberculosis and, rarely, M.bovis It was isolated by Robert Koch in 1882 The morbidity and mortality of tuberculosis are high in developing countries.
    2. 2. General Considerations The disease is confined to the lungs in most patients but may spread to almost any part of the body
    3. 3. Etiology • The tubercle bacillus (M.Tuberculosis) is aerobic, non-motil,nonspore-forming, high in lipid content, and acid and alcohol-fast • It grows slowly . • It can’t tolerate heat, but It can live in humid or dry or cold surroundings.
    4. 4. epidemiology A key link of epidemic The source of contagious The route of spread Peoples are easily affected
    5. 5. • Tuberculosis is transmitted by airborne droplet nuclei(containi ng tubercle bacilli )
    6. 6. • Many droplet nuclei are capable of floating in the immediate environment for several hours • Large particles may be inhaled by a person breathing the same air and impact on the trachea or wall of the upper
    7. 7. The transmission is determined • The probability of contact with a case of TB • The intimacy and duration of that contact • The degree of infectiouseness of case • The shared environment of the contact
    8. 8. Pathogenesis tubercle bacillus Human immunity
    9. 9. Antituberculosis drugs (by group) Group Description Drug Abbreviation 1. First-line oral antituberculosis drugs isoniazid rifampicin ethambutol pyrazinamide rifabutin H R E Z Rfb 2. Injectable antituberculosis drugs kanamycin amikacin capreomycin streptomycin Km Amk Cm S 3. Fluoroquinolones levofloxacin moxifloxacin ofloxacin Lfx Mfx Ofx 4. Oral bacteriostatic second-line antituberculosis drugs ethionamide protionamide cycloserine terizidone p-aminosalicylic acid Eto Pto Cs Trd PAS 5. Antituberculosis drugs with unclear efficacy or unclear role in MDR-TB treatment (not recommended by WHO for routine use in MDR-TB patients) clofazimine linezolid amoxicillin/clavulanate thioacetazone clarithromycin Cfz Lzd Amx/Clv Thz Clr
    10. 10. Antituberculosis drugs First-line drugs  Isoniazid, rifampin, pyrazinamide, ethambutol and streptomycin Second-line drugs Aminosalicylic acid(PAS), kanamycin
    11. 11. Isoniazid 1952, the most active drug for the treatment of tuberculosis Mechanism of aciton Inhibit the synthesis of mycolic acid which is essential components of mycobacterial cell walls Antimicrobial activity High activity against both extracellular and intracellular tubercle bacilli
    12. 12. Isoniazid Pharmacokinetics Diffuse readily into all body fluids and tissues Metabolized by acetylation Clinical uses First choice for all types of tuberculosis
    13. 13. Isoniazid Adverse reactions Peripheral neuropathy CNS toxicity: memory loss, psychosis, seizures  Hepatoxicity: the most frequent, increase in aminotransferase, hepatitis Allergic reactions
    14. 14. Rifampicin Antimicrobial activity Mycobacteria, some G+ and G- cocci, chlamydiae and some virus Mechanism of action Bind to β-subunit of bacterial DNA- dependent RNA polymerase and inhibit RNA synthesis
    15. 15. Rifampicin Clinical uses Tuberculosis and leprosy Infections caused by stapylococci and other ripfampicin-susceptible bacteria Adverse reactions Gastrointestinal disturbance Liver toxicity: cholestatic jaundice, hepatitis
    16. 16. Ethambutol Mechanism:  interfering with synthesis of RNAby combination with Mg2+ Used in combination with INH or rifampicin Adverse effect Loss of visual disturbance, optical neuritis, red-green color blindness
    17. 17. Rationale for the use of antituberculosis drugs Use as early as possible Drug combination Appropriate doses Use regularly and enough time
    18. 18. LEPROSY:HANSEN’S DISEASE (HD)
    19. 19. CAUSE:Mycobacterium leprae: One of the causative agents of leprosy. As acid-fast bacteria, M. leprae appear red. When a Zehl-Neelsen stain is used.
    20. 20. Kinds of Anti Leprotic drugs:Sulfone :- Dapsone (DDS), Phenazine derivative - Clofazimine, Antitubercular drugs - Rifampicin, Ethionamide, Solapsone, Other antibiotics - Oflaxacin, Minocycline, Clarithromycin.
    21. 21. Leprosy - one of the few diseases which can be eliminated Leprosy meets the demanding criteria for elimination practical and simple diagnostic tools: can be diagnosed on clinical signs alone; the availability of an effective intervention to interrupt its transmission: multidrug therapy a single significant reservoir of infection: humans.
    22. 22. Why integrate leprosy into the general health services? Integration means to provide “comprehensive” essential services from one service point to improve patients’ access to leprosy services and thereby ensure timely treatment to remove the “special” status of leprosy as a complicated and terrible disease to consolidate substantial gains made to ensure that all future cases receive timely and correct treatment to ensure that leprosy is treated as a simple disease
    23. 23. How to diagnose leprosy Examine skin Check for patches Test for sensation Count the number of patches Look for damage to nerves
    24. 24. Signs of leprosy Pale or slightly reddish patch Definite loss of sensation in the patch Signs of damage to nerves definite loss of sensation in hands/feet weakness of muscles of hands/feet/face visible deformity of hands/feet/face
    25. 25. Classification of Leprosy:Based on the 2 commonly used classifications, leprosy is classified into six types based on the clinical features (Ridley & Jopling classification):   Disease Clinical features Indeterminate leprosy:- They are the first type of skin lesions characterized by hypo-pigmented spots. The lesions undergo healing spontaneously Disease Clinical features Paucibacillary (tuberculoid leprosy):- A large red patch with well-defined raised borders or a large hypo pigmented asymmetrical lesion. Lesion is dry and hairless Infectivity is minimal at this stage Loss of sensation is seen Nerves become thick followed by loss of function It either progresses to the borderline stage or spontaneously get cured
    26. 26. Borderline tuberculoid leprosy:- Characterized by small and numerous skin lesions The disease goes back to the tuberculoid stage or progresses to the next stage Borderline borderline leprosy:- Several small, irregular red lesions are seen Moderate sensory loss is seen It either goes back to the previous stage or progresses to the next Borderline lepromatous leprosy:- Several lesions such as plaques, macules, papules, and nodules are seen. Lesions have a characteristic inverted saucer like appearance.
    27. 27. Borderline tuberculoid leprosy:- Characterized by small and numerous skin lesions The disease goes back to the tuberculoid stage or progresses to the next stage Borderline borderline leprosy:- Several small, irregular red lesions are seen Moderate sensory loss is seen It either goes back to the previous stage or progresses to the next Borderline lepromatous leprosy:- Several lesions such as plaques, macules, papules, and nodules are seen. Lesions have a characteristic inverted saucer like appearance.
    28. 28. Disease Clinical features Multibacillary Hansen’s disease (lepromatous leprosy):- Early symptoms: Several lesions such as plaques, macules, papules, and nodules are seen. Nasal congestion, and bleeding is seen Inflammation of the leg and ankles Progressive symptoms: Thickening of the dermis (skin) in the forehead and ear lobes Loss of eyebrows and eyelashes Eye defects such as glaucoma and blindness are seen Nodules in the legs break and form ulcers Enlargement of the breast and sterility occurs in the males Internal infection results in the enlargement of the liver and lymph nodes Loss of sensation in the peripheral nerves. Deformation of the fingers and toes results due to painless repeated trauma.
    29. 29. Treatment:Chaulmoogra oil:Indicated that the oil was the product of a tree Chaulmoogra odorata, which had been described in 1815 by William Roxburgh, a surgeon and naturalist, while he was cataloging the plants in the East India Company’s botanical garden in Calcutta. This tree is also known as Gynocardia odorata. For the rest of the 19th century, this tree was thought to be the source of the oil.
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