DEFINITION, ETIOLOGY, EPIDEMIOLOGY, PATHOPHYSIOLOGY, OUTCOMES

1. TB
•Tuberculosis (TB) is a bacterial infection
• In 1993-raise in cases-all continents-World Health Organization (WHO)-
TB-global emergency
•Burden of TB-compounded-HIV & multidrug-resistant tuberculosis (MDR-
TB)
• Treatment of drug-resistant TB is complex-costlier-longer duration
AETIOLOGY:
Tubercle bacilli (genus)-Mycobacterium
Three obligate parasites that can cause TB disease
M. tuberculosis
M. bovis
M. Africanum
Around 15-pathogenic-humans
•Atypical Mycobacterium: Pulmonary disease resembling TB
•Mycobacterium leprae: The cause of leprosy

2. RISK FACTORS
HIV positive
• Injecting drug users
• Solid organ transplantation, jejunoileal bypass or
gastrectomy
• Hematological malignancy, for example leukemia and
lymphomas
• Chronic renal failure or receiving haemodialysis
• Receiving anti-TNFα treatment
• Silicosis
Close contacts of patients with TB

3. EPIDEMIOLOGY
According to WHO 2009
• Globally, it is estimated that TB causes about 2 million deaths worldwide each
year.
•Over 4 million cases of TB disease are notified annually
•440,000 people had MDR-TB worldwide, and one-third of these died
•The majority of cases occur in poor countries
•Most cases of TB are in South East Asia with almost 50% of cases worldwide
estimated to occur in China and India
•Leading cause of death among HIV-positive people
Symptoms
The symptoms and signs of TB include:
• Cough for 3 weeks or more/productive cough
• Sputum usually mucopurulent or purulent
• Haemoptysis not always a feature
• Fever may be associated with night sweats
• Tiredness
• Weight loss variable
• Anorexia variable
• Malaise

4. INCUBATION PERIOD
•2 to 10 weeks
•Latent infection may persist for a lifetime
•HIV-shorten-interval-development-TB
Transmission
•Air-borne droplet such as coughing or sneezing.
•Only respiratory forms of TB are infectious
•Mostly acquired from adults with post-primary pulmonary TB
•Cases of TB in children are non-infectious
•TB cannot be acquired from individuals with latent TB infection
•Patients with smear-negative pulmonary disease are less
infectious than those who are smear positive

5. PATHOPHYSIOLOGY
Organisms in droplet nuclei (1 to 5 mm)
escape the ciliary epithelial cells of
upper respiratory tract
Alveolar implantation
Organisms multiply
macrophages rupture
Releasing bacilli
as a part of cell-mediated immunity
Multiple Activated macrophages the necrotic area
Activation and multiplication of T lymphocytes
Delayed-type hypersensitivity

6. TISSUE NECROSIS AND CALCIFICATION (INFECTED SITE & REGIONAL LYMPH
NODES)
OCCASIONALLY, A MASSIVE INOCULUM OF
ORGANISMS INTO BLOODSTREAM, CAUSING
GRANULOMA FORMATION
MILIARY TB
.
((((SUCCESSFUL CONTAINMENT OF M. TUBERCULOSIS REQUIRES ACTIVATION OF A SUBSET OF CD4
LYMPHOCYTES, WHICH ACTIVATE MACROPHAGES THROUGH SECRETION OF INTERFERON )))

7. Approximately 90% of patients who experience primary disease have
no further clinical manifestations other than a positive skin test either
alone or in combination with radiographic evidence of stable
granulomas
Approximately 10% of patients develop reactivation disease, which
arises subsequent to the hematogenous spread of the organism.
DESIRED OUTCOME
• Rapid identification of new cases of TB
• Isolation of the patient with active disease to prevent spread
• Collection of appropriate samples for smears and cultures
• Prompt resolution of signs and symptoms of disease after initiation
of
treatment
• Achievement of a noninfectious state, thus ending isolation
• Adherence to the treatment regimen
• Cure as quickly as possible (generally with at least 6 months of
treatment)

8. ROGER WALKER, CATE WHITTLESEA, CLINICAL PHARMACY &
THERAPEUTICS, 5TH EDITION
BARBARA G WELLS, JOSEPH T DIPIRO, TERRY L
SCHWINGHAMMER,CEILY V DIPIRO, PHARMACOTHERAPY HANDBOOK,
7TH EDITION