This document provides guidelines for tuberculosis control in Bangladesh. It begins with background on TB as a major public health problem in the country, with nearly 900 new cases and 175 deaths daily. Over 90% of global TB cases occur in developing countries. The vision is to eliminate TB as a public health problem in Bangladesh. TB is defined as an infectious disease caused by Mycobacterium tuberculosis, which usually affects the lungs. Distinctions are made between TB infection and active TB disease. Treatment involves a combination of drugs taken for several months to cure the patient and prevent transmission. Special considerations are provided for treating TB in patients with conditions like hepatitis, renal failure, pregnancy and diabetes. Drug-resistant TB is also discussed.
Tarannum Yasmin1*, Krishan Nandan2
1Associate Professor, Department of Microbiology, Katihar Medical College Katihar, Bihar, India
2Assistant Professor, Department of Microbiology, Katihar Medical College Katihar, Bihar, India
*Address for Correspondence: Dr Tarannum Yasmin, Associate Professor, Department of Microbiology, Katihar
Medical College, Katihar, Bihar, India
Received: 15 September 2016/Revised: 03 October 2016/Accepted: 22 October 2016
ABSTRACT- INTRODUCTION- HIV/AIDS pandemic is responsible for the resurgence of Tuberculosis worldwide,
resulting in increased morbidity and mortality. Co-infection with HIV infection leads to difficulty in both the diagnosis
and treatment of Tuberculosis, increased risk of death, treatment failure and relapse.
OBJECTIVE- The present study highlights the correlation of Pulmonary Tuberculosis in HIV positive cases and its
association with CD4 count.
MATERIAL & METHODS- A total of 72 known case of HIV were screened for tuberculosis infection by clinical
examination, radiology & ZN staining.
RESULTS AND CONCLUSIONS- From our study 60 (83.33%) were diagnosed as tuberculosis and 12 (16.67%) were
negative. More common HIV infection in case of male 48 (66.67%). Out of 60 tuberculosis infection 53 (88.33%) were
diagnosed as Pulmonary Tuberculosis and 7 (11.67%) were diagnosed as Extrapulmonary Tuberculosis. The result of
study emphasizes that co-infection of tuberculosis in HIV/AIDS patient is a concern. There is direct correlation between
CD4 counts depletion and Pulmonary Tuberculosis in HIV/AIDS patients.
Key-words- Pulmonary Tuberculosis, HIV, AIDS, CD4 count
Tarannum Yasmin1*, Krishan Nandan2
1Associate Professor, Department of Microbiology, Katihar Medical College Katihar, Bihar, India
2Assistant Professor, Department of Microbiology, Katihar Medical College Katihar, Bihar, India
*Address for Correspondence: Dr Tarannum Yasmin, Associate Professor, Department of Microbiology, Katihar
Medical College, Katihar, Bihar, India
Received: 15 September 2016/Revised: 03 October 2016/Accepted: 22 October 2016
ABSTRACT- INTRODUCTION- HIV/AIDS pandemic is responsible for the resurgence of Tuberculosis worldwide,
resulting in increased morbidity and mortality. Co-infection with HIV infection leads to difficulty in both the diagnosis
and treatment of Tuberculosis, increased risk of death, treatment failure and relapse.
OBJECTIVE- The present study highlights the correlation of Pulmonary Tuberculosis in HIV positive cases and its
association with CD4 count.
MATERIAL & METHODS- A total of 72 known case of HIV were screened for tuberculosis infection by clinical
examination, radiology & ZN staining.
RESULTS AND CONCLUSIONS- From our study 60 (83.33%) were diagnosed as tuberculosis and 12 (16.67%) were
negative. More common HIV infection in case of male 48 (66.67%). Out of 60 tuberculosis infection 53 (88.33%) were
diagnosed as Pulmonary Tuberculosis and 7 (11.67%) were diagnosed as Extrapulmonary Tuberculosis. The result of
study emphasizes that co-infection of tuberculosis in HIV/AIDS patient is a concern. There is direct correlation between
CD4 counts depletion and Pulmonary Tuberculosis in HIV/AIDS patients.
Key-words- Pulmonary Tuberculosis, HIV, AIDS, CD4 count
GUIDELINES FOR THE MANAGEMENT OF TUBERCULOSIS IN CHILDREN Surya Amal
GUIDELINES FOR THE MANAGEMENT OF TUBERCULOSIS IN CHILDREN, 2013. Published by the Department of Health, Private Bag X828, Pretoria 0001, South Africa April 2013
India is the highest TB burden country in the world & accounts for nearly 1/5th (20 per cent) of global burden of tuberculosis, 2/3rd of cases in SEAR. Every year approximately 1.8 million persons develop tuberculosis, of which about 0.8 million are new smear positive highly'- infectious cases.Annual risk of becoming infected with TB is 1.5 % and once infected there is 10 % life-time risk of developing TB disease
Clinic Epidemiological Characteristics of Chronic Hepatitis C on the Backgrou...ijtsrd
Since the problem of the incidence of hepatitis C and tuberculosis in the population is still a very important and urgent problem not only in Uzbekistan and the whole world, we decided to study how these diseases flow against the background of each other. During our study, we observed 80 patients at the regional tuberculosis dispensary and at the regional infectious diseases hospital in Samarkand, which were divided into 2 clinical groups. Mukhammedova Fariza Farkhodovna "Clinic - Epidemiological Characteristics of Chronic Hepatitis C on the Background of Tuberculosis" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-5 , August 2021, URL: https://www.ijtsrd.com/papers/ijtsrd45174.pdf Paper URL: https://www.ijtsrd.com/economics/other/45174/clinic--epidemiological-characteristics-of-chronic-hepatitis-c-on-the-background-of-tuberculosis/mukhammedova-fariza-farkhodovna
this presentation is based on national health program in india in relation to tuberculosis and malaria as these are mostly occuring disease in india so national program are organised to irradicate the spread of vector borne disease by various methods like controlling the vector (mosquitos) from spreading
role of community pharmacist in educating and monitoring of patients for infection and counselling and educating them regarding the control of malaria and tb.
GUIDELINES FOR THE MANAGEMENT OF TUBERCULOSIS IN CHILDREN Surya Amal
GUIDELINES FOR THE MANAGEMENT OF TUBERCULOSIS IN CHILDREN, 2013. Published by the Department of Health, Private Bag X828, Pretoria 0001, South Africa April 2013
India is the highest TB burden country in the world & accounts for nearly 1/5th (20 per cent) of global burden of tuberculosis, 2/3rd of cases in SEAR. Every year approximately 1.8 million persons develop tuberculosis, of which about 0.8 million are new smear positive highly'- infectious cases.Annual risk of becoming infected with TB is 1.5 % and once infected there is 10 % life-time risk of developing TB disease
Clinic Epidemiological Characteristics of Chronic Hepatitis C on the Backgrou...ijtsrd
Since the problem of the incidence of hepatitis C and tuberculosis in the population is still a very important and urgent problem not only in Uzbekistan and the whole world, we decided to study how these diseases flow against the background of each other. During our study, we observed 80 patients at the regional tuberculosis dispensary and at the regional infectious diseases hospital in Samarkand, which were divided into 2 clinical groups. Mukhammedova Fariza Farkhodovna "Clinic - Epidemiological Characteristics of Chronic Hepatitis C on the Background of Tuberculosis" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-5 , August 2021, URL: https://www.ijtsrd.com/papers/ijtsrd45174.pdf Paper URL: https://www.ijtsrd.com/economics/other/45174/clinic--epidemiological-characteristics-of-chronic-hepatitis-c-on-the-background-of-tuberculosis/mukhammedova-fariza-farkhodovna
this presentation is based on national health program in india in relation to tuberculosis and malaria as these are mostly occuring disease in india so national program are organised to irradicate the spread of vector borne disease by various methods like controlling the vector (mosquitos) from spreading
role of community pharmacist in educating and monitoring of patients for infection and counselling and educating them regarding the control of malaria and tb.
**Stop the Spread of TB**
==>Take all of your medicines as they're prescribed, until your doctor takes you off them.
==>Keep all your doctor appointments.
==>Always cover your mouth with a tissue when you cough or sneeze. ...
==>Wash your hands after coughing or sneezing.
==>Don't visit other people and don't invite them to visit you
Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs. Tuberculosis is curable and preventable.
TB is spread from person to person through the air. When people with lung TB cough, sneeze or spit, they propel the TB germs into the air. A person needs to inhale only a few of these germs to become infected.
The causative agent is Mycobacterium tuberculosis (also known as the tubercle bacillus).
Tuberculosis (TB) is an infectious disease that primarily affects the lung parenchyma. The primary infection usually involves the middle or lower lung area.
It is also may be transmitted to other parts of the body, including the Meninges, kidneys, bone, joints, pericardium, GI tract and lymph nodes And this condition known as Extra pulmonary TB.
The disease also can affects animals such as cattle, this is known as “bovine tuberculosis” which may sometimes be transmitted to man.The primary infectious agent, “ M.Tuberculosis”, is an acid – fast aerobic (AFB) rod that grows slowly and is sensitive to heat and ultraviolet light.
Pulmonary tuberculosis
The bacterium Mycobacterium tuberculosis causes tuberculosis (TB), a contagious, airborne infection that destroys body tissue. Pulmonary TB occurs when M. tuberculosis primarily attacks the lungs. However, it can spread from there to other organs.
New treatment regimen is mentioned here.
Infertility is defined as the inability of a couple to conceive after at least one year of regular unprotected intercourse.
Male infertility refers to a male's inability to cause pregnancy in a fertile female.
IDD situation in our country has improved
A good number of thyroid disorder patients are either undiagnosed and or untreated
Thyroid disorder in pregnancy- Rate high
As a sound thyroid functioning status is crucial for growth, development in children; reproduction, psychological and general wellbeing in adults, we must be proactive in screening, diagnosing and treating our patients.
Over the past several years it has been proved that maternal thyroid disorder influence the outcome of mother and fetus, during and also after pregnancy. The most frequent thyroid disorder in pregnancy is maternal hypothyroidism. It is associated with fetal loss, placental abruptions, pre-eclampsia, preterm delivery and reduced intellectual function in the offspring.1 In pregnancy, overt hypothyroidism is seen in 0.2% cases2 and sub clinical hypothyroidism in 2.3% cases3. Fetal loss, fetal growth restriction, pre-eclampsia and preterm delivery are the usual complications of overt hyperthyroidism (low TSH and high T3, T4) seen in 2 of 1000 pregnancies whereas mild or sub clinical hyperthyroidism (suppressed TSH alone) is seen in
1.7% of pregnancies and not associated with adverse outcomes4. Autoimmune positive euthyroid pregnancy shows doubling of incidence of miscarriage and preterm delivery. Worldwide more than 20 million people develop neurological sequel due to intra uterine, iodine deprivation5. Other problems of thyroid disorders in pregnancy are post partum thyroiditis, thyroid nodules and cancer, hyper emesis gravidarum etc. Debates and disputes persist regarding several protocol and management plan in this specific spectrum of diseases.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Bangladesh national guidelines and operational manual for tuberculosis dr shahjadaselim
1. Bangladesh National Guidelines and
Operational Manual for Tuberculosis Control
NTP, 2014
Dr Shahjada Selim
Registrar
Department of Medicine
Shaheed Suhrawardy Medical College & Hospital, Dhaka
2. Background
• Tuberculosis (TB) is a major public health problem
in Bangladesh since long. Estimates suggest that
daily about 880 new TB cases and 176 TB deaths
occur in the country.
• Nearly one-third of the global population, i.e. two
billion people, is infected with Mycobacterium
tuberculosis and thus at risk of developing the
disease. More than nine million people develop
active TB every year and about two million die.
3. • More than 90% of global TB cases and deaths
occur in the developing world, where 75% of
cases are in the most economically productive
age group (15-54 years).
4.
5. Vision Statement of the National TB
Control Programme
• To eliminate tuberculosis as a public
health problem in Bangladesh.
6. Goal of Tuberculosis Control for
Bangladesh
• The overall goal of TB control is to reduce
morbidity, mortality and transmission of TB
until it is no longer a public health problem.
7. Definition of tuberculosis
• Tuberculosis is an infectious disease, caused
by the bacillus called
Mycobacterium tuberculosis.
• The bacilli usually enter the body by inhalation
through the lungs and spread to other parts of
the body via the blood stream, the lymphatic
system, or through direct extension to other
organs.
8. • Tuberculosis of the lungs or pulmonary
tuberculosis is the most common form of TB
and occurs in about 80% of cases. Extra-
pulmonary tuberculosis can affect any part of
the body other than lungs.
10. TB infection
• TB spreads through droplet infection. TB
bacilli stay suspended in the air as droplets.
Healthy people become infected with TB
through inhalation of the droplets containing
TB bacilli. Around 90% of the infected people
do not progress to TB disease because of their
immunity. Around 10% of the infected people
develop TB disease in their lifetime.
11. TB disease
• Around 10% of the people infected with TB bacilli
may progress to TB disease in their lifetime. TB
bacilli multiply in their lungs or other organs and
produce the symptoms and signs. Around 5% of
the infected people develop TB disease within
months or years and the remaining in their old
age that is known as reactivation of the
disease. TB disease means TB infection plus
presence of signs and symptoms of TB.
12. Spread of tuberculosis bacilli
• Patients with pulmonary tuberculosis who
cough up TB bacilli through coughing,
sneezing and spitting are the main source of
TB infection. Presence of TB bacilli in the
sputum can be identified on microscopic
examination of sputum specimens. Such
patients whose sputum contains TB bacilli are
known as smear- positive cases.
13. • If the bacilli cannot be identified on
microscopy examination of sputum specimens
of pulmonary cases, the patients are known as
smear-negative cases.
Extra-pulmonary cases are almost never
infectious, unless they have pulmonary
tuberculosis as well.
14. Development of tuberculosis
• If the body immune mechanism is not
seriously compromised, approximately 90% of
the infected cases will not develop
tuberculosis disease; in this case the bacilli
usually remain dormant within the body. The
remaining 10% of infected individuals will
subsequently develop disease, half of them
shortly after infection, the other half later in
their life
15. Signs and symptoms of TB
• Pulmonary TB should be suspected in a person
who presents with persistent cough for three
weeks or more, with or without production of
sputum despite the administration of a non-
specific antibiotic.
• Respiratory symptoms: shortness of breath,
chest pain, coughing up of blood.
• General symptoms: loss of weight, loss
of appetite, fever, night sweats.
16. Signs and symptoms of
extra-pulmonary TB
• TB lymph adenitis: swelling of lymph nodes
• Pleural effusion: fever, chest pain, shortness
of breath
• TB arthritis: pain and swelling of joints
• TB of the spine: radiological findings with or
without loss of function
• Meningitis: headache, fever, stiffness of neck
and subsequent mental confusion
17. Diagnosis
• The most cost-effective tool for screening
pulmonary TB suspects is microscopy
examination of their sputum by the Ziehl-
Neelsen method.
• Radiological (X-ray) examination of the lungs.
• Tuberculin skin test (Mantoux Test).
• Culture of TB bacilli.
• FNAC and Biopsy (LN or other affected
organs).
23. Aims of treatment
• To cure the patient of TB
• To prevent death from active TB or its late
effects
• To prevent relapse of TB
• To decrease transmission of TB to others
• To prevent the development of acquired drug
resistance
24. Basic Principles of TB treatment
• Right combination of drugs to kill
different bacterial populations.
• Drugs are given for the right duration (several
months) to kill the bacilli.
• Drugs are given in the right dosage to achieve
therapeutic but not toxic effect
32. Treatment of tuberculosis in special
situation
• Drug-induced hepatitis
• Most anti-TB drugs can damage the liver. Isoniazid,
pyrazinamide and rifampicin are most commonly
responsible, ethambutol rarely. When a patient
develops hepatitis duringTB treatment, the hepatitis
may be due to the anti-TB drugs but may also have
another cause. It is important to rule out other
possible causes before deciding that the hepatitis is
drug induced. If the diagnosis of drug-induced
hepatitis is made, the anti-TB drugs should be
stopped.
33. The drugs must be withheld until the jaundice or hepatic
symptoms have resolved and liver function tests have
returned to normal. If liver function tests cannot be
done, then it is advisable to wait two weeks after the
jaundice has disappeared before recommencing anti-TB
treatment. In most cases the patient can restart the
same anti-TB drugs without return of hepatitis.
34. • This can be done either gradually (one by one) or all at
once (if the hepatitis was mild). However if the
hepatitis produced severe jaundice, it is advisable to
avoid pyrazinamide. A suggested regimen in such
patient is 2SHE/10HE. A severely ill TB patient with
drug-induced hepatitis may die without anti-TB drugs.
In this case the patient should be treated with two of
the least hepatotoxic dugs, streptomycin and
ethambutol. After the hepatitis has resolved, usual TB
treatment should be restarted. Incase of extensive TB,
ofloxacin can be considered in conjunction with
streptomycin and ethambutol as an interim non-
hepatotoxic regimen.
35. • Acute viral hepatitis
• TB treatment should be deferred until the acute
hepatitis has resolved. When it is necessary to
treat during acute hepatitis, the combination of
streptomycin and ethambutol for three months is
the safest option. If the hepatitis has resolved,
the patient can receive a continuation phase of
six months isoniazid and rifampicin. If the
hepatitis has not fully resolved, streptomycin and
ethambutol should be continued for a total of 12
months
36. • Chronic liver disease
• Patients with liver disease should not receive
pyrazinamide. Isoniazid plus rifampicin plus
one or two non-hepatotoxic drugs such as
streptomycin and ethambutol can be used for
total treatment duration of 8 months
(2SHRE/6HR)
37. • Renal failure
• Isoniazid, rifampicin and pyrazinamide are
either eliminated almost entirely by billiary
excretion or metabolized into non-toxic
compounds. These drugs can therefore be
given in normal doses to patients with renal
failure. Patients with severe renal failure
should receive pyridoxine with isoniazid in
order to prevent peripheral neuropathy.
38. • Pregnancy
Most anti TB drugs are safe for use in pregnancy
with the exception of streptomycin which is
ototoxic to the fetus.
39. • Breast-feeding women
• A woman with TB who is breast-feeding should receive
a full course of anti-TB drugs.Regular and full course
chemotherapy is the best way to prevent transmission
of tubercle bacilli to her baby. The mother and baby
should stay together and breast-feeding should be
continued. Prophylactic treatment with isoniazid
should be given for at least three months ahead of the
time the mother is considered non-infectious. BCG
vaccination of the newborn should be postponed until
the end of the isoniazid prophylax.
40. • Women taking oral contraceptive pills
• Rifampicin reduces the efficacy of estrogen
thus increases the risk of pregnancy. A higher
dose of estrogen (50 µ) can be used with
rifampicin or another form of contraception .
may be used.
41. • Diabetes mellitus
• During the course of anti-TB treatment a
diabetes mellitus patient may require
treatment with insulin.
42. DRUG-RESISTANT TUBERCULOSIS
• Depending on the number of resistant drugs,
we distinguish the following categories of
resistance:
• Mono-resistance: resistance to one type of
drugs (e.g. isoniazid).
• Poly-resistance: resistance to more than one
type of drug (e.g. streptomycin,isoniazid and
ethambutol).
43. MDR-TB: this is a subcategory of poly-
resistance. TB resistant to at least
isoniazid and rifampicin.
Extensive drug-resistant tuberculosis
(XDR-TB): this is a subcategory of MDR-
TB.XDR-TB is defined as MDR-TB plus
resistance to a quinolone and an
injectable second-line drug (kanamycin,
capreomycin etc.)
44. • The Standard MDR TB Regimen
• 8{Km-Z-Lfx(Ofx)-Eto-Cs}/12{Lfx(Ofx)-Eto-Cs-Z}
45. Length of treatment for the standard
MDR TB regimen
Date of first sustained
conversion
Length of injectable agent Length of total treatment
for standard MDR TB
regimen
Between month 0 and 4 8 month total 20-22 months
Between months 5 and 8 Add 4 months from
conversion date
Add 18 months from
conversion date
46. • The Standard XDR TB Regimen
• 12(Cm-Z-Mfx-PAS-Cs-Amx/Clv-Lzd-Cfz)/12(Z-
Mfx-PAS-Cs-Amx/Clv-Lzd-Cfz)
47. Length of treatment for standard XDR
TB regimen
Date of first sustained
conversion
Length of injectable agent Length of total treatment
for standard MDR TB
regimen
Between month 0 and 2 12 month total 24 months
Between months 3 and 6 Add 10 months from
conversion date
Add 22 months from
conversion date