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Mycobacterium Tuberculosis Presentation
- 1. CLINICAL PHARMACY PRESENTATION BY SAMREEN FATIMA MUHAMMADMUBASSHIR Presented to Dr Faksheena
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- 3. OUTLINE DEFINITION MYCOBACTERIUM TUBERCULOSIS AETIOLOGY PATHOPHYSIOLOGY DIAGNOSIS TREATMENT ANDMANAGEMENT i) Pharmacological ii) Non Pharmacological DESIRED OUTCOMES
- 4. What is T uberculosis (TB) ? Causativeagent “MYCOBACTERIUM TUBERCULOSIS” Communicable infectious disease Produce silent , latent infections Progressive , active disease
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- 6. Aetiology MYCOBACTERIUM TUBERCULOSIS Mycobacteria– Rod shaped- Aerobic Bacilli Characteristics of both gram +ve and –ve Cell wall – Mycolicacid Mycolic acid Virulent Long chain Beta hydroxylated fatty acids Highly Lipophilic Ziehl-Neelsen Stain(Acid fast staining method)
- 7. Aetiology Latent TB infection Active TB infection MilliaryTB infection (MTBI)
- 8. RISK FACTORS OFTUBERCULOSIS Co infection with Human immunodeficiency Virus (HIV) Crowded living conditions Immunosuppressants Migration from a country with a high number of TB cases Alcoholism Cancer of the head and neck Smoking - Smokers who develop TB should be encouraged to stop smoking to decrease the risk of relapse
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- 10. EPIDEMIOLOGY Roughly oneof every three people is infected by M. Tuberculosis High incidence of TB in Southern Asia and Sub – Saharan Africa 59% of TB patients in United State are foreign born , most often from Mexico , Philippines , Vietnam , India With The Spread of AIDS , TB continues to lay waste to large populations The emergency of drug resistant organism threatens to make this disease once again incurable
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- 12. PATHOPHYSIOLOGY EXPOSURE TO SOURCE AEROSOLIZA TION OF DROPLETS MUCOCILIARY BEATING NO INFECTION (>50%) CD4LYMPHOCYTE GRANULOMATOUS LESIONS BEGINS TO FORM (NECROSIS) BACTERIA MULTIPLY IN MACROPHAGES LESION LIQUIFIES SPREAD TO BLOOD ORGANS DEA TH BACTERIA CEASE TOGROW IMMUNE SUPPRESSION REACTIVATION BACTERIA COUGHED UP IN SPUTUM LUNGS
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- 14. DIAGNOSIS TUBERCULIN SKIN TEST SPUTUM TESTCHEST RADIOGRAPHY NUCLEIC ACID AMPLIFICATION
- 15. DIAGNOSIS > TUBERCULINSKIN TEST
- 16. DIAGNOSIS > SPUTUMTEST Smear is prepared Zeihl Nielsen Acid Fast Stain Method
- 17. DIAGNOSIS >CHEST RADIOGRAPHY The radiographshows an abnormal shadow of lungs with active tuberculosis.
- 18. DIAGNOSIS >NUCLEIC ACIDAMPLIFICATION A new test can reveal in less than two hours , with very high accuracy
- 19. DIAGNOSIS > NUCLEICACIDAMPLIFICATION Species identification : several hours Low sensitivity High cost
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- 21. TREATMENT AND MANAGEMENT PHARMACOLOGICALNON PHARMACOLOGICAL
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- 23. TREATMENT AND MANAGEMENT FIRSTLINE ANTI TB RIFAMYCINS ISONIAZID PYRAZINAMIDE ETHAMBUTOL SECOND LINE ANTI TB QUINOLONES STREPTOMYCIN KANAMYCIN MACROLIDES CYCLOSERINE ETHIONAMIDE
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- 26. TREATMENT – ACTIVETB ISONIAZID 6MONTHS ADULT 300MG/DAY CHILD 10MG/KG RIFAMPICIN 6 MONTHS ADULT600MG/DAY CHILD 600MG PYRAZINAMIDE 2 MONTHS ADULT 2G/DAY CHILD 300MG INITIAL PHASE 2 MONTHS CONTINUOUS PHASE 4 MONTHS
- 27. TREATMENT – LATENTTB ISONIAZID 9 MONTHS >30KG PO qDAY TREATMENT IN HIVNEGATIVE ISONIAZID + RIF APENTENE 3 MONTHS PO 900MG ONCE WEEKLY TREATMENT IN HIV HEALTHY NOT TAKINGANTI RETROVIRALTHERAPY
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- 29. NON PHARMACOLOGICAL WHAT TOEAT VEGETABLE WITH HIGH Fe+ & VIT B CONTENT BRIGHT (RED)VEGETABLES VEGETABLE OIL WHOLE GRAIN NOT TO EAT ALCOHOL TOBACO IN ALLFORM SUGAR (REFINED PRODUCTS) WHITE BREAD HIGH FATDIET HIGH CHOLESTEROL RED MEAT
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- 31. MYCOBACTERIUM TUBERCULOSIS RESISTANCE MDRTB RIFAMPIN ISONIAZID XDR TB ISONIAZID RIFAMPIN ANY FLUOROQUINONE ONE OF 3 INJECTIBLES IMIKACIN KANAMYCIN CAPREOMYCIN
- 32. TREATMENT OF MDRTB UTILIZEATLEAST 3-5 UNUSED DRUGS LEVOFLOXACIN DON’T ADD DRUG IN FAILED REGIMEN ADD 3 PREFFERABLE MEDICINES FROM FOLLOWING AMINOGLYCOSIDE FLUOROQUINONE THIONAMIDE CYCLOSERINE BEDAQUILINE
- 33. Treatment optionsare very limited Carries a very high mortality rate TREATMENT OF MDR TB
- 34. DESIRED OUTCOMES RAPID IDENTIFICATION OFNEW CASESOF TB INITIATION OF SPECIFICANTI TUBERSULOSIS TREATMENT PROMPT RESOLUTION OF SIGNAND SYMPTOM OF DISEASE ADHERENCE THE TREATMENT REGIMEN BY THE PATIENT CURE AS QUICKLY ASPOSSIBLE
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- 36. REFERENCE https://reference.medscape.com/drug/rifadin- rimactane-rifampin-342570 British National formulary(BNF) https://emedicine.medscape.com/article/230802- treatment#d12
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