PPT Concia "Localizzazioni extrapolmonari nella coinfezione"StopTb Italia
This document discusses various sites of extrapulmonary tuberculosis. It begins by listing common sites of extrapulmonary TB, with percentages of extrapulmonary cases that occur at each site. The most common sites are pleura (20-25%), lymphatics (20-40%), and genitourinary (5-18%). It then discusses specific forms of extrapulmonary TB including tuberculosis of the central nervous system, bones/joints, skin, and other organ systems. Risk factors for developing extrapulmonary TB are also mentioned.
PPT Concia "Localizzazioni extrapolmonari nella coinfezione"StopTb Italia
This document discusses various sites of extrapulmonary tuberculosis. It begins by listing common sites of extrapulmonary TB, with percentages of extrapulmonary cases that occur at each site. The most common sites are pleura (20-25%), lymphatics (20-40%), and genitourinary (5-18%). It then discusses specific forms of extrapulmonary TB including tuberculosis of the central nervous system, bones/joints, skin, and other organ systems. Risk factors for developing extrapulmonary TB are also mentioned.
PPT Rizzardini "HAART, sostenibilità di un miracolo"StopTb Italia
This document discusses the sustainability of highly active antiretroviral therapy (HAART) for HIV/AIDS treatment. It begins by recounting the history of HAART from initial hope to "miracle" outcomes. However, it notes the global economic crisis challenges sustainability of healthcare systems. Charts show rising healthcare costs as a percentage of GDP in many nations by 2030 and 2050. Italy faces a large national debt and rising healthcare spending. The document questions if the HAART miracle can continue given these economic pressures and need to control costs.
PPT Rusconi "Le multiresistenze dell'HIV/AIDS"StopTb Italia
This document discusses HIV drug resistance and multiresistance. It notes that the emergence of resistance is an inevitable consequence of incomplete viral suppression by antiretroviral drugs. Resistance can develop through the selection of pre-existing mutations under drug pressure or the generation of new mutations over time. The level of resistance depends on factors like the genetic barrier of the drugs. Long-term failing treatment can lead to the accumulation of multiple resistance mutations. Data is presented on increasing resistance prevalence correlated with higher viral loads. Resistance testing is important to identify mutations and guide treatment choices.
PPT Bonora "Clinica e terapia dell'HIV"StopTb Italia
The document discusses the clinical management of HIV infection and lessons from anti-tuberculosis therapy. It notes that combination antiretroviral therapy is effective at suppressing HIV due to its ability to prevent the selection of drug-resistant strains, in contrast to less effective single-drug regimens. Over time, combination therapy has resulted in more HIV-infected individuals achieving sufficient immune recovery to approach the life expectancy of the general population. However, non-AIDS comorbidities have become more prevalent as the HIV-infected population ages.
This document summarizes a presentation on immunological testing for tuberculosis (TB) and HIV co-infection. It discusses the clinical utility of interferon gamma release assays (IGRAs) for detecting latent TB infection (LTBI) in HIV-infected individuals. While IGRAs perform similarly to the tuberculin skin test (TST) in identifying those who could benefit from LTBI treatment, important questions remain about their use in HIV-positive populations with different CD4 counts. The document also examines the diagnostic value of IGRAs for active TB, finding no evidence they are more sensitive than the TST, especially in low- and middle-income countries.
PPT Castelli "Dall'HIV all'AIDS fino alla coinfezione: una diagnosi difficile?"StopTb Italia
This document discusses the challenges of diagnosing HIV, AIDS, and co-infections. It notes that distinguishing between HIV infection, AIDS, and co-infections can be difficult. Point-of-care rapid tests have helped increase HIV testing, though they cannot identify acute HIV infections. The document emphasizes the importance of confirming positive rapid HIV tests with supplemental tests due to the potential for false positives in low prevalence populations.
PPT Bocchino "Diagnosi dell'infezione tubercolare"StopTb Italia
This document summarizes guidelines for diagnosing tuberculosis infection. It discusses the characteristics and performance of interferon gamma release assays (IGRAs) like QFT-IT and T-SPOT compared to the tuberculin skin test (TST). While IGRAs generally have higher specificity than TST, their sensitivity can be reduced in high prevalence settings. Factors like BCG vaccination, repeated exposures, and immunocompromise can affect test performance. Guidelines provide recommendations on using IGRAs and TST depending on the clinical setting and population. Further research is still needed to optimize IGRA testing methods and better predict which individuals will develop active tuberculosis.
PPT Angarano "Storia naturale dell'HIV"StopTb Italia
The document summarizes the natural history of HIV/AIDS, beginning with its identification and description in 1981. It describes how HIV attacks and destroys CD4+ T cells, ultimately overwhelming the immune system. As the immune system is compromised, victims develop secondary infections and diseases that they are no longer able to fight off, leading to AIDS and death if left untreated. The introduction of antiretroviral therapy in the 1990s was able to control viral replication and boost CD4+ counts, reducing AIDS-related illnesses and death rates dramatically. However, even with treatment, chronic inflammation persists and contributes to accelerated aging effects and non-AIDS comorbidities over time.
The document discusses the genetic epidemiology of tuberculosis. It summarizes that analysis of TB epidemics in Europe from the 18th-19th centuries found mortality rates of up to 2% per year without chemotherapy. There was an initial spike in cases over the first 50-100 years, followed by a slow decline over the next 200-250 years. This supports the hypothesis that the initial phase eliminated the most susceptible 20% of the population.
The document summarizes epidemiological data on tuberculosis (TB) in Italy and globally. It notes that the TB notification rate in Italy decreased by 7.7% from 2007 to 2012. In 2012, 58.3% of Italian TB cases were in foreign-born individuals and the rate of multi-drug resistant TB was 3%. Globally in 2012, there were an estimated 8.6 million incident TB cases and 1.3 million deaths, with South-East Asia and Africa accounting for most cases and deaths. Major ongoing challenges include TB/HIV co-infection, multi-drug resistant TB, and improving detection of "missing" TB cases.
TB situation in 2011:Findings from the ECDC and WHO/EURO joint TB surveillanc...StopTb Italia
The document summarizes tuberculosis (TB) data from 2011 in the European Union and European Economic Area (EU/EEA). Some key findings include:
- 72,334 TB cases were reported in the EU/EEA in 2011, with notification rates ranging widely between countries.
- Overall notification rates have declined steadily between 2007-2011.
- Laboratory confirmation of TB cases varied between countries, from 28-95% of cases.
- Foreign-born individuals accounted for 25.8% of TB cases on average across EU/EEA countries.
PPT Raviglione "Stop TB in my lifetime -Giornata Mondiale della Tubercolosi"StopTb Italia
This document summarizes the global burden of tuberculosis (TB) in 2011. Some key points:
- There were an estimated 8.7 million new TB cases and 1.4 million TB deaths in 2011. The majority of cases and deaths occurred in Asia and Africa.
- TB is a leading cause of death among people living with HIV, with 1.1 million new HIV-associated TB cases in 2011. 80% of the global TB/HIV burden is in Africa.
- There were an estimated 630,000 multi-drug resistant TB cases in 2011, with over 60% occurring in China, India, Russia and other countries.
- Women and children also face a large burden,
PPT Besozzi "Stop TB Italia: hosting fundraising events to help high burden c...StopTb Italia
Stop TB Italia was founded in 2004 to raise awareness of tuberculosis (TB) and support TB programs in high-burden countries. It aims to advocate for political changes, provide health worker training, and financial support. Activities include advocacy events, awareness concerts, and training health workers in Senegal. Due to financial challenges, it is pursuing new partnerships and a collaborative network to continue its work through a TB art exhibition and museum that would generate ongoing funding.
PPT Besozzi "Stop TB Italia: hosting fundraising events to help high burden c...
PPT Olivani "Naga and urban TB control"
1. Giornata mondiale contro la tubercolosi
(Milano, 23 marzo 2012)
LA TUBERCOLOSI
NELLE AREE
METROPOLITANE
Pierfranco Olivani, Daniela Panizzut
2.
3. QUESTIONARIO per MALATTIA TUBERCOLARE
(da: Lega polmonare svizzera, modificato)
Sei già stato curato per
tubercolosi ?
La
Tosse da più di 3 Sputi di più negli
settimane ultimi mesi?
Famigliari o conviventi affetti da malattia Sudorazione Dimagrimento negli
tubercolare? notturna ultimi 3 mesi
3
5. SUDDIVISIONE DEI PAZIENTI IN BASE:
-all’incidenza della malattia tubercolare nei Paesi di
origine,
- all’ entità dell’immigrazione verso l’Italia
anno 2010,
n° totale: 12.714
6. Risultati dello screening TB
( di primo livello) (anno 2010)
n° pazienti sottoposti al questionario : 1005
11. Consensus Conferen. 2008: Raccomandazioni
• Strategie per migliorare l'accesso ai servizi
Informazione degli immigrati su diritti/doveri e percorsi
Riorientamento dei servizi
• Strategie per migliorare l'adesione al
trattamento antitubercolare
Presa in carico del paziente
Figure dedicate alla gestione del caso
Migliorare l’accesso, semplificare la terapia, gratuità
DOT (per pazienti già trattati o con TB multiresistente)
• Programmi di ricerca attiva dei casi di infezione
e malattia (vedi poi)
11
• Ruolo della vaccinazione nei bambini immig. (vedi poi)
12. Programmi di ricerca attiva dei casi di infezione e malattia
1a) Diagnosi precoce in soggetti sintomatici
I Medici per ogni nuova persona proveniente da un paese ad alto
rischio (incidenza stimata dall’OMS >100 casi/100.000) devono:
informare sui rischi legati alla tubercolosi e sui sintomi iniziali di questa
malattia;
raccogliere l’anamnesi tubercolare (precedente vaccinazione con BCG,
precedente malattia tubercolare, malati di TB “in famiglia”);
indagare sulla eventuale presenza di sintomi suggestivi di tubercolosi:
se l’anamnesi o i sintomi sono positivi proporre una radiografia del torace.
I Pediatri per ogni nuovo bambino (inclusi i bambini adottati) nato in
un paese ad alto rischio (incidenza stimata dall’OMS >100 casi/100.000)
12
devono:
13. Programmi di ricerca attiva dei casi di infezione e malattia
1b) Diagnosi precoce in soggetti asintomatici
Durante le occasioni di contatto è proponibile eseguire anche la ricerca
dell’infezione tubercolare e della malattia nei soggetti asintomatici provenienti
da paesi ad incidenza di tubercolosi >100/100.000 e residenti in Italia da <5
anni, oppure provenienti dalle stesse aree e che vivono in condizioni socio-
sanitarie di emarginazione indipendentemente dall’epoca di soggiorno oppure
dopo un soggiorno prolungato (3-6 mesi) in paesi di origine ad alta endemia
tubercolare (Raccomandazione debole):
Il
test di riferimento è il test tubercolinico con il metodo Mantoux (TST) (da
considerare positivo se il diametro dell’infiltrato è uguale o superiore a 10 mm
a 48-72 ore dall’inoculazione);
O
ve possibile può essere opportuno confermare la positività alla tubercolina con
test basato sul rilascio di interferon-gamma (TIG-TB) (QuantiFeron-TB),
Il
test tubercolinico positivo richiede l’esclusione della malattia attiva mediante
esame radiografico del torace ed eventuali ulteriori indagini diagnostiche 13
ritenute utili a confermare o escludere una diagnosi di tubercolosi (esame