Downloaded 48 times
Uploaded byDr Amit Vatkar
Recent advances in tuberculosis
Dr. Amit Vatkar, a pediatric neurologist in Mumbai, discusses recent updates in childhood tuberculosis, highlighting diagnosis methods and treatment regimens for drug-resistant strains. The document outlines definitions of TB disease and latent infection, as well as new diagnostic tools recommended by WHO, such as nucleic acid amplification tests. Key recommendations include the use of Xpert MTB/RIF for diagnosing various forms of TB in children.
More Related Content
Similar to Recent advances in tuberculosis
Recent advances in tuberculosis
- 1. Dr. Amit Vatkar MBBS,DCH, DNB Pediatrics Fellow in Pediatric Neurology, Mumbai Trained in Neurophysiology & Epilepsy, USA Contact No. : +91-8767844488 Email: vatkaramit@yahoo.com RECENT UPDATES IN CHILDHOOD TUBERCULOSIS
- 2. Tuberculosis – thefacts • Most cases occurred in – Asia (59%) and – Africa (26%) WHO report 2011
- 3.
- 4. RESISTANCE PATTERN OFTB INDIA
- 5. Pathogens found inlungs from autopsy studies of African children
- 6. TB disease andinfection - definitions TB disease • Detection of M. tuberculosis and/or clinical symptoms compatible with tuberculosis Latent infection with M. tuberculosis (LTBI) • Presence of an immune response in a skin test or an IFN-γ release assay (IGRA) • Absence of clinical symptoms
- 7. Diagnosis of activetuberculosis • Patient history • Chest X-ray • Culture • Acid-fast bacilli staining • Nucleic acid amplification testing
- 8.
- 9.
- 13. NEW GROUPING OFDRUGS
- 14.
- 15. TREATMENT REGIMENS INRESISTANT TUBERCULOSIS
- 18.
- 19. TUBERCULIN SKIN TEST •Two preparations of PPD are available - PPD-S and PPD RT23. • Two TU PPD RT23 withTween 80 is equivalent to 5 TU of PPD-S. • Current recommendation is to use 2 TU RT23. • If it is not available 5 TU is acceptable, but there a risk of false positivity. • Cut off for positive result is an induration of 10 mm. In HIV positive patients 5 mm is the cut off.
- 20. New TB diagnostictools Between 2007 and 2010 the WHO has recommended several new diagnostic tests to improve TB diagnosis: – Fluorescent microscopy using LED technology—2009 – Liquid culture: MGIT (mycobacterium growth indicator tubes) and MODS (microscopic observation drug susceptibility assay)—2007/2009 – Nucleic Acid Amplification Test (NAAT): Xpert MTB/RIF—2010
- 21.
- 22.
- 23. Performance of XpertMTB/RIF vs. other diagnostic modalities Boehme et., Lancet 2011
- 24. Liquid culture: MGIT(mycobacterium growth indicator tubes) and MODS (microscopic observation drug susceptibility assay).Advantages + Both are a lot faster than solid media (2 wks vs. 3-6 wks). + MGIT had 81.5% sensitivity and 99.6% specificity in detecting MTB. + MGIT results had high concordance with solid media: 97% for rifampin and 96% for isoniazid resistance. + MODS is close to 98% sensitive and nearly 99% specific in detecting rifampin resistance, and 98% sensitive and 96% specific for isoniazid resistance. + MODS is inexpensive. Disadvantages - Both MGIT and MODS require trained technicians, sample processing, and biosafety levels appropriate only for reference laboratory settings. - MGIT is costly (@$30,000 per machine and $5 for a tube). - MGIT also requires another test to do rapid speciation to distinguish between MTB and non-TB mycobacteria. - MODS may have standardization issues that can hamper its accuracy.
- 25. Nucleic acid amplificationtest (NAAT): Xpert MTB/RIF Xpert MTB/RIF Advantages Disadvantages 98% sensitivity in smear-positive samples expensive machinery: currently about $17,000 for the machine and $17 per cartridge specificity is 99%. requires electric supply and annual calibration Gives results within 2 hours Does not test resistance to drugs other than rifampicin Requires minimal sample preparation
- 27. NEONATED OF MOTHERWITH TUBERCULOSIS • INH prophylaxis (10 mg/kg) for 6 months to all the babies- diagnosed to have active TB during pregnancy, after delivery or exposed to any case of active disease after delivery. • Rule out congenital TB • practical purpose RNTCP recommends BCG vaccination at birth even if INH chemoprophylaxis is planned. • Isolation of baby is indicated only if mother is having a smear positive MDR TB. • Isolation may be considered when mother is sick, non adherent to therapy, received ATT for less than 2 weeks or suspected to have MDR TB. • Barrier nursing, using face mask and appropriate cough hygiene are advised for all the mothers.
- 28. Recommendation Xpert MTB/RIF shouldbe used rather than conventional microscopy and culture as the initial diagnostic test in children suspected of having • children suspected of having TB • MDR TB or HIV-associated TB • extrapulmonary TB • TB meningitis
- 29.
- 30.
- 31. DURATION OF ATTIN ETB
- 32. Dr. Amit Vatkar PediatricNeurologist, Navi Mumbai MBBS, DNB Email: vatkaramit@yahoo.com Contact No.: +91-8767844488 Visit us at: http://pediatricneurology.in/ THANK YOU !