Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic o
Hello Guys,
This presentation consists of the updated guidelines under National tuberculosis elimination programme of India (MOHFW). The presentation includes case definitions and diagnostic algorithms for Pulmonary, Extrapulmonary and Drug resistant TB(MDR/ XDR TB) and the tratment protocols in pediatric cases.
Hope you find it useful.
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.
Hello Guys,
This presentation consists of the updated guidelines under National tuberculosis elimination programme of India (MOHFW). The presentation includes case definitions and diagnostic algorithms for Pulmonary, Extrapulmonary and Drug resistant TB(MDR/ XDR TB) and the tratment protocols in pediatric cases.
Hope you find it useful.
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.
The bacteria that cause tuberculosis (TB) can develop resistance to the antimicrobial drugs used to cure the disease. Multidrug-resistant TB (MDR-TB) is TB that does not respond to at least isoniazid and rifampicin, the 2 most powerful anti-TB drugs.
The 2 reasons why multidrug resistance continues to emerge and spread are mismanagement of TB treatment and person-to-person transmission. Most people with TB are cured by a strictly followed, 6-month drug regimen that is provided to patients with support and supervision. Inappropriate or incorrect use of antimicrobial drugs, or use of ineffective formulations of drugs (such as use of single drugs, poor quality medicines or bad storage conditions), and premature treatment interruption can cause drug resistance, which can then be transmitted, especially in crowded settings such as prisons and hospitals.
In some countries, it is becoming increasingly difficult to treat MDR-TB. Treatment options are limited and expensive, recommended medicines are not always available, and patients experience many adverse effects from the drugs. In some cases even more severe drug-resistant TB may develop. Extensively drug-resistant TB, XDR-TB, is a form of multidrug-resistant TB with additional resistance to more anti-TB drugs that therefore responds to even fewer available medicines. It has been reported in 117 countries worldwide.
Drug resistance can be detected using special laboratory tests which test the bacteria for sensitivity to the drugs or detect resistance patterns. These tests can be molecular in type (such as Xpert MTB/RIF) or else culture-based. Molecular techniques can provide results within hours and have been successfully implemented even in low resource settings.
New WHO recommendations aim to speed up detection and improve treatment outcomes for MDR-TB through use of a novel rapid diagnostic test and a shorter, cheaper treatment regimen. At less than US$ 1000 per patient, the new treatment regimen can be completed in 9–12 months. Not only is it less expensive than current regimens, but it is also expected to improve outcomes and potentially decrease deaths due to better adherence to treatment and reduced loss to follow-up.
Solutions to control drug-resistant TB are to:
cure the TB patient the first time around
provide access to diagnosis
ensure adequate infection control in facilities where patients are treated
ensure the appropriate use of recommended second-line drugs.
In 2015, an estimated 480 000 people worldwide developed MDR-TB, and an additional 100 000 people with rifampicin-resistant TB were also newly eligible for MDR-TB treatment. India, China, and the Russian Federation accounted for 45% of the 580 000 cases. It is estimated that about 9.5% of these cases were XDR-TB.
Pharmacotherapy Of Tuberculosis infection.pptxdrsriram2001
Tuberculosis (TB) is a contagious infectious disease caused by the bacterium Mycobacterium tuberculosis. It primarily affects the lungs but can also affect other parts of the body, such as the brain, kidneys, or spine. Here's a four-step explanation of tuberculosis:
Cause and Transmission: Tuberculosis is caused by the bacterium Mycobacterium tuberculosis. When an infected person with active TB coughs, sneezes, or talks, they release droplets containing the bacteria into the air. Another person can become infected by inhaling these droplets. TB is primarily transmitted through the air, making close and prolonged contact with an infected individual the main risk factor for transmission.
Symptoms: TB can manifest differently depending on whether it's active or latent. Latent TB infection occurs when the bacteria are present in the body but are not causing symptoms or spreading to others. Active TB disease occurs when the bacteria are actively multiplying and causing symptoms. Common symptoms of active TB include a persistent cough, chest pain, coughing up blood, fatigue, weight loss, fever, and night sweats.
Diagnosis: Diagnosis of TB involves several steps. Firstly, a medical history and physical examination are conducted to assess symptoms and risk factors. Following this, diagnostic tests such as the tuberculin skin test (TST) or interferon-gamma release assays (IGRAs) are used to determine if a person has been infected with TB bacteria. If these tests are positive, further tests such as chest X-rays, sputum tests, or cultures may be performed to confirm active TB disease and determine the most effective treatment.
Treatment and Prevention: Treatment for TB usually involves a combination of antibiotics taken for several months. Commonly used antibiotics include isoniazid, rifampin, ethambutol, and pyrazinamide. It's essential to complete the full course of treatment to prevent the development of drug-resistant strains of TB. Additionally, preventive measures such as vaccination with the Bacillus Calmette-Guérin (BCG) vaccine, good ventilation in living and working spaces, and early identification and treatment of active cases can help control the spread of TB.
RNTCP in India has gone a lot of updates in the resent times. The recent updates in RNTCP in India have been summarised in this presentation. Management of Drug sensitive and Drug Resistant TB have been included in the presentation.
Brief overview of OR guideliens and basic etiquette to be maintained in OR.
For interns, undergraduate and surgical residents. This would help to learn correct protocols and unlearn wrong things. Based on evidence from recent cochrane database studies and WHO guidelines for infection control following elective surgeries.
The bacteria that cause tuberculosis (TB) can develop resistance to the antimicrobial drugs used to cure the disease. Multidrug-resistant TB (MDR-TB) is TB that does not respond to at least isoniazid and rifampicin, the 2 most powerful anti-TB drugs.
The 2 reasons why multidrug resistance continues to emerge and spread are mismanagement of TB treatment and person-to-person transmission. Most people with TB are cured by a strictly followed, 6-month drug regimen that is provided to patients with support and supervision. Inappropriate or incorrect use of antimicrobial drugs, or use of ineffective formulations of drugs (such as use of single drugs, poor quality medicines or bad storage conditions), and premature treatment interruption can cause drug resistance, which can then be transmitted, especially in crowded settings such as prisons and hospitals.
In some countries, it is becoming increasingly difficult to treat MDR-TB. Treatment options are limited and expensive, recommended medicines are not always available, and patients experience many adverse effects from the drugs. In some cases even more severe drug-resistant TB may develop. Extensively drug-resistant TB, XDR-TB, is a form of multidrug-resistant TB with additional resistance to more anti-TB drugs that therefore responds to even fewer available medicines. It has been reported in 117 countries worldwide.
Drug resistance can be detected using special laboratory tests which test the bacteria for sensitivity to the drugs or detect resistance patterns. These tests can be molecular in type (such as Xpert MTB/RIF) or else culture-based. Molecular techniques can provide results within hours and have been successfully implemented even in low resource settings.
New WHO recommendations aim to speed up detection and improve treatment outcomes for MDR-TB through use of a novel rapid diagnostic test and a shorter, cheaper treatment regimen. At less than US$ 1000 per patient, the new treatment regimen can be completed in 9–12 months. Not only is it less expensive than current regimens, but it is also expected to improve outcomes and potentially decrease deaths due to better adherence to treatment and reduced loss to follow-up.
Solutions to control drug-resistant TB are to:
cure the TB patient the first time around
provide access to diagnosis
ensure adequate infection control in facilities where patients are treated
ensure the appropriate use of recommended second-line drugs.
In 2015, an estimated 480 000 people worldwide developed MDR-TB, and an additional 100 000 people with rifampicin-resistant TB were also newly eligible for MDR-TB treatment. India, China, and the Russian Federation accounted for 45% of the 580 000 cases. It is estimated that about 9.5% of these cases were XDR-TB.
Pharmacotherapy Of Tuberculosis infection.pptxdrsriram2001
Tuberculosis (TB) is a contagious infectious disease caused by the bacterium Mycobacterium tuberculosis. It primarily affects the lungs but can also affect other parts of the body, such as the brain, kidneys, or spine. Here's a four-step explanation of tuberculosis:
Cause and Transmission: Tuberculosis is caused by the bacterium Mycobacterium tuberculosis. When an infected person with active TB coughs, sneezes, or talks, they release droplets containing the bacteria into the air. Another person can become infected by inhaling these droplets. TB is primarily transmitted through the air, making close and prolonged contact with an infected individual the main risk factor for transmission.
Symptoms: TB can manifest differently depending on whether it's active or latent. Latent TB infection occurs when the bacteria are present in the body but are not causing symptoms or spreading to others. Active TB disease occurs when the bacteria are actively multiplying and causing symptoms. Common symptoms of active TB include a persistent cough, chest pain, coughing up blood, fatigue, weight loss, fever, and night sweats.
Diagnosis: Diagnosis of TB involves several steps. Firstly, a medical history and physical examination are conducted to assess symptoms and risk factors. Following this, diagnostic tests such as the tuberculin skin test (TST) or interferon-gamma release assays (IGRAs) are used to determine if a person has been infected with TB bacteria. If these tests are positive, further tests such as chest X-rays, sputum tests, or cultures may be performed to confirm active TB disease and determine the most effective treatment.
Treatment and Prevention: Treatment for TB usually involves a combination of antibiotics taken for several months. Commonly used antibiotics include isoniazid, rifampin, ethambutol, and pyrazinamide. It's essential to complete the full course of treatment to prevent the development of drug-resistant strains of TB. Additionally, preventive measures such as vaccination with the Bacillus Calmette-Guérin (BCG) vaccine, good ventilation in living and working spaces, and early identification and treatment of active cases can help control the spread of TB.
RNTCP in India has gone a lot of updates in the resent times. The recent updates in RNTCP in India have been summarised in this presentation. Management of Drug sensitive and Drug Resistant TB have been included in the presentation.
Brief overview of OR guideliens and basic etiquette to be maintained in OR.
For interns, undergraduate and surgical residents. This would help to learn correct protocols and unlearn wrong things. Based on evidence from recent cochrane database studies and WHO guidelines for infection control following elective surgeries.
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
2. Strategic Framework to END TB in India
• PILLAR 1: B U I L D, S T R E N G T H E N A N D S U S T A I N A N
E N A B L I N G E N V I R O N M E N T F O R T B E L I M I N A T I O N
Build, strengthen and sustain enabling policies, empowered institutions,
multi-sectoral collaborations, engaged communities, and human
resources with enhanced capacities to create a supportive ecosystem
which accelerates PREVENT – DETECT – TREAT
3. PILLAR 2: P R E V E N T
Prevent the emergence of TB in susceptible populations using a combination of
biomedical, behavioural, social and structural interventions.
S T R A T E G I C A R E A
Access to shorter and effective TB Preventive Treatment (TPT) and
Programmatic management of LTBI
Scale up TB - infection control (TB-IC) measures at home, community, and
health care facilities
4. PILLAR 3 : D E T E C T A L L
Early identification of presumptive TB, at the first point of contact be it private or
public sectors, and prompt diagnosis using high sensitivity diagnostic tests to
provide universal access to quality TB diagnosis including drug resistant TB in the
country.
S T R A T E G I C A R E A
Scale-up free, high sensitivity TB diagnostic tests and algorithms
Intensify TB case finding efforts amongst all programmes within the
MOHFW and other ministries
5. PILLAR 4 : TREAT ALL
S T R A T E G I C A R E A
Strengthen treatment of DSTB
Expand treatment and management of DRTB
Address TB in priority populations
Strengthen and expand coverage of patient support systems
6. Objectives of NTEP
• To achieve 90% notification rate for all cases.
• To achieve 90% success rate for all NEW and 85% success rate for retreatment cases.
• Improve outcome of treatment for DR-TB cases.
• To achieve decreased morbidity and mortality for HIV associated TB cases.
• To improve outcome of TB care in private sector.
7. TERMINOLOGIES
1.) New Case –
never taken treatment before or taken treatment for <1 month duration.
2.) Previously Treated Case –
patients who have received 1 month or more of TB treatment in past.
3.) Recurrent TB –
completed course of treatment/declared cured & now presenting as
microbiologically confirmed case.
8. TERMINOLOGIES (cont…)
4.) Treatment after failure –
treated for TB & treatment failed at end of most recent course of
treatment.
5.) Treatment after loss to follow up –
treated >1month on ATT & registered as loss to follow up & now
presenting as microbiologically confirmed case of TB
6.) Transferred IN –
received in TB unit after having registered in another TB unit for
treatment.
9. TERMINOLOGIES (newer ones in NTEP)
1.) Presumptive TB case in place of TB suspect –
*person with cough >2 weeks duration
*individual having fever or night sweats for >2 weeks
*contacts of smear positive TB patients having cough for any duration
*suspected / confirmed extra pulmonary TB having cough of any
duration
2.) Bacteriologically Confirmed Case in place of sputum positive TB
3.) Clinically Diagnosed TB Case
diagnosed with active TB by a clinician & decided to be given full course
of TB treatment, NOT bacteriologically confirmed.
10. Diagnosis and Investigations
1.) Roentgenogram
AP & lateral views & X-ray of the chest are mandatory.
Localized osteoporosis – 1st radiological sign of active disease
Articular margins & bony cortices become hazy
11. Thickened synovium, capsule & pericapsular tissues cause a soft tissue swelling.
Involvement of articular cartilage - joint space seen on X-rays.
Collapse of bone, subluxation/ dislocation, migration & deformity of joint.
12. 2.) Blood
A relative lymphocytosis, low hemoglobin, & raised ESR rate in active stage of disease.
3.) Mantoux (Heaf) Test
4.) Biopsy
5.) Smear and Culture
6.) Isotope Scintigraphy
7.) Modern Technologies – CT scan/MRI
13. DETECTION of TB
(Recent Advances in Detection of TB)
1.) CBNAAT (aka Gene Xpert) – DNA based technology
offered to any person with cough for >2 weeks
duration at baseline to rule out rifampicin resistance.
(Earlier CBNAAT was offered only to PLHIV/paediatric
contact cases/contacts of DRTB/recurrent TB cases)
False Positive results – contamination or error in testing process/cross reactivity with non TB
mycobacteria
False Negative results – low bacterial load below LOD (130 CFU/ml)/technical errors while
testing
14. On completion of a test run, the Cartridge-based Nucleic Acid Amplification Test (CBNAAT) gives the
following results:
1.MTB DETECTED; Rif Resistance DETECTED
2.MTB DETECTED; Rif Resistance NOT DETECTED
3.MTB DETECTED; Rif Resistance INDETERMINATE
4.MTB NOT DETECTED
5.Error
6.Invalid
7.No result
Conclusive results include:
MTB NOT DETECTED, MTB DETECTED
with Rif Resistance/ without Rif
Resistance.
Non-conclusive results include:
MTB Detected, Rif Resistance
Indeterminate, Errors, Invalid and No
Result - the test has to be repeated in
these cases.
15. The Cartridge-based Nucleic Acid Amplification Test (CBNAAT) test has some limitations such as:
1. load below LOD ~ 130 CFU/ml result in false-negative result.
2. on anti-TB regimen can have positive results due to killed bacilli in specimen.
3. positive test result does not indicate presence of viable organisms.
16. 4. result affected by anti-TB medication, therapeutic success or failure cannot be
assessed by test.
5. Mutations or polymorphisms in primer or probe binding regions may affect the
detection of new or unknown MDR or Rif-resistant strains, resulting in a false-
negative result.
6. modification in sample processing - alter performance of test.
17. 2.) Line Probe Assay (LPA)
offered at baseline to all previously treated TB patients to rule out both
rifampicin and isoniazid resistance.
FL-LPA : to r/o isoniazid resistance
SL-LPA : to r/o rifampicin resistance
18. Mycobacteria Growth Indicator Tube (MGIT)
• Intended for the detection and recovery of mycobacteria.
• Contains 7 mL of modified Middlebrook 7H9 Broth base.
• One of the most commonly used liquid media for the cultivation of mycobacteria.
• All types of clinical specimens, pulmonary as well as extra-pulmonary
(except blood and urine), can be processed.
19. Classification Based on Resistance
1.) Mono resistant – resistant to one 1st line anti TB drug.
2.) Poly Drug Resistant – resistant to more than one 1st line anti TB drug
except Rifampicin.
3.) Rifampicin Resistant – resistance to rifampicin with or without resistance
to other drugs.
Patients with rifampicin resistance have to managed as MDR TB case.
20. 4.) MDR TB – resistance to both isoniazid and rifampicin.
5.) XDR TB – resistance to
* isoniazid + rifampicin
* any one fluoroquinolone
* any one 2nd line injectable
(kanamycin/amikacin/capreomycin)
NEW classification of XDR TB as per NSP 2020-25
MDR/RR TB + any one fluoroquinolone + atleast one Group A drug
Group A drugs – levo/moxifloxacin, bedaquilline, linezolid
Group B drugs – cycloserine/terizidone, clofazimine
Group C drugs – ethambutol, pyrazinamide, ethionamide, amikacin, delamanid, etc
21. 6.) Presumptive MDR
*currently on ATT, but poor response (no clinical improvement or sputum positive on 3rd or 5th
month of follow up)
*any contact of MDR case
7.) Recurrent Case
*cured after ATT but now microbiologically confirmed case of TB
*Relapse of TB is no longer a used terminology.
22. Types of the Skeletal TB
1. Caseous exudative :
more destruction, more exudation & abscess formation.
onset is less insidious,
constitutional symptoms & local signs of inflammation & swelling are more marked,
abscess & sinus formation common
2. Granular type :
less destructive,
insidious onset & course,
abscess formation is rare.
Its classical example is that of caries sicca of shoulder.
23. CATEGORIES for TB Management
1.) Category I – New & previously treated cases.
2.) Category IV – MDR TB
3.) Category V – XDR TB
24. TREATMENT OF TB
FIRST LINE
1. Isoniazid (H)
2. Rifampicin (R)
3. Pyrazinamide (Z)
4. Ethambutol (E)
5. Streptomycin (S)
SECOND LINE
1. Fluoroquinolones – ofloxacin, levofloxacin,
moxifloxacin, ciprofloxacin
2. Oral Drugs –
ethionamide, prothionamide, cycloserine,
PAS, rifabutin, thiacetazone, terizidone
3. Injectable drugs –
kanamycin, amikacin, capreomycin
25. NEWER DRUGS
1.) BEDAQUILINE :
i) MOA – inhibits mycobacterial ATP synthase.
ii) Food increases absorption of Bedaquiline
iii) Shows cross resistance with clofazimine.
iv) Used in treatment of XDR-TB
v) S/E – GI toxicity, hyperuricemia, hepatotoxicity, QT prolongation
26. NEWER DRUGS (cont…)
2. DELAMANID & PRETOMANID
> act by inhibiting mycolic acid
> S/E – QT prolongation
> Pretomanid is a prodrug that requires activation by bacteria.
3. TEDUZOLID & SUTEZOLID – derivatives of Linezolid
27. ATT for Osteoarticular TB
2 months of intensive phase with 4 drugs to be taken daily – 2(HRZE)
10 months of continuation phase with 3 drugs to be taken daily – 10(HRE)
Total duration of 12 months, which can be maximally extended upto 18 months.
No extension of Intensive Phase as per new guidelnes.
28. Dosage
• Isoniazid : 3-8 mg/kg/day
• Rifampicin : 10 mg/kg/day
• Pyrizinamide : 35 mg/kg/day
• Ethambutol : 2.5 mg/kg/day in IP followed by 15 mg/kg/day in CP
In chidren, Ethambutol is replaced by Streptomycin as the former causes Optic
Neuritis.
30. FIXED DOSE COMBINATION
Adults : Children :
1 FDC contains - 1 FDC contains -
H : 75mg H : 50mg
R : 150mg R : 75mg
Z : 400mg Z : 150mg
E : 275mg E is given separately
as per age of the child
In Intensive Phase - (2) HRZE, i.e 56 FDC tablets in total
In Continuation phase – (4) HRE, i.e 112 FDC tablets in total
31. Summary of Regimens
1.) Category 1 : 2HRZE + 4HRE
2.) Shorter MDR Regimen : (4-6) Mfx, Km, Eto, Cfz, Z, Hh, E
(5) Mfx, Cfz, Z, E
3.) Conventional MDR Regimen : (6-9) Lfx, Km, Eto, Cs, Z, E
(18) Lfx, Eto, Cs
32. 4.) INH Resistance – (6) Z, E, R, O
5.) Conventional XDR Regimen – (6-12) Cs, PAS, Mfx, H, Cfz, Lzd, Amx/Clv
(18) PAS, Mfx, H, Cfz, Lzd, Amx/Clv
6.) New XDR Regimen – BPaL : Bedaquilline, Pretomanid, Linezolid
Post Treatment follow-up screening at 6, 12, 18, 24 months
Summary of Regimens (cont…)
33. Dosage in BPaL Regimen
Pretomanid : 200mg once daily for 26 weeks
Bedaquilline : 400mg once daily for first 2 weeks f/b 200mg thrice a week for 24 weeks
Linezolid : 1200mg once daily for 24 weeks
(after 1 month, dose & duration modification for linezolid is permissible – with an option to
extend treatment to 39 weeks if patient was culture positive at week 1)
34. Inclusion Criteria for Bedaquilline/Delamanid
1. Aged > 6 years with MDR/RR/XDR TB
2. Non pregnant females
3. Well controlled arrhythmia & no cardiac disease
Exclusion criteria for Bedaquilline/Delamanid
1. Conduction abnormality
2. Prolonged QT
3. Heart failure, hypokalemia, family h/o long QT syndrome
41. Chemoprophylaxis
Infants & children staying in contact with infected mother or attendants.
Isoniazid - 5 mg/kg/wt daily, for 6 months OR
Isoniazid & ethambutol for 4 to 6 months OR
Rifampicin & Isoniazid for 3 to 6 months
42. Prophylactic chemotherapy for:
• Close-contacts TB patient
• Positive tuberculin test with abnormal chest X-ray
• Tuberculin skin test converters at any age
• Tuberculin skin test reactors younger than 35 years
43. NEW INITIATIVES IN NTEP (NSP 2020-25)
1.) Nikshay Poshan Yojna :
*nutritional incentive of Rs 500/month for notified TB patients.
*In tribal areas Rs 750/month.
2.) Incentive for DOTS providers – on successful completion of treatment
i) New & previously treated TB patient : Rs 1000/-
ii) MDR & XDR TB : Rs 5000/- (2000/- on IP & 3000/- on CP)
3.) Incentive given to private paractitioners on notification of a case of TB is
Rs 500/-
Incentive given to private practitioner on completion of treatment is Rs
500/-
44. NEW INITIATIVES IN NTEP (NSP 2020-25)
(cont…)
4.) Number of days within which private practitioner has to notify a case of TB is 30 days.
If failed to do so , punishable under IPC 269/270.
5.) Daily DOTS regimen dispensed in form of fixed dose combination (FDC).
Depending on weight of the patient, he/she is adviced to take number of medications
per day.
6.) CBNAAT
7.) Line Probe Assay (LPA)
45. Middle Path Regimen for TB Spine
1. Rest in hard beds
2. Use of anti TB drugs
3. Radiographs & ESR at 3-6 months interval. Measurement of kyphosis & CT/MRI scan for
cervicodorsal, cervicovertebral, LS & SI joint assessment at 6 month interval for 2 years.
4. Gradual mobilization –
a) In absence of neural deficit with help of brace.
b) 3-9 weeks post-treatment patient is put on back extension exercises for 5 to 10 minutes for
3-4 times a day.
c) Braces used for 18 to 24 months.
46. 5. Abscesses
a) Aspirated near the surface.
b)1 gm of streptomycin +/- isoniazid instilled at each aspiration.
c) I&D if aspiration fails.
d)All radiologically visible abscess is not drained.
6. Sinus
a) Majority heal within 6-12 weeks of treatment.
b)In few cases, treatment should be prolonged or sinus tract excised.
47. 7. Neural Complications
a) Surgical decompression unnecessary for progressive improvement.
b) Decompression done for:
i) Failure to respond to conservative treatment
ii) New appearance of neurological complications
iii)Worsening of neurological symptoms
iv)Recurrence of neurological complications
8. Excisional surgery done for posterior spinal disease associated with sinus or abscess
formation if no improvement seen after 3-4 weeks of therapy.
9. Posterior spinal arthrodesis – for symptomatic unstable spinal lesions
48. 10. Operative Debridement
a) Failure to improve after 3-6 months of chemotherapeutic treatment
b) Recurrence of disease
11. Postoperative
a) Nursed in hard bed
b) Mobilization after 3-5 months – in absence of paraplegia
49. Indications for Surgery in Spinal TB
1. Neurological deficit
2. Rapidly worsening deficits
3. New onset or deteriorating deficits during chemotherapy
4. No improvement after 6-8 weeks of chemotherapy
5. Spinal Instability
6. Panvertebral disease
7. > 3 contiguous vertebrae involved
50. 8. Children with initial kyphosis > 30 deg
9. Posterior neural arch with pedicular destruction
10. Clinical instability
11. Late deformity
12. Severe kyphosis with late onset neurological deficits
13. Disease recurrence despite chemotherapy
14. Primary drug resistance