Tuberculosis (TB) remains a major global health problem. The document discusses TB, including its epidemiology in Pakistan. It describes the etiology, signs and symptoms, diagnosis, and treatment of active TB. TB is caused by the bacterium Mycobacterium tuberculosis. Diagnosis involves sputum smear, culture and chest x-ray. Treatment requires a multi-drug regimen over 6-9 months using drugs like isoniazid and rifampin under direct observation. Drug resistant TB poses a challenge to effective treatment.
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While MIC is a good measure of antibiotic activity, it is static and reflects in vitro activity. PK and PD of the drug needs to be considered together with MIC if we wish to obtain an in vivo prediction of drug action and success.
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Medishared.org
You can get..
--- Premium Layest Released Medical Books
--- MBBS & M.D Examination papers with Answer Keys
--- Important Exam Helping Documents
--- Detaile Explained MCQs
--- MCQs Online Testing
And Much more than your expectation from website.
While MIC is a good measure of antibiotic activity, it is static and reflects in vitro activity. PK and PD of the drug needs to be considered together with MIC if we wish to obtain an in vivo prediction of drug action and success.
Tuberculosis (TB): clinical background,diagnosis and managementAbdusalam Halboup
Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as brain, bone, the kidney and. In 2017, the incidence of TB among population in Yemen is 48 cases per 100,000 people.
he WHO Global Tuberculosis Report 2022 provides a comprehensive and up-to-date assessment of the TB epidemic and of progress in prevention, diagnosis and treatment of the disease, at global, regional and country levels.
Identification of genetic regions in the yuk operon of Bacillus subtilis that are differentially required for secretion of YukE, a homolog to the virulence factor, ESXA in Mycobacterium tuberculosis
Tuberculosis (TB): clinical background,diagnosis and managementAbdusalam Halboup
Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as brain, bone, the kidney and. In 2017, the incidence of TB among population in Yemen is 48 cases per 100,000 people.
he WHO Global Tuberculosis Report 2022 provides a comprehensive and up-to-date assessment of the TB epidemic and of progress in prevention, diagnosis and treatment of the disease, at global, regional and country levels.
Identification of genetic regions in the yuk operon of Bacillus subtilis that are differentially required for secretion of YukE, a homolog to the virulence factor, ESXA in Mycobacterium tuberculosis
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
This is about tuberculosis , features, diagnosis and management. With reference to Uganda Clinical Guidelines
By Okeke Gloria, Kasule Steven, Sengooba Dennis Nyanzi
Bio303 Lecture 2 Two Old Enemies, TB and LeprosyMark Pallen
In this lecture I will focusing on another of the most serious infectious threats to humanity, tuberculosis, outlining its evolutionary origins, impact on human health and wealth and the steps taken to control and treat this infection. I will also discuss a related mycobacterial infection, leprosy and recent progress in its control.
ABSTRACT- Tuberculosis (TB) is one of the most virulent diseases, caused by Mycobacterium tuberculosis (MTB). It has been estimated that about one-third of world’s population to be affected with TB Tuberculosis (TB) is a chronic infectious granulomatous disease. The causative agent of tuberculosis is Mycobacterium tuberculosis. Extra pulmonary tuberculosis (EPTB) constitutes about 20% of all TB. It is very challenging the diagnosing EPTB because the sample obtained from relatively inaccessible sites. EPTB is the TB involving organs other than the lungs (e.g., pleura, lymph nodes, abdomen, genitourinary tract, skin, joints and bones, or meninges). The biochemical markers in TB-affected fluids (adenosine deaminase or gamma interferon) and other techniques such as polymerase chain reaction (PCR) may be useful in the diagnosis of EPTB. Although the disease usually responds to standard anti-TB drug therapy, the duration of treatment has not yet been established because smear microscopy or culture is not available to monitor patients with EPTB, clinical monitoring is the usual way to assess the response to treatment. Key-words- Tuberculosis (TB), Mycobacterium tuberculosis, PCR, EPTB
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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
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.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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
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Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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!
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
2. Introduction
TB remains one of the most common causes of
death amongst infectious diseases worldwide.
Despite the fact that Mycobacterium tuberculosis
colonizes few hosts other than man and survives
only briefly when isolated in the environment,
efforts to eliminate the disease have failed to date.
TB has staged a comeback in the US and other
parts of the world because of shifts in the
population considered endemic for TB, healthcare
policies changes, ↑ in the number of
immunocompromised individuals, and
development of drug resistance.
3. TB Burden 2012
8.6 million people fell ill with TB in 2012,
including 1.1 million cases among people
living with HIV
In 2012, 1.3million people died from TB,
including 320000 among people who were
HIV-positive
4. Epidemiology of TB Pakistan…
Tuberculosis (TB) is a massive public health problem and
according to World Health Organization, (WHO) Pakistan ranks
5th in the countries having high disease burden.
It contributes 26% of avoidable deaths among adults and
children in our country.
The present annual incidence of open TB cases is estimated to
be between 231/100,000 persons and subsequently about
361,000 new cases of TB are added every year in Pakistan
http://data.worldbank.org/indicator/SH.TBS.INCD
5. Epidemiology of TB…
Four out of 5 TB patients in Pakistan still remain
undetected, untreated and inadequately managed.
One untreated or poorly treated “open case” of TB can
make 10-15 people more patients in a year’s time.
Lack of proper diagnostic equipment and skills, irrational
prescription and non-availability of essential anti TB drugs
are among the major contributing factors of various
complications including emerging resistance.
Multi Drug Resistant TB is a contributing factor to
increasing costs, mortality and duration of treatment.
A simple TB case management incurs a cost of 6000
rupees for the treatment of 9 months while a MDR TB
case, which requires treatment for 2 years, costs about
300,000 rupees
6. Etiology of TB
TB is caused by M. tuberculosis, an
aerobic, non-spore-forming bacillus.
Also called Acid-fast bacillus (AFB).
M. tuberculosis replicates slowly (q 24hrs)
(20-40 minutes with other organisms).
M. tuberculosis thrive well in environment
where O2 tension is high such as renal
parenchyma, growing ends of bones.
7. Mycobacterium species include:
M. tuberculosis complex: M. tuberculosis, M. bovis,
M. africanum
Mycobacteria other than tuberculosis: Around 15 are
recognised as pathogenic to humans and some cause
pulmonary disease resembling TB. They have been
found
in soil, milk and water. They are also referred to as
atypical mycobacteria.
Mycobacterium leprae: The cause of leprosy.
8. Pulmonary (respiratory) TB
extrapulmonary (non-respiratory) TB.
Sites of extrapulmonary disease include the pleura, lymph
nodes, pericardium, kidneys,meninges, bones and joints,
larynx, skin, intestines, peritoneum and eyes.
Pulmonary TB may arise from exogenous reinfection or
endogenous reactivation of a latent focus remaining from
the initial infection.
9. Transmission
Tubercle bacilli are transmitted through the air by
aerosolized droplet nuclei that are produced when a
person with pulmonary or laryngeal TB coughs, sneezes,
speaks, or sings.
Droplet nuclei may also be produced by other methods
such as bronchoscopy, endotracheal intubation,
processing of secretions in labs and hospitals.
The nuclei, which contains one to 3 M. tuberculosis
organisms, are small enough to remain airborne for long
periods of time and to reach the alveoli within the lungs
when inhaled.
10. Transmission…
Tubercle bacilli are not transmitted on inanimate
objects such as dishes, clothing, or beddings, and
organisms deposited on skin or intact mucosa do
not invade tissues.
Several factors influence the likelihood of
transmission of M. tuberculosis, including
the number of organisms expelled into the air,
the length of time an exposed person breathes the
contaminated air,
and presumably the immune status of the exposed
individual.
11. Transmission…
Family household contacts, especially children, and
people working or living in an enclosed environment
(hospitals, prisons, nursing homes) with an infected
person are at increased risk.
Individuals with impaired cell-mediated immunity are
thought to be more likely to become infected with M.
tuberculosis after exposure than persons with normal
immune functions.
Most effective means of reducing transmission is by
treating infected patients with effective chemotherapy.
12. Pathophysiology of TB
Latent Infection vs. Active Disease (TB).
Upon inhalation, droplet nuclei settle into the
bronchioles and alveoli of the lungs.
Development of infection in the lungs will
depend on virulence and other factors.
Individuals with latent TB infections are not
infectious and cannot transmit the
organisms.
13. Pathophysiology of TB…
The extent of the disease produced by M. tuberculosis in
humans depends on the size of the inoculum of bacteria
inhaled (most common route of acquisition) and the
immune status of the host at the time of initial infection and
at a later time.
If the patient is immunocompromised at the time of initial
infection, the disease will more likely progress into
bacterial pneumonia at the site of implantation, known as
primary progressive disease.
In the remaining group whose immune system is
competent, the infection will usually be halted after a brief
period of bacillary dissemination.
14. Pathophysiology of TB…
In individuals who inhale a massive inoculum of
organisms, however, clinical disease may occur
despite an intact immune system.
In immunocompetent individuals, the 1º infection is
held in check due to the development of T cell-
mediated hypersensitivity that usually occurs 4-8
weeks after initial infection.
At this time, the patient will demonstrate a positive
reaction to a TST, and any remaining viable
organisms within the body will be walled off in
caseating granulomas.
15. Pathophysiology of TB…
1/10 persons with symptomatic 1º infection will at
some later date develop active TB (reactivation
disease) because the immune system fails to
contain the organism.
This most often presents as pulmonary
tuberculosis (PTB), although extrapulmonary
tuberculosis (CNS, renal, hepatic, GI, skeletal) is
not uncommon.
16. Diagnosis of Tuberculosis
The most common form of TB in adults is
post-primary pulmonary tuberculosis
(PTB).
Has great epidemiological significance.
Based on clinical, radiological and/or
bacteriological evidence.
17. Signs & Symptoms of PTB
Persistent cough (more than 2 weeks).
Cough with blood-stained sputum
(hemoptysis).
Dyspnea, chest pain, hoarseness of voice.
Fever with night sweats.
Loss of weight and loss of appetite.
18. Signs & Symptoms of PTB…
Consolidation.
Pulmonary fibrosis.
Stony dullness caused by pleural effusion.
20. Laboratory Investigations
Sputum direct smear for AFB (3 specimens).
C&S using egg-based media.
Chest X-ray often reveals lesions in the
apical and posterior segments of the upper
lobes (soft, usually little or no fibrosis).
Mantoux Test (Tuberculin PPD Skin Test)
has some role in diagnosis.
21.
22. Laboratory Investigations
Erythrocyte Sedimentation Rate (ESR) has
little role and cannot be recommended for
routine use in the diagnosis and follow-up
evaluation of patients.
Techniques utilizing PCR can give rapid
results, but are expensive.
23. Diagnosis of Extra-pulmonary TB
Due to lympho-hematogenous dissemination
during 1º TB infection.
Symptoms are often non-specific: anorexia,
fever, weight loss.
Specific features related to the organ
involved.
TB lymphadenitis, GU TB, TB of joints and
bones, miliary TB.
24. High Risk Group
Contacts of sputum positive TB cases.
Persons with HIV infections.
Immigrants from countries with high
prevalence.
Persons in institutions such as prison or drug
rehabilitation centers.
Persons with other risk factors (DM, silicosis,
prolonged corticosteroids and
immunosuppressive therapies).
25. Treatment of Active TB
A. GOALS OF TREATMENT
Cure the individual to prevent morbidity and
mortality.
Prevent relapse of the disease.
Minimize transmission of M. tuberculosis.
Prevent emergence of MDR-TB.
26. Treatment of Active TB
B. Essential First Line Drugs
i. Isoniazid, INH (H)
ii. Rifampicin (R)
iii. Pyrazinamide (Z)
iv. Streptomycin (S)
v. Ethambutol (E)
31. Treatment of Active TB
C. DOTS Regimen
Directly observed treatment (DOT) is an
important element in the internationally
recommended policy package for TB control.
DOTS remains at the heart of the Stop TB
Strategy.
32. Treatment of Active TB
C. DOTS Regimen
Directly observed treatment means that an
observer watches the patient swallowing their
tablets, in a way that is sensitive and supportive
to the patient's needs.
This ensures that a TB patient takes the right
antituberculosis drugs, in the right doses, at the
right intervals.
33. Treatment of Active TB
C. DOTS Regimen
The five elements of DOTS:
Political commitment with increased and sustained
financing.
Case detection through quality-assured bacteriology.
Standardized treatment, with supervision and patient
support.
An effective drug supply and management system.
Monitoring and evaluation system, and impact
measurement.
34. Treatment of Active TB
D. Treatment Regimens
Effective treatment of TB requires substantial
period (minimum 6 months) of intensive drug
therapy with at least two (2) bactericidal drugs
that are active against the organism.
The initial phase of treatment is crucial for
preventing the emergence of resistance and for
ultimate outcomes of therapy.
35. Treatment of Active TB
D. Treatment Regimens
The course of treatment is divided into: Initial
(Intensive) Phase and the Continuation (Maintenance)
Phase.
The 2-month Intensive Phase with 3 or 4 drugs is to
rapidly convert the sputum and improve clinical
symptoms.
The 4-month Continuation Phase with 2 or 3 drugs
has a sterilizing effect to eliminate the remaining bacilli
and prevent relapse.
41. Category II: Treatment Failure,
Relapse, Treatment after Default
DO NOT initiate conventional therapy as above.
Send sputum sample for C &S.
Refer case to Respiratory or Chest Physician.
Treatment should be based on C&S results and
clinical response.
42. Category III: Chronic Case
DO NOT initiate conventional therapy as above.
Send sputum sample for C &S.
Refer case to Respiratory or Chest Physician.
Treatment should be based on C&S results and
clinical response.
43. Drug and Multidrug-Resistant TB (MDR-TB)
Anti-tuberculosis (TB) drug resistance is a major
public health problem that threatens the success
of DOTS.
MDR-TB is a specific form of drug-resistant TB
due to a bacillus resistant to at least isoniazid and
rifampicin, the two most powerful anti-TB drugs.
“MDR-TB” is not synonymous to “Chronic TB”.
MDR-TB patients respond poorly to shortcourse
chemotherapy and need to be treated intensively
and for up to 24 months with a regimen based on
reserve antituberculosis drugs…
44. Therapeutic Options IN HIV/AIDS
Isoniazid, rifampin, pyrazinamide, and
ethambutol for 2 months (daily or 5x/week),
followed by isoniazid and rifampin for 4
months (daily, 5x/week, or 3x/week).
Alternatively, isoniazid, rifampin, and
ethambutol for 2 months (daily or 5x/week),
followed by isoniazid and rifampin for 7
months (daily or 5x/week)
45. Case
M.W., a 36-year-old woman, is admitted to the hospital with a 2-month
history of cough, which has recently become productive. She is also
experiencing fatigue, night sweats, and has lost 15 pounds. Other
medical problems include diabetes mellitus, which is controlled with 10
units of NPH insulin daily, and poor nutritional status secondary to
frequent dieting. M.W. works as a volunteer in a nursing home several
days a week. Recently, it was discovered that two patients who she had
been caring for had undiagnosed active tuberculosis.
M.W.'s physical examination was normal, but her chest radiograph
revealed bibasilar infiltrates. A tuberculin purified protein derivative
(PPD) skin test, sputum collections for cultures and susceptibility
testing, and a sputum AFB smear were ordered as part of M.W.'s
diagnostic workup. Initial laboratory test findings were within normal
limits.
The result of her tuberculin PPD skin test, read at 48 hours, was a
palpable induration of 14 mm. Her sputum smear was positive for AFB,
and additional sputum cultures for M. tuberculosis were ordered to
confirm the diagnosis of active TB disease.
46. Q. 1. What subjective and objective findings does M.W. have
that are consistent with active TB disease?
Subjective Findings:
M.W.'s history of cough (which gradually became productive),
bibasilar infiltrates, fatigue, and night sweats are consistent with
the classic symptoms of active TB.
The cough may be nonproductive early in the course of the
illness, but with subsequent inflammation and tissue necrosis,
sputum is usually produced and is key to most of the diagnostic
studies.
Anorexia from TB, along with frequent dieting, may have resulted
in M.W.'s weight loss. Other symptoms of TB can include fever,
pleuritic pain secondary to inflammation of lung parenchyma
adjacent to the pleural space, and general malaise. Dyspnea is
unusual unless there is extensive disease.
47. Objective Findings:
M.W. has a chest radiograph consistent with a lower respiratory
tract infection. In pulmonary TB, nodular infiltrates are usually
found in the apical or posterior segments of the upper lobes, but
markings may be found in any segment.
M.W. also has a positive sputum smear for AFB, a positive PPD
skin test (14 mm), and diabetes mellitus, which is a risk factor for
TB. Although her laboratory test results are within normal limits,
peripheral blood leukocytosis and anemia are the most common
hematologic manifestations of TB.18 The white blood cell count
is normal or slightly increased, and an increase in monocytes
and eosinophils may be observed.
48. Q.2. What is tuberculin skin testing? How should
the results be interpreted in M.W.?
Ans. 2.
The tuberculin skin test (Mantoux method) has been used as a
diagnostic tool for infection with M. tuberculosis for decades, but a
positive skin test is not necessary for the diagnosis of active TB
disease.
The test is frequently referred to as the PPD test, which contains a
protein prepared from a culture of the tubercle bacilli. The skin test is
performed by injecting 0.1 mL of solution containing 5-TU PPD
intracutaneously into the volar or dorsal surface of the forearm.
An induration ≥5 mm in diameter read 48 to 72 hours after injection is
considered to be a positive reaction in an individual with a recent history
of close contact with a person with active TB.
An induration ≥10 mm in diameter is considered to be a positive
reaction in persons with clinical conditions that put them at increased
risk for TB, such as diabetes mellitus, silicosis, chronic renal failure,
malnutrition, leukemia, lymphoma, gastrectomy, jejunoileal bypass, and
weight loss of >10% of ideal body weight.
49. Q. 3 Because M.W.'s Mantoux PPD skin test is positive, does
this confirm her diagnosis of active TB?
Ans. 3
No. M.W.'s positive reaction to 5-TU PPD alone does not
confirm active TB disease.
It merely signifies that she has previously been infected
with M. tuberculosis. To confirm the diagnosis of active
TB disease in M.W. and other patients, M. tuberculosis
must be isolated from sputum, gastric aspirate, spinal
fluid, urine, or tissue biopsy, depending on the site of
infection
50. Q.4. How should treatment be initiated in M.W pending the
results of the sputum culture and sensitivity?
Ans. 4
INH 5mg/kg max 300mg
Rifampacin 600 mg
Ethambutal 15-25 mg/kg/day
Pyrazinamide 15-50 mg /kg/day
51. Q.5. What are the monitoring parameters for M.W therapy?
Ans.5
ESR
Blood CP
LFT’s
Fundoscopic examination
Extremities
Urine
52. Q.6 What are the possible side effects of ATT treatment
INH: GI Intolerance: -Nausea, abdominal pain common-Vomiting less common, Peripheral
neuropathy: -dose-related -<0.2% will have, rash, Hepatitis
-10-20% of persons who take isoniazid will develop asymptomatic LFT increase
-In most cases these will resolve with continued treatment
Rifampacin: GI side effects
• Orange urine/body fluids (sweat) -harmless but may stain contact lenses,
clothing-need to let patients know beforehand Hepatitis:
-occurs in about 0.6% of patients, flu like syndrome
Pyrazinamide—Side Effects
• GI symptoms
• Arthralgias (joint pain)
•Rash
• Hyperuricemia (elevated uric acid) uric acid)
-usually asymptomatic
-may precipitate gout, kidney stones
-TB medications do not usually require discontinuation
Hepatitis dose related
53. Ethambutol— Side Effects
• Optic neuritis:-blurred vision
-”spots” in patient’s field of vision-red/green
color blindness• Dose related Dose related
• Uncommon with intermittent tx
• Drug should be discontinued
• Usually reversible if stopped right away