Tuberculosis (TB) is an infectious disease usually caused by Mycobacterium tuberculosis (MTB) bacteria. Tuberculosis generally affects the lungs, but can also affect other parts of the body. Most infections show no symptoms, in which case it is known as latent tuberculosis.
TB is spread from person to person through the air. When people with lung TB cough, sneeze or spit, they propel the TB germs into the air. A person needs to inhale only a few of these germs to become infected.
Tuberculosis (TB) is an infectious disease usually caused by Mycobacterium tuberculosis (MTB) bacteria. Tuberculosis generally affects the lungs, but can also affect other parts of the body. Most infections show no symptoms, in which case it is known as latent tuberculosis.
TB is spread from person to person through the air. When people with lung TB cough, sneeze or spit, they propel the TB germs into the air. A person needs to inhale only a few of these germs to become infected.
This powerpoint, deals with HIV pathophysiology, signs and symptoms, mode of transmission and diagnostic parameters.
Purely based on clinical pharmacist perspective.
Pulmonary TB is a bacterial infection of the lungs that can cause a range of symptoms, including chest pain, breathlessness, and severe coughing. Pulmonary TB can be life-threatening if a person does not receive treatment. People with active TB can spread the bacteria through the air.
tuberculosis lecture | pulmonary Tuberculosis
my self ritesh padghan
tuberculosis is infectious disease caused by mycobacterium tuberculosis in active and latent type of tuberculosis .
BRIEF DISCUSSION INCLUDE
:-LEARNING ABOUT
Introduction
Definition
Causative organism
Risk factor
Transmission
Clinical manifestation
Diagnostic evaluation
Medical management
In this lecture the pathophysiology and phathogenesis of tuberculosis has been discussed
HOPE YOU LIKE
#tuberculosis #respiratorysystem #chronicdiorder #TBkid #endTB #lunghealth # COVID19 #COMMUNIOTY #INFLUNZA #worldtbday # disease
This is about tuberculosis , features, diagnosis and management. With reference to Uganda Clinical Guidelines
By Okeke Gloria, Kasule Steven, Sengooba Dennis Nyanzi
This powerpoint, deals with HIV pathophysiology, signs and symptoms, mode of transmission and diagnostic parameters.
Purely based on clinical pharmacist perspective.
Pulmonary TB is a bacterial infection of the lungs that can cause a range of symptoms, including chest pain, breathlessness, and severe coughing. Pulmonary TB can be life-threatening if a person does not receive treatment. People with active TB can spread the bacteria through the air.
tuberculosis lecture | pulmonary Tuberculosis
my self ritesh padghan
tuberculosis is infectious disease caused by mycobacterium tuberculosis in active and latent type of tuberculosis .
BRIEF DISCUSSION INCLUDE
:-LEARNING ABOUT
Introduction
Definition
Causative organism
Risk factor
Transmission
Clinical manifestation
Diagnostic evaluation
Medical management
In this lecture the pathophysiology and phathogenesis of tuberculosis has been discussed
HOPE YOU LIKE
#tuberculosis #respiratorysystem #chronicdiorder #TBkid #endTB #lunghealth # COVID19 #COMMUNIOTY #INFLUNZA #worldtbday # disease
This is about tuberculosis , features, diagnosis and management. With reference to Uganda Clinical Guidelines
By Okeke Gloria, Kasule Steven, Sengooba Dennis Nyanzi
More than 5.7 million new cases of TB (all forms, both pulmonary and extra-pulmonary) were reported to the World Health Organization (WHO) in 2013; 95% of cases were reported from developing countries
Latest figures from 20151 indicate an estimated 10.4 million people had TB, and 1.8 million people died (1.4 million HIV negative and 400 000 HIV positive).
Of further concern is that 480 000 cases of multidrug-resistant (MDR) TBa and a further 100 000 that were estimated to be rifampicin-resistant (RR) TB have occurred in the same period.
surgeries involved in gastroenterology: gastrointestinal surgery, conditions treated with gastrointestinal surgeries,procedure and side effects of these surgeries, open gastrointestinal surgeries and minimally invasive gastrointestinal surgeries
surgeries involved in cardiovascular department:angioplasty,atherectomy,cardiomyoplasty,coronary artery bypass grafting, transmyocardial revascularization , myectomy , heart valve repair or replacement, artificial heart valve surgery, arrhythymia treatment, aneurysm repair, heart transplant, surgery to place total artificial hearts: open heart surgery, off pump heart surgery, minimally invasive heart surgery
Observation of Io’s Resurfacing via Plume Deposition Using Ground-based Adapt...Sérgio Sacani
Since volcanic activity was first discovered on Io from Voyager images in 1979, changes
on Io’s surface have been monitored from both spacecraft and ground-based telescopes.
Here, we present the highest spatial resolution images of Io ever obtained from a groundbased telescope. These images, acquired by the SHARK-VIS instrument on the Large
Binocular Telescope, show evidence of a major resurfacing event on Io’s trailing hemisphere. When compared to the most recent spacecraft images, the SHARK-VIS images
show that a plume deposit from a powerful eruption at Pillan Patera has covered part
of the long-lived Pele plume deposit. Although this type of resurfacing event may be common on Io, few have been detected due to the rarity of spacecraft visits and the previously low spatial resolution available from Earth-based telescopes. The SHARK-VIS instrument ushers in a new era of high resolution imaging of Io’s surface using adaptive
optics at visible wavelengths.
Cancer cell metabolism: special Reference to Lactate PathwayAADYARAJPANDEY1
Normal Cell Metabolism:
Cellular respiration describes the series of steps that cells use to break down sugar and other chemicals to get the energy we need to function.
Energy is stored in the bonds of glucose and when glucose is broken down, much of that energy is released.
Cell utilize energy in the form of ATP.
The first step of respiration is called glycolysis. In a series of steps, glycolysis breaks glucose into two smaller molecules - a chemical called pyruvate. A small amount of ATP is formed during this process.
Most healthy cells continue the breakdown in a second process, called the Kreb's cycle. The Kreb's cycle allows cells to “burn” the pyruvates made in glycolysis to get more ATP.
The last step in the breakdown of glucose is called oxidative phosphorylation (Ox-Phos).
It takes place in specialized cell structures called mitochondria. This process produces a large amount of ATP. Importantly, cells need oxygen to complete oxidative phosphorylation.
If a cell completes only glycolysis, only 2 molecules of ATP are made per glucose. However, if the cell completes the entire respiration process (glycolysis - Kreb's - oxidative phosphorylation), about 36 molecules of ATP are created, giving it much more energy to use.
IN CANCER CELL:
Unlike healthy cells that "burn" the entire molecule of sugar to capture a large amount of energy as ATP, cancer cells are wasteful.
Cancer cells only partially break down sugar molecules. They overuse the first step of respiration, glycolysis. They frequently do not complete the second step, oxidative phosphorylation.
This results in only 2 molecules of ATP per each glucose molecule instead of the 36 or so ATPs healthy cells gain. As a result, cancer cells need to use a lot more sugar molecules to get enough energy to survive.
Unlike healthy cells that "burn" the entire molecule of sugar to capture a large amount of energy as ATP, cancer cells are wasteful.
Cancer cells only partially break down sugar molecules. They overuse the first step of respiration, glycolysis. They frequently do not complete the second step, oxidative phosphorylation.
This results in only 2 molecules of ATP per each glucose molecule instead of the 36 or so ATPs healthy cells gain. As a result, cancer cells need to use a lot more sugar molecules to get enough energy to survive.
introduction to WARBERG PHENOMENA:
WARBURG EFFECT Usually, cancer cells are highly glycolytic (glucose addiction) and take up more glucose than do normal cells from outside.
Otto Heinrich Warburg (; 8 October 1883 – 1 August 1970) In 1931 was awarded the Nobel Prize in Physiology for his "discovery of the nature and mode of action of the respiratory enzyme.
WARNBURG EFFECT : cancer cells under aerobic (well-oxygenated) conditions to metabolize glucose to lactate (aerobic glycolysis) is known as the Warburg effect. Warburg made the observation that tumor slices consume glucose and secrete lactate at a higher rate than normal tissues.
Earliest Galaxies in the JADES Origins Field: Luminosity Function and Cosmic ...Sérgio Sacani
We characterize the earliest galaxy population in the JADES Origins Field (JOF), the deepest
imaging field observed with JWST. We make use of the ancillary Hubble optical images (5 filters
spanning 0.4−0.9µm) and novel JWST images with 14 filters spanning 0.8−5µm, including 7 mediumband filters, and reaching total exposure times of up to 46 hours per filter. We combine all our data
at > 2.3µm to construct an ultradeep image, reaching as deep as ≈ 31.4 AB mag in the stack and
30.3-31.0 AB mag (5σ, r = 0.1” circular aperture) in individual filters. We measure photometric
redshifts and use robust selection criteria to identify a sample of eight galaxy candidates at redshifts
z = 11.5 − 15. These objects show compact half-light radii of R1/2 ∼ 50 − 200pc, stellar masses of
M⋆ ∼ 107−108M⊙, and star-formation rates of SFR ∼ 0.1−1 M⊙ yr−1
. Our search finds no candidates
at 15 < z < 20, placing upper limits at these redshifts. We develop a forward modeling approach to
infer the properties of the evolving luminosity function without binning in redshift or luminosity that
marginalizes over the photometric redshift uncertainty of our candidate galaxies and incorporates the
impact of non-detections. We find a z = 12 luminosity function in good agreement with prior results,
and that the luminosity function normalization and UV luminosity density decline by a factor of ∼ 2.5
from z = 12 to z = 14. We discuss the possible implications of our results in the context of theoretical
models for evolution of the dark matter halo mass function.
THE IMPORTANCE OF MARTIAN ATMOSPHERE SAMPLE RETURN.Sérgio Sacani
The return of a sample of near-surface atmosphere from Mars would facilitate answers to several first-order science questions surrounding the formation and evolution of the planet. One of the important aspects of terrestrial planet formation in general is the role that primary atmospheres played in influencing the chemistry and structure of the planets and their antecedents. Studies of the martian atmosphere can be used to investigate the role of a primary atmosphere in its history. Atmosphere samples would also inform our understanding of the near-surface chemistry of the planet, and ultimately the prospects for life. High-precision isotopic analyses of constituent gases are needed to address these questions, requiring that the analyses are made on returned samples rather than in situ.
A brief information about the SCOP protein database used in bioinformatics.
The Structural Classification of Proteins (SCOP) database is a comprehensive and authoritative resource for the structural and evolutionary relationships of proteins. It provides a detailed and curated classification of protein structures, grouping them into families, superfamilies, and folds based on their structural and sequence similarities.
Nutraceutical market, scope and growth: Herbal drug technologyLokesh Patil
As consumer awareness of health and wellness rises, the nutraceutical market—which includes goods like functional meals, drinks, and dietary supplements that provide health advantages beyond basic nutrition—is growing significantly. As healthcare expenses rise, the population ages, and people want natural and preventative health solutions more and more, this industry is increasing quickly. Further driving market expansion are product formulation innovations and the use of cutting-edge technology for customized nutrition. With its worldwide reach, the nutraceutical industry is expected to keep growing and provide significant chances for research and investment in a number of categories, including vitamins, minerals, probiotics, and herbal supplements.
Introduction:
RNA interference (RNAi) or Post-Transcriptional Gene Silencing (PTGS) is an important biological process for modulating eukaryotic gene expression.
It is highly conserved process of posttranscriptional gene silencing by which double stranded RNA (dsRNA) causes sequence-specific degradation of mRNA sequences.
dsRNA-induced gene silencing (RNAi) is reported in a wide range of eukaryotes ranging from worms, insects, mammals and plants.
This process mediates resistance to both endogenous parasitic and exogenous pathogenic nucleic acids, and regulates the expression of protein-coding genes.
What are small ncRNAs?
micro RNA (miRNA)
short interfering RNA (siRNA)
Properties of small non-coding RNA:
Involved in silencing mRNA transcripts.
Called “small” because they are usually only about 21-24 nucleotides long.
Synthesized by first cutting up longer precursor sequences (like the 61nt one that Lee discovered).
Silence an mRNA by base pairing with some sequence on the mRNA.
Discovery of siRNA?
The first small RNA:
In 1993 Rosalind Lee (Victor Ambros lab) was studying a non- coding gene in C. elegans, lin-4, that was involved in silencing of another gene, lin-14, at the appropriate time in the
development of the worm C. elegans.
Two small transcripts of lin-4 (22nt and 61nt) were found to be complementary to a sequence in the 3' UTR of lin-14.
Because lin-4 encoded no protein, she deduced that it must be these transcripts that are causing the silencing by RNA-RNA interactions.
Types of RNAi ( non coding RNA)
MiRNA
Length (23-25 nt)
Trans acting
Binds with target MRNA in mismatch
Translation inhibition
Si RNA
Length 21 nt.
Cis acting
Bind with target Mrna in perfect complementary sequence
Piwi-RNA
Length ; 25 to 36 nt.
Expressed in Germ Cells
Regulates trnasposomes activity
MECHANISM OF RNAI:
First the double-stranded RNA teams up with a protein complex named Dicer, which cuts the long RNA into short pieces.
Then another protein complex called RISC (RNA-induced silencing complex) discards one of the two RNA strands.
The RISC-docked, single-stranded RNA then pairs with the homologous mRNA and destroys it.
THE RISC COMPLEX:
RISC is large(>500kD) RNA multi- protein Binding complex which triggers MRNA degradation in response to MRNA
Unwinding of double stranded Si RNA by ATP independent Helicase
Active component of RISC is Ago proteins( ENDONUCLEASE) which cleave target MRNA.
DICER: endonuclease (RNase Family III)
Argonaute: Central Component of the RNA-Induced Silencing Complex (RISC)
One strand of the dsRNA produced by Dicer is retained in the RISC complex in association with Argonaute
ARGONAUTE PROTEIN :
1.PAZ(PIWI/Argonaute/ Zwille)- Recognition of target MRNA
2.PIWI (p-element induced wimpy Testis)- breaks Phosphodiester bond of mRNA.)RNAse H activity.
MiRNA:
The Double-stranded RNAs are naturally produced in eukaryotic cells during development, and they have a key role in regulating gene expression .
Richard's entangled aventures in wonderlandRichard Gill
Since the loophole-free Bell experiments of 2020 and the Nobel prizes in physics of 2022, critics of Bell's work have retreated to the fortress of super-determinism. Now, super-determinism is a derogatory word - it just means "determinism". Palmer, Hance and Hossenfelder argue that quantum mechanics and determinism are not incompatible, using a sophisticated mathematical construction based on a subtle thinning of allowed states and measurements in quantum mechanics, such that what is left appears to make Bell's argument fail, without altering the empirical predictions of quantum mechanics. I think however that it is a smoke screen, and the slogan "lost in math" comes to my mind. I will discuss some other recent disproofs of Bell's theorem using the language of causality based on causal graphs. Causal thinking is also central to law and justice. I will mention surprising connections to my work on serial killer nurse cases, in particular the Dutch case of Lucia de Berk and the current UK case of Lucy Letby.
2. TUBERCULOSIS
Chronic airborne infection caused by Mycobacterium tuberculosis.
Mycobacterium tuberculosis is also known as acid fast bacilli.
It can also caused by Mycobacterium avium & Mycobacterium
africanus.
3. EPIDEMOLOGY
Tuberculosis (TB) is one of the top 10 causes of death worldwide.
In 2016, 10.4 million people fell ill with TB, and 1.7 million died
from the disease (including 0.4 million among people with HIV).
Over 95% of TB deaths occur in low- and middle-income countries.
Seven countries account for 64% of the total, with India leading the
count, followed by Indonesia, China, Philippines, Pakistan, Nigeria,
and South Africa.
In 2016, an estimated 1 million children became ill with TB and 250
000 children died of TB (including children with HIV associated
TB).
TB is a leading killer of HIV-positive people: in 2016, 40% of HIV
deaths were due to TB.
4. Multidrug-resistant TB (MDR-TB) remains a public health crisis
and a health security threat. WHO estimates that there were 600 000
new cases with resistance to rifampicin – the most effective first-
line drug, of which 490 000 had MDR-TB. Globally, TB incidence
is falling at about 2% per year. This needs to accelerate to a 4–5%
annual decline to reach the 2020 milestones of the End TB Strategy.
An estimated 53 million lives were saved through TB diagnosis and
treatment between 2000 and 2016.
Ending the TB epidemic by 2030 is among the health targets of the
sustainable development goals.
7. STAGES
OF
TUBERCULOSIS
Latent TB Active TB
TB lives but does not grow in the
body.
TB is active and grows in the
body.
Does not make a person feel sick
or have symptoms .
Makes a person feel sick and
have symptoms.
Cannot spread from person to
person.
Can spread from person to
person.
Can advance to TB disease. Can cause death if not treated.
8. ETIOLOGY
Close contact. Having close contact with someone who has an
active TB.
Low immunity. Immunocompromised status like those with HIV,
cancer, or transplanted organs increases the risk of acquiring
tuberculosis.
Substance abuse. People who are IV/injection drug users and
alcoholics have a greater chance of acquiring tuberculosis.
Inadequate health care. Any person without adequate health care
like the homeless, impoverished, and the minorities often develop
active TB.
Immigration. Immigration from countries with a high prevalence of
TB could affect the patient.
Overcrowding. Living in an overcrowded, substandard housing
increases the spreading of the infection.
9. PATHOGENESIS
Droplet nuclei
containing
tubercle bacilli
are inhaled
enter the lungs
, and travel
into alveoli
Tubercle bacilli
multiply in the alveoli
A small number
of tubercle
bacilli enter the
blood stream
and spread
throughout the
body
1
2
3
4
Macrophages form
a hard shell &
keeps bacilli under
control
5 Hard shell breaks down
and tubercle bacilli
escape and multiply
10. PATHO-
PHYSIOLOGY
Inhalation. Tuberculosis begins when a susceptible person inhales
mycobacteria and becomes infected.
Transmission. The bacteria are transmitted through the airways to
the alveoli, and are also transported via lymph system and
bloodstream to other parts of the body.
Defence. The body’s immune system responds by initiating an
inflammatory reaction and phagocytes engulf many of the bacteria,
and TB-specific lymphocytes lyse the bacilli and normal tissue.
Protection. Granulomas new tissue masses of live and dead bacilli,
are surrounded by macrophages, which form a protective wall.
11. Ghon’s tubercle. They are then transformed to a fibrous tissue mass,
the central portion of which is called a Ghon’s tubercle.
Scarring. The bacteria and macrophages turns into a cheesy mass
that may become calcified and form a collagenous scar.
Dormancy. At this point, the bacteria become dormant, and there is
no further progression of active disease.
Activation. After initial exposure and infection, active disease may
develop because of a compromised or inadequate immune system
response.
12. CLINICAL
MANIFESTATIONS
After an incubation period of 4 to 8 weeks, TB is usually
asymptomatic in primary infection.
Nonspecific symptoms. Nonspecific symptoms may be produced
such as fatigue, weakness, anorexia, weight loss, night sweats, and
low-grade fever, with fever and night sweats as the typical
hallmarks of tuberculosis.
Cough. The patient may experience cough with mucopurulent
sputum.
Hemoptysis. Occasional hemoptysis or blood on the saliva is
common in TB patients.
Chest pain. The patient may also complain of chest pain as a part of
discomfort.
13. DIAGNOSIS
Sputum culture: Positive for Mycobacterium tuberculosis in the active
stage of the disease.
Ziehl-Neilsen (acid-fast stain applied to a smear of body fluid): Positive
for acid-fast bacilli (AFB).
Skin tests (purified protein derivative [PPD] or Old tuberculin [OT]
administered by intradermal injection [Mantoux]): A positive reaction
(area of induration 10 mm or greater, occurring 48–72 hr after inter
dermal injection of the antigen) indicates past infection and the
presence of antibodies but is not necessarily indicative of active
disease. Factors associated with a decreased response to tuberculin
include underlying viral or bacterial infection, malnutrition,
lymphadenopathy, overwhelming TB infection, insufficient antigen
injection, and conscious or unconscious bias. A significant reaction in a
patient who is clinically ill means that active TB cannot be dismissed as
a diagnostic possibility. A significant reaction in healthy persons
usually signifies dormant TB or an infection caused by a different
mycobacterium.
14. Enzyme-linked immunosorbent assay (ELISA)/Western blot: May
reveal presence of HIV.
Chest x-ray: May show small, patchy infiltrations of early lesions in
the upper-lung field, calcium deposits of healed primary lesions, or
fluid of an effusion. Changes indicating more advanced TB may
include cavitation, scar tissue/fibrotic areas.
CT or MRI scan: Determines degree of lung damage and may
confirm a difficult diagnosis.
Bronchoscopy: Shows inflammation and altered lung tissue. May
also be performed to obtain sputum if patient is unable to produce
an adequate specimen.
Histologic or tissue cultures (including gastric washings; urine and
cerebrospinal fluid [CSF]; skin biopsy): Positive for Mycobacterium
tuberculosis and may indicate extrapulmonary involvement.
Needle biopsy of lung tissue: Positive for granulomas of TB;
presence of giant cells indicating necrosis.
15. Electrolytes: May be abnormal depending on the location and
severity of infection; e.g., hyponatremia caused by abnormal water
retention may be found in extensive chronic pulmonary TB.
ABGs: May be abnormal depending on location, severity, and
residual damage to the lungs.
Pulmonary function studies: Decreased vital capacity, increased
dead space, increased ratio of residual air to total lung capacity, and
decreased oxygen saturation are secondary to parenchymal
infiltration/fibrosis, loss of lung tissue, and pleural disease
(extensive chronic pulmonary TB).
16. TREATMENT
Treatment goals
Promote airway clearance.
Adhere to treatment regimen.
Promote activity and adequate nutrition.
Prevent spread of tuberculosis infection.
17. Pulmonary tuberculosis is treated primarily with anti tuberculosis
agents for 6 to 12 months.
First line treatment. First-line agents for the treatment of
tuberculosis are isoniazid (INH), rifampin (RIF), ethambutol
(EMB), and pyrazinamide.
Active TB. For most adults with active TB, the recommended
dosing includes the administration of all four drugs daily for 2
months, followed by 4 months of INH and RIF.
Latent TB. Latent TB is usually treated daily for 9 months.
18. Treatment guidelines. Recommended treatment guidelines for
newly diagnosed cases of pulmonary TB have two parts: an initial
treatment phase and a continuation phase.
Initial phase. The initial phase consists of a multiple-medication
regimen of INH, rifampin, pyrazinamide, and ethambutol and lasts
for 8 weeks.
Continuation phase. The continuation phase of treatment include
INH and rifampin or INH and rifapentine, and lasts for an additional
4 or 7 months.
Prophylactic isoniazid. Prophylactic INH treatment involves taking
daily doses for 6 to 12 months.
DOT. Directly observed therapy may be selected, wherein an
assigned caregiver directly observes the administration of the drug
19. PHARMA-
COLOGICAL
THERAPY
The first line anti-tuberculosis medications include:
Isoniazid (INH). INH is a bactericidal agent that is used as
prophylaxis for neuritis, and has side effects of peripheral neuritis,
hepatic enzyme elevation, hepatitis, and hypersensitivity.
Rifampin (Rifadin). Rifampin is a bactericidal agent that turns the
urine and other body secretions into orange or red, and has common
side effects of hepatitis, febrile reaction, purpura, nausea, and
vomiting.
Pyrazinamide. Pyrazinamide is a bactericidal agent which increases
the uric acid in the blood and has common side effects of
hyperuricemia, hepatotoxicity, skin rash, arthralgias, and GI
distress.
Ethambutol (Myambutol). Ethambutol is a bacteriostatic agent that
should be used with caution with renal disease, and has common
side effects of optic neuritis and skin rash.
20. TREATMENT
OF
TUBERCULOSIS
IN
SPECIAL
CASES
Pregnancy: Always ask a woman if she is pregnant before
commencing treatment, most of anti-TB is safe during pregnancies
except streptomycin, which causes permanent deafness in the foetus
therefore it should be avoided during pregnancy
Breastfeeding: Full TB treatments are safe and are best way to
prevent tuberculosis in the baby mother and child can stay together
for the entire duration of treatment. In the mothers with pulmonary
tuberculosis, the baby should receive INH preventive (5mg/kg) for
6months followed BCG vaccination
Oral contraceptives: Rifampicin interacts with oral contraceptives
and reduces the efficacy of this contraception. Women using
contraceptive should be advised to use pills with higher dose of
oestrogen (50mcg) or change to another method
21. Liver disease: Most of anti-TB can cause liver damage. In case a
patient develops jaundice, treatment should be stopped and restarted
as soon as the jaundice resolves. In severely ill patients start
streptomycin and ethambutol only. If the patient improves follow
with a gradual step up introduction of isoniazid followed by
rifampicin until full dose. Monitor liver functions and clinical
picture. If the condition deteriorates stop the drug which was added.
Patients with established chronic liver disease should not receive
pyrazinamide
Renal failure; Isoniazid, Rifampicin and Pyrazinamide are almost
entirely excreted by the liver and therefore safe to use. Streptomycin
and Ethambutol are excreted by the kidneys and should either be
avoided or given in a reduced dose. The safest regimen for patients
with renal failure is 2 RHZ/4 RH combined with pyridoxine to
prevent Isoniazid induced peripheral neuropathy
22. HIV/AIDS: There is a danger of interaction between Rifampicin
and protease inhibitors in HIV positive patients receiving anti
retroviral (ARV) treatments. Rifampicin stimulates the activity of
the liver enzyme system, which metabolises protease inhibitors (PI)
and Nucleoside Reverse Transcriptase Inhibitors (NRTIs). This can
lead to decreased blood levels of PIs and NsRTIs. Of the NsRTIs
the concentration of Nevirapine is significant reduced and hence
Nevirapine and Rifampicin should not be used concomitantly. On
other hand PIs enhance the liver enzyme system which influences
the blood levels of rifampicin resulting in ineffective TB treatment
or drug toxicity. NRTIs can cause peripheral neuropathy, which can
result in an added toxicity caused by Isoniazid.
23. MDR-TB
Multi drug resistance Tuberculosis: MDR TB is a laboratory
diagnosis confirmed after culturing
Mycobacterium tuberculosis strains and performing drug
susceptibility tests (DST). Resistant strains will be identified
because they will be able to survive exposure to anti TB drugs
which were previously toxic to them. Four different categories of
drug resistance have been identified:
Mono-resistance: Resistance to one anti-tuberculosis drug
Poly-resistance: Resistance to more than one anti-tuberculosis drug,
other than both isoniazid and Rifampicin (e.g. against both
pyrazinamide and isoniazid)
Multidrug-resistance: Resistance to at least isoniazid and
rifampicin
Extensive drug resistance TB (XDR-TB): Multi drug resistance
with additional resistance to any fluoroquinolone, and at least one
of three injectable second-line drugs (capreomycin, kanamycin and
amikacin
24. Diagnosis of MDR –TB: The required baseline investigations of
any DR -TB suspect include:
• Comprehensive medical history including outcomes of prior TB
treatment
• Physical examination
• Collection of 2 sputum samples (spot – morning) for smear
microscopy, culture and DST
• Provider Initiated Testing and Counselling (PITC) for HIV
• Chest X-ray examination
DST confirmed MDR TB patients shall be referred and transported
by a special ambulance to the MDR TB Hospital where they will be
admitted
25. TREATMENT
OF
MDR-TB
Standardized treatment: Regimens are designed according to
representative Drug Resistance Well-defined patient populations.
All patients in a patient group or category receive the same regimen
. Suspected MDR TB should be confirmed by DST whenever
possible.
Intensive Phase (minimum 6 months, or 6 months post culture
conversion) :
Amikacin or Kanamycin
Ofloxacin or Levofloxacin
Pyrazinamide
Ethionamide
Cycloserine
Ethambutol
26. Continuation Phase (minimum 12 months or 18 months post culture
conversion)
Ofloxacin or Levofloxacin
Ethionamide
Pyrazinamide
Cycloserine
Ethambutol
27. PATIENT
EDUCATION
Disposal of secretions. Cough and sneeze into tissues and to
dispose of all secretions in a separate trash can.
Isolation. Wear a mask when going outside of the room.
Activity and nutrition. Remind the patient to take a lot of rest and
to eat balanced meals to aid recovery.
Adverse effects. Advise the patient to watch out for adverse effects
of medications and to report them to the physician immediately
