Tuberculosis is a chronic, wasting, communicable disease, which made a huge comeback with the HIV pandemic, making it an opportunistic infection, and and an AID-defining infection. This presentation explores the different types of tuberculosis in terms of their locations (pulmonary and extra-pulmonary) as well as in terms of their drug susceptibility. It also addresses the approach to the management of each one of these.
In the early days of the COVID pandemic, the World Tuberculosis Day was marked, with the Theme: "It is Time". It is time to take action, to ensure universal access to treatment, to stop stigma and discrimination, and to end TB.
I had the opportunity to present this topic as part of the wellness efforts for our staff members. Many of our patients live with TB, many of our staff develop TB in the process, and the COVID pandemic was already in the country, complication case identification and case management of the disease.
The document discusses typhoid ileal perforation, a common surgical complication of typhoid fever. It presents information on the epidemiology, pathogenesis, clinical features, investigations, treatment, and prognosis. Typhoid ileal perforation remains problematic in developing countries due to poor sanitation and is associated with significant morbidity and mortality. The definitive treatment is surgical intervention to repair perforations and prevent further contamination. Proper resuscitation, antibiotic therapy, and postoperative management are important for reducing complications and improving outcomes.
1. Typhoid fever, caused by Salmonella Typhi, commonly involves the abdomen and can lead to serious surgical complications if left untreated. The small intestine is frequently affected, with perforations in the ileum being common from the third or fourth week of illness.
2. Other abdominal organs like the gallbladder, liver, spleen and pancreas can also be impacted, such as gallbladder perforation or pancreatic abscesses. Neurological issues occasionally arise as well.
3. Early diagnosis of abdominal complications through awareness of clinical signs is important to provide prompt surgical treatment, like laparotomy, and thereby reduce high morbidity and mortality risks. Exteriorization of the intestine is often the best approach for severely se
This document discusses fever of unknown origin (FUO). It begins by classifying FUO into categories like classical FUO and nosocomial FUO. It then discusses the epidemiology and common etiologies of FUO, which include infections, collagen vascular diseases, and malignancies. The diagnostic approach involves a thorough history, repeated physical exams, and diagnostic testing like blood tests, imaging, and biopsies. Empirical therapeutic drug trials can help diagnose certain conditions but have limitations. The prognosis depends on the underlying cause, with poorer outcomes seen in elderly patients or those with neoplasms or diagnostic delays.
This presentation focuses on the entity known as pyrexia of unknown origin / fever of unknown origin. It demonstrates both common and rare causes, and the epidemiological trend, its clinical presentation, management and prognosis.
Acute pyelonephritis is a bacterial infection of the kidneys that is commonly caused by E. coli. It presents with symptoms like fever, flank pain, nausea, and costovertebral angle tenderness. Diagnosis involves urinalysis showing pyuria and bacteria in the urine along with elevated white blood cell count. Treatment is with intravenous antibiotics initially for severe cases, transitioning to oral antibiotics for 3 weeks along with supportive care like antipyretics and hydration. Nursing care focuses on administering antibiotics, monitoring vital signs and urine output, controlling fever and nausea, and ensuring resolution of the infection.
Pelvic inflammatory disease (PID) is an inflammatory condition of the female upper genital tract that can involve the endometrium, fallopian tubes, and pelvic tissue. It is usually caused by bacteria like Neisseria gonorrhoeae and Chlamydia trachomatis transmitted sexually. Left untreated, PID can lead to long-term complications like infertility or ectopic pregnancy. Treatment involves antibiotics, with hospitalization sometimes needed for severe or unresponsive cases. Prompt treatment is important to prevent permanent damage.
Acute complicated cystitis and pyelonephritis - UpToDateJCarrascoO
This document discusses acute complicated cystitis and pyelonephritis. It defines a complicated urinary tract infection as one associated with an underlying condition that increases the risk of treatment failure, such as diabetes, pregnancy, or urinary tract obstruction. The microbial causes of complicated UTIs are broader in scope and include organisms like Pseudomonas and enterococci that are often resistant to oral antibiotics. Patients may present with symptoms ranging from mild cystitis to severe pyelonephritis with sepsis. Diagnosis involves urine culture and susceptibility testing, and imaging studies may be needed to identify anatomical abnormalities or complications.
In the early days of the COVID pandemic, the World Tuberculosis Day was marked, with the Theme: "It is Time". It is time to take action, to ensure universal access to treatment, to stop stigma and discrimination, and to end TB.
I had the opportunity to present this topic as part of the wellness efforts for our staff members. Many of our patients live with TB, many of our staff develop TB in the process, and the COVID pandemic was already in the country, complication case identification and case management of the disease.
The document discusses typhoid ileal perforation, a common surgical complication of typhoid fever. It presents information on the epidemiology, pathogenesis, clinical features, investigations, treatment, and prognosis. Typhoid ileal perforation remains problematic in developing countries due to poor sanitation and is associated with significant morbidity and mortality. The definitive treatment is surgical intervention to repair perforations and prevent further contamination. Proper resuscitation, antibiotic therapy, and postoperative management are important for reducing complications and improving outcomes.
1. Typhoid fever, caused by Salmonella Typhi, commonly involves the abdomen and can lead to serious surgical complications if left untreated. The small intestine is frequently affected, with perforations in the ileum being common from the third or fourth week of illness.
2. Other abdominal organs like the gallbladder, liver, spleen and pancreas can also be impacted, such as gallbladder perforation or pancreatic abscesses. Neurological issues occasionally arise as well.
3. Early diagnosis of abdominal complications through awareness of clinical signs is important to provide prompt surgical treatment, like laparotomy, and thereby reduce high morbidity and mortality risks. Exteriorization of the intestine is often the best approach for severely se
This document discusses fever of unknown origin (FUO). It begins by classifying FUO into categories like classical FUO and nosocomial FUO. It then discusses the epidemiology and common etiologies of FUO, which include infections, collagen vascular diseases, and malignancies. The diagnostic approach involves a thorough history, repeated physical exams, and diagnostic testing like blood tests, imaging, and biopsies. Empirical therapeutic drug trials can help diagnose certain conditions but have limitations. The prognosis depends on the underlying cause, with poorer outcomes seen in elderly patients or those with neoplasms or diagnostic delays.
This presentation focuses on the entity known as pyrexia of unknown origin / fever of unknown origin. It demonstrates both common and rare causes, and the epidemiological trend, its clinical presentation, management and prognosis.
Acute pyelonephritis is a bacterial infection of the kidneys that is commonly caused by E. coli. It presents with symptoms like fever, flank pain, nausea, and costovertebral angle tenderness. Diagnosis involves urinalysis showing pyuria and bacteria in the urine along with elevated white blood cell count. Treatment is with intravenous antibiotics initially for severe cases, transitioning to oral antibiotics for 3 weeks along with supportive care like antipyretics and hydration. Nursing care focuses on administering antibiotics, monitoring vital signs and urine output, controlling fever and nausea, and ensuring resolution of the infection.
Pelvic inflammatory disease (PID) is an inflammatory condition of the female upper genital tract that can involve the endometrium, fallopian tubes, and pelvic tissue. It is usually caused by bacteria like Neisseria gonorrhoeae and Chlamydia trachomatis transmitted sexually. Left untreated, PID can lead to long-term complications like infertility or ectopic pregnancy. Treatment involves antibiotics, with hospitalization sometimes needed for severe or unresponsive cases. Prompt treatment is important to prevent permanent damage.
Acute complicated cystitis and pyelonephritis - UpToDateJCarrascoO
This document discusses acute complicated cystitis and pyelonephritis. It defines a complicated urinary tract infection as one associated with an underlying condition that increases the risk of treatment failure, such as diabetes, pregnancy, or urinary tract obstruction. The microbial causes of complicated UTIs are broader in scope and include organisms like Pseudomonas and enterococci that are often resistant to oral antibiotics. Patients may present with symptoms ranging from mild cystitis to severe pyelonephritis with sepsis. Diagnosis involves urine culture and susceptibility testing, and imaging studies may be needed to identify anatomical abnormalities or complications.
Acute pyelonephritis is a urinary tract infection that has progressed to the kidneys. It typically causes flank pain, nausea, fever and tenderness. Laboratory tests show pyuria on urinalysis and culture usually isolates E. coli bacteria. Acute pyelonephritis can be uncomplicated or complicated by conditions like obstruction or infection with resistant bacteria. Uncomplicated cases are usually treated initially with oral fluoroquinolones as outpatients. Complicated or severe cases require hospitalization and intravenous antibiotics along with treatment of underlying conditions. Proper diagnosis, culture and treatment duration are important to resolve the infection.
A 26-year-old woman presented to the emergency department with increased urinary urgency over the past 4 days. She reported a history of urinary tract infection at age 14 but no other issues. A urine culture showed gram-negative rods. She was assessed with an uncomplicated urinary tract infection. A 53-year-old woman reported abdominal and flank pain, nausea, and vomiting. Tests showed pyelonephritis in her left kidney. She had risk factors like age, hypertension, and a complicated urinary tract infection. A pregnant woman was found to have asymptomatic bacteriuria with a urine culture showing E. coli. She required antibiotic treatment due to pregnancy, and cefalexin or nitrofurant
This document discusses acute pelvic infections in females. It defines pelvic inflammatory disease (PID) and lists its causes such as sexually transmitted infections. PID can range from mild to severe, with severe cases sometimes requiring hospitalization. Imaging plays a role in diagnosis and assessing complications. Findings on ultrasound, CT, and MRI are described for various stages of PID as well as other pelvic infections like tuberculosis, actinomycosis, and appendicitis that can mimic PID. Treatment involves antibiotics, with severe cases sometimes needing drainage procedures.
A 50-year-old female patient presented with decreased urine output for 3 months, abdominal pain for 1 week, burning urination for 3 days, and fever for 3 days. She was diagnosed with a urinary tract infection and chronic kidney disease based on objective findings including a GFR of 23.375 and BP of 160/90 mm Hg. She was treated with medications including cefotaxime that can cause nausea, vomiting, and diarrhea, and advised on lifestyle modifications like drinking cranberry juice and maintaining good sexual hygiene.
This document provides information about enteric (typhoid) fever, including:
- It is caused by the bacterium Salmonella enterica and is a global public health problem affecting millions annually.
- Clinical features include prolonged high fever, abdominal discomfort, diarrhea or constipation, and potential complications like intestinal perforation.
- Diagnosis involves blood, stool, or bone marrow cultures and serologic tests. Ceftriaxone is the treatment of choice for multidrug-resistant cases. Early diagnosis and appropriate antibiotic treatment are important to prevent complications.
Pelvic inflammatory disease (PID) is an infection of the female reproductive organs caused by bacteria that spreads from the vagina or cervix. Common symptoms include abdominal pain and unusual discharge. Left untreated, PID can cause long-term complications like infertility, ectopic pregnancy, and chronic pelvic pain. PID is diagnosed based on symptoms and examination findings and treated with antibiotics. Prevention focuses on safer sex practices and STI screening/treatment to reduce risk of initial infection.
Surgical problems are a risk in typhoid fever, most commonly perforation of the small intestine or bleeding. Perforation occurs in around 2% of cases but has a higher incidence in parts of Africa. It typically involves a single ulcer perforating the terminal ileum in the third week of illness. Diagnosis involves signs of peritonitis. Management may involve conservative treatment if the patient's general condition is poor or surgery to repair the perforation. Bleeding occurs in 10-20% of cases in the third week and usually responds to conservative management without surgery. Other less common surgical risks include complications affecting the hepatobiliary system, pancreas, spleen, genitourinary system or bones.
A 31-year-old female presented with painful urination, dysuria, urgency, and frequency. Her history was notable for a previous urinary tract infection. On examination, she was afebrile with no abdominal tenderness. A urinalysis showed bacteria and red blood cells. She was diagnosed with an uncomplicated urinary tract infection and prescribed levofloxacin and etoricoxib. Patients with uncomplicated infections typically improve with short-term antibiotic treatment, while those with recurrent infections may require long-term prophylaxis.
pelvic inflammatory disease: case presentation & disease overview farah al souheil
pelvic inflammatory disease is a very common type of Sexually transmitted disease among young sexually active females. in this presentation we discuss a case suffering from PID and then we evaluate the plan of discharge based on disease and treatment overview
The document discusses the management of typhoid ileal perforation (TIP) in Nigeria. It provides details on the epidemiology, relevant anatomy, etiology, pathogenesis, clinical presentation, investigations, and definitive surgical treatment of TIP. The definitive treatment involves laparotomy with either simple repair of the perforation, segmental resection and anastomosis, or creating an enterostomy like an ileostomy. Complications are also discussed as well as prevention, prognosis, and differential diagnosis of TIP.
Pelvic inflammatory disease (PID) is an infection of the female upper genital tract that can cause long-term complications if not treated promptly. It is usually caused by bacteria spreading from the vagina or cervix, such as Chlamydia trachomatis and Neisseria gonorrhoeae. Left untreated, PID can lead to infertility, ectopic pregnancy, chronic pelvic pain, and increased risk of HIV transmission. Treatment involves a combination of antibiotics to cover common causative organisms, with hospitalization recommended for severe cases. Prompt treatment is important to prevent long-term complications.
This document discusses typhoid fever and its surgical complications. It provides background on the disease, including its history, distribution, risk factors, presentation and various complications. Intestinal perforation is a major complication that can require surgery. Other surgical complications mentioned include intestinal hemorrhage, typhoid cholecystitis, and chronic gallbladder carriage. The document emphasizes the importance of prompt treatment to improve prognosis from complications.
This document discusses pediatric urinary tract infections. It covers the incidence, etiology, risk factors, clinical presentation, investigations including urinalysis, urine culture and radioimaging tests, management including choice of antimicrobials and prophylaxis, prognosis, and prevention of urinary tract infections in children. The management involves treating with antibiotics based on culture results and sensitivity, with inpatient versus outpatient treatment determined by factors like age and severity of symptoms. Prognosis depends on factors like presence of renal abnormalities, with recurrence increasing risk of long term issues like renal scarring and failure.
PID and its newer concepts.This presentation is done after grouping information from a variety of textbooks,journals and of course our professors.will definitely enlighten you
Clinical Cases Study for Intra-abdominal infections Sameh Abdel-ghany
This document describes four clinical cases involving intra-abdominal infections. The first case involves a 67-year-old man with cirrhosis presenting with abdominal pain. Laboratory results indicate primary bacterial peritonitis. The second case involves a 34-year-old man with Crohn's disease presenting with abdominal pain and fever, found to have an abdominal wall abscess. The third case involves a woman on peritoneal dialysis presenting with cloudy dialysate fluid. The fourth case involves a 12-year-old girl presenting with symptoms of appendicitis. The document provides questions and answers regarding treatment for each case.
PID is a common gynecologic infection that is often difficult to diagnose and can have serious complications if not treated properly. It is caused by a polymicrobial infection that frequently involves Chlamydia trachomatis and Neisseria gonorrhoeae. Risk factors include young age, multiple sexual partners, IUD use, and previous PID episodes. Symptoms are often nonspecific but may include pelvic pain, abnormal bleeding, and fever. Diagnosis involves clinical examination along with tests like ultrasound and labs. Treatment involves antibiotics to eradicate the infection. Surgery may be needed for complications like tubo-ovarian abscesses. Recurrent PID can lead to long term issues like infertility, ectopic pregnancy
This document provides an overview of pulmonary and extrapulmonary tuberculosis. It discusses the microbiology of M. tuberculosis and describes the pathogenesis and typical presentations of pulmonary TB, including epidemiology, transmission, risk factors, clinical presentation, diagnosis, and treatment. It also reviews common forms of extrapulmonary TB, such as TB lymphadenitis, pleural-pericardial-peritoneal TB, CNS tuberculosis, skeletal TB, miliary TB, and multidrug-resistant TB. The take-home message is that TB remains a global health burden that can affect multiple body systems and requires a high index of suspicion for diagnosis.
The document discusses the evaluation and diagnosis of pyrexia of unknown origin (PUO). It defines PUO and provides classifications. The most common causes are infections (30-40%), neoplasms (20-30%), and non-infectious inflammatory conditions (10-20%). The initial approach involves thorough history, physical exam, and basic lab tests. Further targeted testing is based on clues from initial evaluation and may include specialized cultures, biopsies, and imaging. The goal is to methodically consider and rule out more likely causes through an intensive diagnostic process to identify the underlying condition.
Pelvic inflammatory disease (PID) is caused by ascending infections from the cervix by bacteria like Neisseria gonorrhoeae and Chlamydia trachomatis. It causes inflammation of the female reproductive organs within the pelvis. Symptoms include pelvic pain and abnormal vaginal bleeding or discharge. Diagnosis is based on clinical features and confirmed through tests and imaging. Treatment involves antibiotics and sometimes surgery to drain abscesses. Untreated PID can lead to serious long-term complications like infertility.
This document provides information on the history, epidemiology, microbiology, pathogenesis, diagnosis and clinical features of tuberculosis. Some key points:
- Tuberculosis is an ancient disease that has affected humans for thousands of years. Robert Koch discovered the causative bacteria, Mycobacterium tuberculosis, in 1882.
- In 2020, there were an estimated 10 million new TB cases and 1.5 million TB deaths worldwide, making it one of the top 10 causes of death. India has the highest burden of cases.
- M. tuberculosis is an aerobic bacterium with a complex cell wall structure that allows it to be acid-fast staining. It typically causes a chronic pulmonary infection but can spread to other
Tuberculosis is caused by the bacterium Mycobacterium tuberculosis and can affect the lungs (pulmonary TB) or other organs (extrapulmonary TB). It spreads through the air when people with active TB cough, sneeze or speak. While most exposed people develop latent TB infection, 10% will develop active disease. Diagnosis involves chest x-rays, sputum smear and culture tests, and treatment requires a multi-drug regimen to prevent drug resistance. HIV co-infection increases the risks of developing active TB and facing treatment challenges.
Acute pyelonephritis is a urinary tract infection that has progressed to the kidneys. It typically causes flank pain, nausea, fever and tenderness. Laboratory tests show pyuria on urinalysis and culture usually isolates E. coli bacteria. Acute pyelonephritis can be uncomplicated or complicated by conditions like obstruction or infection with resistant bacteria. Uncomplicated cases are usually treated initially with oral fluoroquinolones as outpatients. Complicated or severe cases require hospitalization and intravenous antibiotics along with treatment of underlying conditions. Proper diagnosis, culture and treatment duration are important to resolve the infection.
A 26-year-old woman presented to the emergency department with increased urinary urgency over the past 4 days. She reported a history of urinary tract infection at age 14 but no other issues. A urine culture showed gram-negative rods. She was assessed with an uncomplicated urinary tract infection. A 53-year-old woman reported abdominal and flank pain, nausea, and vomiting. Tests showed pyelonephritis in her left kidney. She had risk factors like age, hypertension, and a complicated urinary tract infection. A pregnant woman was found to have asymptomatic bacteriuria with a urine culture showing E. coli. She required antibiotic treatment due to pregnancy, and cefalexin or nitrofurant
This document discusses acute pelvic infections in females. It defines pelvic inflammatory disease (PID) and lists its causes such as sexually transmitted infections. PID can range from mild to severe, with severe cases sometimes requiring hospitalization. Imaging plays a role in diagnosis and assessing complications. Findings on ultrasound, CT, and MRI are described for various stages of PID as well as other pelvic infections like tuberculosis, actinomycosis, and appendicitis that can mimic PID. Treatment involves antibiotics, with severe cases sometimes needing drainage procedures.
A 50-year-old female patient presented with decreased urine output for 3 months, abdominal pain for 1 week, burning urination for 3 days, and fever for 3 days. She was diagnosed with a urinary tract infection and chronic kidney disease based on objective findings including a GFR of 23.375 and BP of 160/90 mm Hg. She was treated with medications including cefotaxime that can cause nausea, vomiting, and diarrhea, and advised on lifestyle modifications like drinking cranberry juice and maintaining good sexual hygiene.
This document provides information about enteric (typhoid) fever, including:
- It is caused by the bacterium Salmonella enterica and is a global public health problem affecting millions annually.
- Clinical features include prolonged high fever, abdominal discomfort, diarrhea or constipation, and potential complications like intestinal perforation.
- Diagnosis involves blood, stool, or bone marrow cultures and serologic tests. Ceftriaxone is the treatment of choice for multidrug-resistant cases. Early diagnosis and appropriate antibiotic treatment are important to prevent complications.
Pelvic inflammatory disease (PID) is an infection of the female reproductive organs caused by bacteria that spreads from the vagina or cervix. Common symptoms include abdominal pain and unusual discharge. Left untreated, PID can cause long-term complications like infertility, ectopic pregnancy, and chronic pelvic pain. PID is diagnosed based on symptoms and examination findings and treated with antibiotics. Prevention focuses on safer sex practices and STI screening/treatment to reduce risk of initial infection.
Surgical problems are a risk in typhoid fever, most commonly perforation of the small intestine or bleeding. Perforation occurs in around 2% of cases but has a higher incidence in parts of Africa. It typically involves a single ulcer perforating the terminal ileum in the third week of illness. Diagnosis involves signs of peritonitis. Management may involve conservative treatment if the patient's general condition is poor or surgery to repair the perforation. Bleeding occurs in 10-20% of cases in the third week and usually responds to conservative management without surgery. Other less common surgical risks include complications affecting the hepatobiliary system, pancreas, spleen, genitourinary system or bones.
A 31-year-old female presented with painful urination, dysuria, urgency, and frequency. Her history was notable for a previous urinary tract infection. On examination, she was afebrile with no abdominal tenderness. A urinalysis showed bacteria and red blood cells. She was diagnosed with an uncomplicated urinary tract infection and prescribed levofloxacin and etoricoxib. Patients with uncomplicated infections typically improve with short-term antibiotic treatment, while those with recurrent infections may require long-term prophylaxis.
pelvic inflammatory disease: case presentation & disease overview farah al souheil
pelvic inflammatory disease is a very common type of Sexually transmitted disease among young sexually active females. in this presentation we discuss a case suffering from PID and then we evaluate the plan of discharge based on disease and treatment overview
The document discusses the management of typhoid ileal perforation (TIP) in Nigeria. It provides details on the epidemiology, relevant anatomy, etiology, pathogenesis, clinical presentation, investigations, and definitive surgical treatment of TIP. The definitive treatment involves laparotomy with either simple repair of the perforation, segmental resection and anastomosis, or creating an enterostomy like an ileostomy. Complications are also discussed as well as prevention, prognosis, and differential diagnosis of TIP.
Pelvic inflammatory disease (PID) is an infection of the female upper genital tract that can cause long-term complications if not treated promptly. It is usually caused by bacteria spreading from the vagina or cervix, such as Chlamydia trachomatis and Neisseria gonorrhoeae. Left untreated, PID can lead to infertility, ectopic pregnancy, chronic pelvic pain, and increased risk of HIV transmission. Treatment involves a combination of antibiotics to cover common causative organisms, with hospitalization recommended for severe cases. Prompt treatment is important to prevent long-term complications.
This document discusses typhoid fever and its surgical complications. It provides background on the disease, including its history, distribution, risk factors, presentation and various complications. Intestinal perforation is a major complication that can require surgery. Other surgical complications mentioned include intestinal hemorrhage, typhoid cholecystitis, and chronic gallbladder carriage. The document emphasizes the importance of prompt treatment to improve prognosis from complications.
This document discusses pediatric urinary tract infections. It covers the incidence, etiology, risk factors, clinical presentation, investigations including urinalysis, urine culture and radioimaging tests, management including choice of antimicrobials and prophylaxis, prognosis, and prevention of urinary tract infections in children. The management involves treating with antibiotics based on culture results and sensitivity, with inpatient versus outpatient treatment determined by factors like age and severity of symptoms. Prognosis depends on factors like presence of renal abnormalities, with recurrence increasing risk of long term issues like renal scarring and failure.
PID and its newer concepts.This presentation is done after grouping information from a variety of textbooks,journals and of course our professors.will definitely enlighten you
Clinical Cases Study for Intra-abdominal infections Sameh Abdel-ghany
This document describes four clinical cases involving intra-abdominal infections. The first case involves a 67-year-old man with cirrhosis presenting with abdominal pain. Laboratory results indicate primary bacterial peritonitis. The second case involves a 34-year-old man with Crohn's disease presenting with abdominal pain and fever, found to have an abdominal wall abscess. The third case involves a woman on peritoneal dialysis presenting with cloudy dialysate fluid. The fourth case involves a 12-year-old girl presenting with symptoms of appendicitis. The document provides questions and answers regarding treatment for each case.
PID is a common gynecologic infection that is often difficult to diagnose and can have serious complications if not treated properly. It is caused by a polymicrobial infection that frequently involves Chlamydia trachomatis and Neisseria gonorrhoeae. Risk factors include young age, multiple sexual partners, IUD use, and previous PID episodes. Symptoms are often nonspecific but may include pelvic pain, abnormal bleeding, and fever. Diagnosis involves clinical examination along with tests like ultrasound and labs. Treatment involves antibiotics to eradicate the infection. Surgery may be needed for complications like tubo-ovarian abscesses. Recurrent PID can lead to long term issues like infertility, ectopic pregnancy
This document provides an overview of pulmonary and extrapulmonary tuberculosis. It discusses the microbiology of M. tuberculosis and describes the pathogenesis and typical presentations of pulmonary TB, including epidemiology, transmission, risk factors, clinical presentation, diagnosis, and treatment. It also reviews common forms of extrapulmonary TB, such as TB lymphadenitis, pleural-pericardial-peritoneal TB, CNS tuberculosis, skeletal TB, miliary TB, and multidrug-resistant TB. The take-home message is that TB remains a global health burden that can affect multiple body systems and requires a high index of suspicion for diagnosis.
The document discusses the evaluation and diagnosis of pyrexia of unknown origin (PUO). It defines PUO and provides classifications. The most common causes are infections (30-40%), neoplasms (20-30%), and non-infectious inflammatory conditions (10-20%). The initial approach involves thorough history, physical exam, and basic lab tests. Further targeted testing is based on clues from initial evaluation and may include specialized cultures, biopsies, and imaging. The goal is to methodically consider and rule out more likely causes through an intensive diagnostic process to identify the underlying condition.
Pelvic inflammatory disease (PID) is caused by ascending infections from the cervix by bacteria like Neisseria gonorrhoeae and Chlamydia trachomatis. It causes inflammation of the female reproductive organs within the pelvis. Symptoms include pelvic pain and abnormal vaginal bleeding or discharge. Diagnosis is based on clinical features and confirmed through tests and imaging. Treatment involves antibiotics and sometimes surgery to drain abscesses. Untreated PID can lead to serious long-term complications like infertility.
This document provides information on the history, epidemiology, microbiology, pathogenesis, diagnosis and clinical features of tuberculosis. Some key points:
- Tuberculosis is an ancient disease that has affected humans for thousands of years. Robert Koch discovered the causative bacteria, Mycobacterium tuberculosis, in 1882.
- In 2020, there were an estimated 10 million new TB cases and 1.5 million TB deaths worldwide, making it one of the top 10 causes of death. India has the highest burden of cases.
- M. tuberculosis is an aerobic bacterium with a complex cell wall structure that allows it to be acid-fast staining. It typically causes a chronic pulmonary infection but can spread to other
Tuberculosis is caused by the bacterium Mycobacterium tuberculosis and can affect the lungs (pulmonary TB) or other organs (extrapulmonary TB). It spreads through the air when people with active TB cough, sneeze or speak. While most exposed people develop latent TB infection, 10% will develop active disease. Diagnosis involves chest x-rays, sputum smear and culture tests, and treatment requires a multi-drug regimen to prevent drug resistance. HIV co-infection increases the risks of developing active TB and facing treatment challenges.
1. Pulmonary tuberculosis is caused by the bacteria Mycobacterium tuberculosis and is transmitted through inhaling droplets from an infected person when they cough, sneeze or talk. It most commonly affects the lungs but can spread to other organs.
2. Risk factors include a weakened immune system due to conditions like HIV/AIDS, diabetes or malnutrition. Diagnosis involves tests like chest x-rays, tuberculin skin tests, and sputum smear microscopy.
3. Treatment involves a combination of antibiotics taken for 6-9 months under DOTS therapy to prevent drug resistance. Prevention strategies include BCG vaccination, mask wearing around infected individuals, and the WHO's tuberculosis elimination program aiming to eliminate TB globally
This document discusses nontuberculous mycobacteria (NTM), which are ubiquitous environmental bacteria that can cause disease in humans. NTM disease is classified into four main syndromes: pulmonary disease, lymphadenitis, cutaneous disease, and disseminated disease. Pulmonary disease, often caused by the Mycobacterium avium complex, presents with cough and abnormalities on chest imaging. Lymphadenitis commonly affects children. Disseminated disease mainly impacts immunocompromised individuals. Diagnosis involves clinical evaluation, imaging, and microbiological culture of NTM from respiratory or tissue samples.
Tuberculosis is a chronic infectious disease caused by the bacterium Mycobacterium tuberculosis. It typically affects the lungs but can also affect other parts of the body. It spreads through the air when people who are sick with TB disease of the lungs or throat cough, sneeze, speak, or sing. Diagnosis involves a combination of physical examination, chest X-ray, tuberculin skin test, blood tests, and microbiological examinations of body fluids and tissues. Treatment requires multiple antibiotics taken for a minimum of 6 months. Proper treatment is important to cure the individual and prevent further transmission.
This document provides an overview of pulmonary tuberculosis (TB). It defines TB as an infectious disease caused by the bacterium Mycobacterium tuberculosis, which primarily affects the lungs. TB is spread through airborne droplets when an infected person coughs or sneezes. The document discusses the pathogenesis, stages, risk factors, signs and symptoms, diagnostic tests, medical management including drug therapy, and nursing care of patients with pulmonary TB. It also covers complications, education on respiratory hygiene and home care considerations for patients.
1) Childhood tuberculosis accounts for around 10% of the global TB disease burden and remains a significant public health problem in India.
2) Diagnosis of childhood TB can be challenging as symptoms are often non-specific and microbiological confirmation is difficult. A high index of suspicion is required based on exposure history and clinical/radiological findings.
3) Revised guidelines by the Revised National Tuberculosis Control Programme (RNTCP) in India provide definitions for presumptive TB, presumptive drug resistant TB, and classifications based on anatomical site and treatment history to help standardize diagnosis and management of childhood TB.
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.
Tuberculosis is a global health problem, infecting one third of the world's population and causing millions of deaths annually. It is the 6th highest cause of disease in Pakistan, where the incidence of active TB cases is over 80 per 100,000 people each year. TB is caused by the bacterium Mycobacterium tuberculosis, which is transmitted through the air when people with active TB cough or sneeze. It most often affects the lungs but can damage other organs. While the immune system usually keeps the infection under control, active disease can develop if the bacteria overpowers immunity.
The document provides an overview of tuberculosis (TB), including its history, transmission, drug resistance, pathogenesis, and progression from latent TB infection to active TB disease. It discusses how TB was historically known as consumption and was a death sentence until discoveries in the 1800s proved it was contagious and identified the causative bacterium. The development of drug treatments in the 1940s-1950s dramatically reduced TB rates, though drug resistance and other factors led to a resurgence in the 1980s. TB spreads via airborne droplets and its pathogenesis involves an initial containment by the immune system that can break down and allow bacterial multiplication and disease. Progression from latent to active TB is more likely in the first two years after infection or
Pulmonary tuberculosis is caused by the bacteria Mycobacterium tuberculosis, which is transmitted through airborne droplets when people with active tuberculosis cough, sneeze or spit. The bacteria become implanted in the lung tissue, forming a primary lesion that may calcify and arrest in most cases. However, in some people the primary infection may spread to other organs, causing miliary tuberculosis. Symptoms of active pulmonary tuberculosis include cough, fever, weight loss and night sweats. Diagnosis involves tuberculin skin tests, sputum tests and chest x-rays. Treatment consists of a combination of antibiotic drugs taken for 9-18 months. Prevention focuses on improving social conditions, health education, vaccination with BCG and controlling the
Tuberculosis is an infectious disease caused by the bacterium Mycobacterium tuberculosis, which most commonly affects the lungs. It spreads through the air when people who are sick with TB expel bacteria into the air, for example by coughing. Common symptoms include coughing, chest pain, and weight loss. TB can be treated by a standard 6-month drug regimen, but drug-resistant forms of the disease require longer, more expensive treatment. Tuberculosis remains a major global health issue and was one of the top 10 causes of death worldwide in 2019. Diagnosis involves tests such as sputum smear microscopy, culture, and molecular tests like Xpert MTB/RIF to detect the bacteria and determine if
Tuberculosis is an infectious disease caused by the bacterium Mycobacterium tuberculosis, which most commonly affects the lungs. It spreads through the air when people who are sick with TB expel bacteria into the air, for example by coughing. Common symptoms include coughing, chest pain, and weight loss. TB can be treated by a standard 6-month drug regimen, but drug-resistant forms of the disease require longer, more expensive treatment. Tuberculosis remains a major global health problem and was one of the top 10 causes of death worldwide in 2019. Diagnosis involves tests such as sputum smear microscopy, culture, and molecular tests like Xpert MTB/RIF that can also detect drug resistance.
Melioidosis is caused by the bacterium Burkholderia pseudomallei, which thrives in tropical climates like Southeast Asia and Northern Australia. People can contract the disease by ingesting or inhaling contaminated water or soil, or through skin wounds exposed to contaminated material. Those at highest risk include individuals with diabetes, renal disease, or other conditions causing immunosuppression. Symptoms vary depending on the infection site, but may include fever, cough, chest pain, skin lesions, and disseminated abscesses. Diagnosis involves culture of the bacteria from body fluids, with PCR testing and serology also useful. Treatment requires prolonged antibiotic therapy for at least 8-12 weeks.
1. Leptospirosis is caused by the bacteria Leptospira interrogans, which is transmitted through contact with infected animal urine or tissues. Common symptoms include jaundice, hemorrhage, and acute renal failure. Diagnosis is challenging due to low success of isolation and unreliable direct demonstration. Early antibiotic treatment is important to prevent complications.
2. Pulmonary tuberculosis is caused by the bacteria Mycobacterium tuberculosis, which is spread through airborne droplets from the lungs of infected individuals. Symptoms include hemoptysis and anorexia. Diagnosis involves tuberculin skin testing, chest radiography, and sputum smear/culture. Standard treatment is a multi-drug
This document provides an overview of tuberculosis (TB). It describes TB as a chronic infectious disease caused by the Mycobacterium tuberculosis bacteria, which most commonly affects the lungs. The document outlines the etiology, transmission, types (primary and secondary), signs and symptoms, pathophysiology, complications, diagnosis, and treatments of TB. Key points include that TB remains a major global health problem, especially in developing countries, and that co-infection with HIV increases the risks of developing active TB disease. Standard TB treatment involves a multi-drug regimen over 6-9 months, while latent TB is usually treated with 9 months of isoniazid alone.
communicable disease topic for Nurses.pptxSagar Masne
- Tuberculosis (TB) is a bacterial infection caused by Mycobacterium tuberculosis that primarily affects the lungs but can spread to other organs. It remains a significant global public health threat despite being preventable and curable. TB is transmitted through airborne droplets when an infected individual coughs or sneezes. Diagnosis involves tests like chest x-rays, sputum smear microscopy, and culture. Treatment requires a combination of antibiotics over at least six months under direct observation to prevent drug resistance. Preventive measures include vaccination, infection control, and addressing social determinants of health.
The document discusses tuberculosis in children, including its epidemiology, etiology, clinical features, diagnosis, and management. It notes that tuberculosis is endemic in Pakistan, with over 200,000 new cases annually. Children under 15 account for 20% of cases. The causative agent is Mycobacterium tuberculosis. Clinical features vary depending on the site of infection, and may include cough, fever, lymph node enlargement, and meningitis. Diagnosis involves tuberculin tests, chest X-rays, and culture of fluid/tissue samples. Standard drug regimens include isoniazid and rifampin for 6-12 months. Prevention involves BCG vaccination, contact screening, and prophylactic treatment of
Similar to TUBERCULOSIS. Presented by Dr KD DELE (20)
Patient safety Incident (PSI) is an unplanned or unintended event or circumstance that could have resulted or did result in harm to a patient while in the care of a health facility. In this presentation, I explored the concepts of patient safety and patient safety incidents. I also explored the concept of Reporting systems, properly now known as reporting and learning systems - because learning is paramount in the reporting system. I focused on the minimal information model, which is more routinely used compared to the intermediate and full information models.
It is unacceptable that there is still a lot of new HIV infections, particularly when there is a known high-risk exposure to the disease. It is important to know that Post-exposure prophylaxis is a medical emergency, and as part of effort to reduce the burden of HIV, post-exposure prophylaxis has been found to be effective when done appropriately. This presentation explores the concept of post-exposure prophylaxis for HIV and the latest changes in the guidelines.
“Undetectable = Untransmittable” (U=U) is a campaign that has caused a few controversies, not to mention the medicolegal implications. This campaign confirms that the sexual transmission of HIV can be stopped once the infected partner is virologically suppressed. How true is this and how relevant is it? In this presentation, I discussed the concept of U=U as one of the measures to reduce the incidence of HIV and help people live a more fulfilling life while also living with the disease.
TB remains an important disease condition globally, particularly with the high prevalence of HIV in many parts of the world. While there is interest in providing the adequate and often readily-available treatment, it might do more harm to the patient. In this presentation, I explored the concept of IRIS in the management of tuberculosis.
Experiencing any type of bleeding can be uncomfortable and frightening for patients, and it is one of the primary reasons they seek medical attention. In this case presentation, I will discuss some crucial approaches to patients who present with lower gastrointestinal bleeding, as well as some key take-home messages.
Headache is a common condition encountered by clinicians in general practice and primary care on a daily basis. Although most headaches are mild, some can be severe and debilitating. It is therefore crucial to recognize common symptoms, identify warning signs, and develop an appropriate management plan for headaches.
This is a presentation about the importance of Evidence Based Medicine and how it acts as a crucial tool in decision making to empower the quality of medical services for better patient outcomes.
It highlights the steps in EBM process, how to identify the parts of a well built clinical question, resources for literature search, critical appraisal of the evidence, and how to apply the evidence to the patient.
Infection Prevention and Control in Hospitals by Dr DeleKemi Dele-Ijagbulu
Infection prevention and control is everybody's business! It is an essential, though often under-recognised and under supported part of the infrastructure of health care. However it saves lives and prevents avoidable morbidity and mortality. This presentation highlights the importance and the practical components of infection prevention and control in the hospital setting.
The document discusses disorders of kidney function, providing information on kidney anatomy, physiology, and common renal diseases. It describes the key components of the nephron including the glomerulus, Bowman's capsule, and renal tubules. Investigations for evaluating kidney function such as urine analysis, blood tests, ultrasound, and biopsy are outlined. Common renal disorders like acute kidney injury, chronic kidney disease, glomerular diseases including nephrotic and nephritic syndromes are mentioned.
This presentation touches briefly on the vaginal discharges, both physiological and pathological, approach to management, and a brief touch on pelvic inflammatory disease.
Abortion remains a topical issue, globally, primary because it affects one of the fundamental rights. This presentation is not for debate, but simply highlights the South African laws and regulations as they relate to Termination of Pregnancy (TOP), and the different methods available.
This presentation focuses on the all important topic of childhood malnutrition. It addresses the different components, both acute and chronic, but focuses more on the severe acute malnutrition which is the most important killer, particularly for the under-5s.
terms like kwashiokor and marasmus are no longer in use.
This presentation focuses on common obstetrics emergencies. These include early pregnancy complications such as miscarriages and ectopic pregnancy. As well as abdominal pain. Other include haemorrhage, hypertensive state, and sepsis.
This presentation addresses respiratory emergencies, and the approach to their management. These include: anaphylaxis, pneumonias, flail chest, pleural effusion, pulmonary embolism,
This presentation focuses on informed decision making in clinical practice making use of evidence based practice. It addresses the use of PICO to formulate clinical question, searching the evidence/literature, critically appraising the evidence, and application of the evidence to improve the quality of clinical practice
Multiple myeloma is mostly a disease of the elderly. It is a form of haematological cancers that affects the Lymphocytes, and causes abnormal proliferation of plasma cells within the bone marrow, thus replacing the marrow, and is associated with multiple organ dysfunction.
This presentation is an introduction to the disease. It however leaves out the specific haematological treatment, because by that point, patient should have been referred to haematology.
Spinal Cord Injuries are uncommon, but they are a leading cause of high cost disability, and with ageing population, the incidence is expected to increase. This presentation looks at the many facets of spinal cord injuries.
Diagnosis of Pulmonary Embolism is often difficult. This presentation highlights step-wise and practical approach to the diagnosis of PE in short and precise fashion.
Poisoning and Overdose have increased in recent times at exponential ratio, and most cases are with the initial attempt to harm oneself. this is very unfortunate. This presentation will help doctors and other health workers to be able to determine how to assist a patients who had overdosed on dangerous substances.
This document provides information about various types of arthritis from an expert in rheumatology. It begins with an introduction to arthritis and how it can originate from the joint or surrounding tissues. It then discusses the diagnostic approach and evaluation of a patient with arthritis. The rest of the document discusses specific types of arthritis in more detail, including septic arthritis, gout, osteoarthritis, and rheumatoid arthritis. It provides information on clinical features, investigations, diagnosis, and management for each type.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
6. OVERVIEW OF TUBERCULOSIS
• Tuberculosis (TB) is a potentially fatal contagious disease that can
affect almost any part of the body but is mainly an infection of the
lungs.
• Neo-latin word :
• “Tubercle” - Round nodule/Swelling
• “Osis” - Condition
7. OVERVIEW CONT.
• It is an airborne disease caused by the bacterium “Mycobacterium spp”
• …whch is expelled when a person with infectious TB coughs, sneezes,
shouts, or sings etcetera
• Transmission occurs when droplet nuclei (airborne particle about 1-5
microns) are inhaled and reach the alveoli of the lungs, via nasal
passages, respiratory tract, and bronchi
8. CAUSATIVE ORGANISMS
• Tuberculosis (TB) is caused by one of several genetically related group
of mycobacterial species that belong to the Mycobacterium
tuberculosis complex
• The human pathogens are M. tuberculosis, M. africanum, and M. bovis .
• The other member of the complex, M. microti, is a rodent pathogen.
• Mycobacterium tuberculosis – Humans
• Mycobacterium Bovis – Animals / cattle
11. MYCOBACTERIUM TUBERCULOSIS…
• Slow generation time 15 – 20 hours – may contribute to virulence)
• Lipid-rich cell wall contains mycolytic acids – 50% of dead weight
• Responsible for many of the bacteria’s characteristics
• Acid- fast (retains acidic substances)
• Confers resistance e.g. detergents and antibiotics
13. EPIDEMIOLOGY
• In 2011,there were an estimated 8.7million incidence cases of TB globally –
equivalent to 125 cases in 1,00,000 population.
• In 2015, figure rose to 9.6million
• Asian : 59%
• African : 26%
• Eastern Mediterranean Region: 7.7%
• The European Region : 4.3%
• Region of the America : 3%
17. WHO TB REPORT 2015
• 90% in developing world
• 75% in economically active people
• 22 high burden countries – Cambodia has managed to stem the tide
and is managing a turn around.
• 74% of patients with TB and HIV co infection are in the African region!
18. WHO TB REPORT 2015
• 9.6million people globally, 12% of these HIV +ve
• 1.5 Million deaths
• Of these 890 000 men, 480 000 women, 140 000 children.
• 1.1 million in HIV negative patients, 400 000 deaths in HIV positive
patients
• 480 000 estimated MDR patients but <25% diagnosed
19. WHO TB REPORT 2015
• African region estimates 281 cases of TB per 100 000 popln i.e. double
the world average of 133/100 000
• However, Indian, Indonesia, China are the top 3 countries
• Halving mortality target only met by one African country i.e. Uganda
• MDR estimated to be 3.3% of all new cases and 20% of all retreatment
cases
• SA has world’s 2nd highest TB prevalence rates!
20. SA TUBERCULOSIS EPIDEMIC
• Spread by airborne droplet nuclei – poor cough hygiene among
patients
• Increase in population, poverty, unemployment, lack of services,
urbanization
• Poor management of TB control programmes – NDOH working hard to
reverse this.
• 60-80% of new TB cases in SA are co-infected with HIV
22. WHO IS MORE PRONE TO DEVELOP ACTIVE
TUBERCULOSIS?
• Diseases, conditions or drugs that weaken the immune system:
• Cancer
• Transplantation
• Malnutrition
• Diabetes
• Alcoholism
• Patients on immunosuppressive medications
23. WHO IS MORE PRONE TO DEVELOP ACTIVE
TUBERCULOSIS?
• HIV infection
• TB is the leading cause of death worldwide in HIV infected individuals
• 10% lifetime risk for developing active TB among HIV uninfected
• 10% annual risk for developing active TB among HIV infected
24. WHO IS MORE PRONE TO DEVELOP ACTIVE
TUBERCULOSIS?
• Infants and children < 3 years
• Kidney failure
• COPD
• Transplant patients
• Genetics
• Silicosis
• Low socioeconomic status
• Homelessness
• Major surgical procedures may
occasionally trigger
dissemination
25. RISK FACTORS FOR TB INFECTION
• Sharing air space with someone sick with TB disease (e.g., live, work, or
play together)
• Crowded living conditions
• Residency or travel in a country with a high-incidence of TB disease
• High risk occupations including laboratory and health care jobs
26. PREVENTION OF SPREAD
• Cough etiquette
• Adequate early diagnosis and treatment
• Plenty of sunlight and good ventilation in any spaces with close
proximity with infectious patients
29. EXTRA PULMONARY
• i. Lymph node TB
• ii. Pleural TB
• iii. TB of upper airways
• iv. Skeletal TB
• v. Genitourinary TB
• vi. Miliary TB
• vii. Pericardial TB
• viii. Gastrointestinal TB
• ix. Tuberculous Meningitis
• x. Less common forms
• 20% of patients of TB Patient are extrapulmonary
31. A. PULMONARY TB
1. Primary Tuberculosis :-
• The infection of an individual who has not been previously infected or
immunised is called Primary tuberculosis or Ghon’s complex or
childhood tuberculosis.
• Lesions forming after infection is peripheral and accompanied by hilar
which may not be detectable on chest radiography.
32. A. PULMONARY TB
2. Secondary Tuberculosis :
• The infection that individual who has been previously infected or
sensitized is called secondary or post primary or reinfection or chronic
tuberculosis.
33. POST-PRIMARY DISEASE
• Occurs after a latent period of months or years
• Reactivation occurs when dormant bacilli start to multiply
• It can result from re-infection
• Only a small fraction of all infected people ever progress to disease
• TB disease often as a result of depressed immunity
34. RISK OF PROGRESSION TO TB DISEASE
• Untreated, 5% of infected persons with normal immunity develop TB in
first 1–2 years post infection, another 5% later in life
• Thus, about 10% of infected persons with normal immunity will develop
TB at some point in life if not treated
35. B. EXTRA PULMONARY TB
1) Lymph node TB ( tuberculuous lymphadenitis):-
• Seen frequently in HIV infected patients.
• Symptoms :- Painless swelling of lymph nodes most commonly at
cervical and Supraclavical (Scrofula)
• Systemic systems are limited to HIV infected patients.
2) Pleural TB :-
• Involvement of pleura is common in Primary TB and results from
penetration of tubercle bacilli into pleural space.
36. B. EXTRA PULMONARY TB
3) TB of Upper airways :-
• Involvement of larynx, pharynx and epiglottis.
• Symptoms :- Dysphagia, chronic productive cough
4) Genitourinary TB :-
• Any part of the genitourinary tract get infected.
• Symptoms :- Urinary frequency, Dysuria, Hematuria.
37. B. EXTRA PULMONARY TB
5) Skeletal TB :-
• Involvement of weight bearing parts like spine, hip, knee.
• Symptoms :- Pain in hip joints n knees, swelling of knees, trauma.
6) Gastrointestinal TB :-
• Involvement of any part of GI Tract.
• Symptoms :- Abdominal pain, diarrhoea, weight loss
38. B. EXTRA PULMONARY TB
• 7) TB Meningitis & Tuberculoma :-
• 5% of All Extra pulmonary TB
• Results from Hematogenous spread of 10 & 20 TB.
• 8) TB Pericarditis :-
• 1- 8% of All Extra pulmonary TB cases.
• Spreads mainly in mediastinal or hilar nodes or from lungs.
39. B. EXTRA PULMONARY TB
• 9) Milliary or disseminated TB :-
• Results from hematogenous spread of Tubercle Bacilli.
• Spread is due to entry of infection into pulmonary vein producing
lesions in different extra pulmonary sites.
• 10) Less common Extra Pulmonary TB
• uveitis, pan-ophthalmitis, painful hypersensitivity related phlyctenular
conjunctivitis.
41. DIAGNOSIS
• Clinicians need a high index of suspicion first!
• Insidious development
• Patients tend to ignore symptoms
• Can occur in any site
• Often associated with other diseases.
42. DIAGNOSIS
• Most cases can be identified by taking thorough history (*screening
questions)
• Do sputum smear microscopy and GXP
• Counselling and testing for HIV
• Send for X-rays and TB culture if smears are negative
• Investigate for extrapulmonary TB
• In children tuberculin skin test
43. SYMPTOMS
• *Cough – any duration
• *Weight loss and anorexia
• *Chills and night sweats
• *Pyrexia of unknown origin
• Chest pain
• Dyspnoea
• Haemoptysis
• Malaise and tiredness
44. CLINICAL SIGNS
• Patient is thin and pale
• Rapid pulse
• Fast respiratory rate
• Nasal flaring
• May have increased temperature
• Chest - crackles, dullness, bronchial breathing, amphoric breathing, use
of accessory muscles for breathing…
48. LAB CHARACTERISTICS OF TB
• Microscopic thin and rod like
• Occur singly or in clusters
• Complex thick waxy cell wall (Mycolic acids)
• need special antibiotics
• special staining methods needed Ziehl- Niehlsen (ZN) or Auramine
stain (acid and alcohol fast)
• survive for long periods in the dark, cool places
• Destroyed by heat, UV light, pasteurisation
51. SPUTUM COLLECTION
• Good specimens
• Bronchial secretions and not saliva
• Ideally 3-5 ml
• When to collect?
• On the spot
52. SPUTUM COLLECTION : WHEN SHOULD SPUTUM
BE COLLECTED?
• Pre-treatment
• One specimen to diagnose
• After intensive treatment phase
• One specimen to monitor progress and smear conversion
• At end of treatment
• to prove cure
• identify treatment failure
53. SPUTUM COLLECTION CONT.
• Sensitivity of microscopy depends on:
• quality of sputum
• quality of laboratory processing and
• quality of staining and microscopy
• Saliva or nasal secretions give false negative results
• Health care workers and other patients should be protected from
potential nosocomial transmission of aerosolised bacilli
55. GENERAL LABORATORY DIAGNOSIS OF
TUBERCULOSIS
• 1. Microscopy:
• Mainstay of NTP (id transmitters of TB, posing a ↑ infection risk)
• Essential for diagnosis and/or management of drug susceptible and
resistant strains of TB
56. GENERAL LABORATORY DIAGNOSIS OF
TUBERCULOSIS
• 2. Culture:
• Adds sensitivity to diagnosis of TB in sputum specimens with lower
bacillary load (e.g. extra-pulmonary TB, HIV co-infected patients),
regardless of drug susceptibility
57. GENERAL LABORATORY DIAGNOSIS OF
TUBERCULOSIS
• 3. Culture and drug susceptibility testing (DST)
• Essential for diagnosis and surveillance of drug resistance (e.g. M(X)DR-
TB)
• 4. Molecular techniques (e.g. Line probe assay, GeneXpert)
• Rapid diagnosis of DR TB
• Identification of mycobacterial species
58. 1. AFB SMEAR MICROSCOPY:
• Advantages
• Identifies patients most likely to transmit TB (i.e. with high pulmonary
bacillary load,5,000- 10 000 bacilli per millilitre of sputum)
• can be done at point-of care, with short turn around time of 24 - 48 hrs
(no need for advanced infrastructure)
• it is accessible to most patients (even in resource limited settings)
• instrumental in monitoring treatment success (patient follow up /
smear conversions)
59. AFB SMEAR MICROSCOPY:
• Limitations
• low sensitivity
• requires presence of at least 5,000 or more AFB/ml of sputum
• worsened by non-cavitary disease as in HIV coinfected patients
• does not distinguish tubercle bacilli from other mycobacteria (most
mycobacteria are acid-fast)
• does not distinguish live bacilli from dead bacilli
• cannot detect drug resistance
60. 2. CULTURES & SENSITIVITIES
• Done for:
• All re-treatment cases
• All symptomatic contacts of MDR TB cases
• Cases who remain positive at end of intensive phase or at end of
treatment
• If drug susceptibility is required
61. CULTURE ADVANTAGES
• more sensitive than microscopy (can detect as few as 10 bacilli per
millilitre of sputum vs >5,000 required for AFB smear microscopy
• very useful in diagnosis of HIV infected TB patients and children, with
normally low sputum bacillary load
• Allows for further identification to distinguish between tubercle bacilli
and other mycobacteria (species identification)
62. CULTURE ADVANTAGES
• allows for drug susceptibility testing (diagnosis of mono-, poly-, multi-,
and extensively-drug resistant TB)
• allows for epidemiological studies (e.g community outbreaks,
nosocomial infections, etc)
• Live vs. dead bacilli
• Culture is the gold-standard for the diagnosis of TB
63. CULTURE LIMITATIONS
• long TAT due to slow growth of tubercle bacilli – Culture takes 2-6
weeks
• requires advanced infrastructure and highly trained personnel
• reagents are expensive
• limited facilities (culture coverage) in the country
• poses higher biohazard risk than microscopy to lab personnel, hence
need for higher level safety measures and quality management.
64. CULTURE RESULTS INTERPRETATION
• A positive culture means that Mycobacteria are present, and the patient needs TB
treatment if MTB cultured.
• A negative culture means that MTB is absent in the sample
• False negative cultures may occur when MTB is killed by decontamination or if a poor
specimen is sent
• A contaminated culture means that normal bacterial flora present in the sputum over-
grew in the MGIT tube. Even if MTB was present, it could not be detected
• False positive cultures are uncommon but can occur
65. 3. DRUG SUSCEPTIBILITY TESTING (DST)
• DST is required to make a definitive diagnosis of drug-resistant TB (DR-
TB)
• It is the Gold standard in the diagnosis of drug resistant TB
• DST is required to make a definitive diagnosis of DR-TB
66. DRUG SUSCEPTIBILITY TESTING (DST)
• 1st line DST:
• well studied and established; reliable and reproducible (INH & Rif);
high correlation with clinical outcome
• Drugs currently tested (NHLS): STP, INH, RMP, EMB, PZA*
67. DRUG SUSCEPTIBILITY TESTING (DST)
• 2nd line DST
• inadequate knowledge on mechanisms of resistance
• lower reproducibility (exceptions: aminoglycosides, fluoroquinolones)
• correlation of laboratory resistance to clinical outcome not well studied
• Drugs currently tested (NHLS): ETH, OFLX, KM, CAP*
68. LIMITATIONS OF DST
• Intrinsic accuracy of DST varies with the drug tested - or first line drugs, DST (FLD) is most
accurate for rifampicin and isoniazid and less so for streptomycin andethambutol
• Testing of second-line drugs is not as simple as DST for the first-line drugs
• Proficiency testing results similar to those obtained for first-line drugs are not available for
any of the second-line agents
• SLD has not been standardized internationally due to in vitro drug instability
• Good reproducibility are for aminoglycosides, fluoroquinolones and polypeptides
• Reproducibility and reliability of DST is much less reliable for PAS, terizidone, ethionamide
and cycloserine
69. 4. LINE PROBE ASSAY (LPA)
• It is a test that diagnoses TB and simultaneously detects resistance to
RIF and INH.
• It does this by detecting the presence of the DNA of Mycobacterium
tuberculosis in the sputum and also identifies any changes/ mutations in
the DNA that may cause rifampicin and/or isoniazid resistance.
• presence of mutations is interpreted as resistance to the antibiotic in
question (e.g. RIF and/or INH)
70. ADVANTAGES OF LPA (GENOTYPE MTBDRPLUS)
• It detects MTB and resistance to RIF & INH at the same time
• – From the same specimen, within the same test.
• Short turnaround time for diagnosis of MDR-TB
• – Processing time for the test itself is approx. 8 hours.
• – minimum TAT is expected to be a week.
• It is specific for MTB complex (i.e. it can differentiate MTB from other mycobacteria).
• – The test is designed to specifically detect MTB complex DNA, and not other mycobacteria
71. LIMITATIONS OF LPA (GENOTYPE MTBDRPLUS)
• Cannot be used for monitoring treatment
• It is dependent on smear results (hence smear TAT)
• The test is done on smear positive specimens or smear-negative culture-positive samples
• NB! 2ND generation tests able to detect MTB DNA even in smear negative samples
• Prone to contamination and human error
• The test is multi-stepped and only partially automated (lab intensive)
• it requires at least 3 separate rooms for different steps
• False positive RIF / INH resistance
72. INTERPRETATION OF LPA RESULTS
• MTB complex positive = positive for MTB
• RIF sensitive OR resistant
• INH sensitive OR resistant
• If both RIF and INH are sensitive → susceptible MTB
• If only RIF or INH is resistant → mono-resistant MTB
• If both RIF and INH are resistant → MDR-TB
• MTB not detected = negative for MTB.This result does not exclude TB
73. 5. GENEXPERT
• What is GeneXpert?
• It is an instrument that is used to conduct rapid diagnosis of
tuberculosis and detection of rifampicin resistance.
• It does this by detecting the presence of the DNA of Mycobacterium
tuberculosis in the sputum and also identifies any changes in the DNA
that may cause rifampicin resistance.
74. GENEXPERT…
• The test is called Xpert MTB/RIF
• This test shares fundamental principles with the LPA
• both are PCR-based;
• detect presence of MTB complex DNA;
• detect changes in the DNA that may cause RIF resistance.
75. ADVANTAGES OF GENE XPERT
• It detects MTB and RIF resistance at the same time.
• From the same specimen, within the same test.
• Short turnaround time.
• Processing time for the test itself is approx. 2 hours.
• minimum turnaround time is expected to be the same or less than that of
smear microscopy.
76. ADVANTAGES OF GENE XPERT
• It is specific for MTB complex,
• i.e. it can differentiate MTB from other mycobacteria.
• Can be used on :
• CSF, aspirates (e.g. gastric and lymph nodes) and tissue (e.g. pleural biopsy)
• Less prone to contamination and human error.
• The test for each specimen is carried out in a closed system (cartridge), so
there is a reduced risk of cross-contamination from other specimens.
77. LIMITATIONS OF GENEXPERT
• Cannot be used for monitoring treatment
• limited to diagnosis largely
• False positive RIF resistant
• a small fraction of resistance detected may not correlate with
physiological resistance
• this leading to discordance between Gene-Xpert and DST results or clinical
outcome)
78. ALGORITHM RECOMMENDED FOR GXP
• In all contacts or symptomatic patients – collect one sputum sample
under supervision
• GXP +ve or GXP –ve or unsuccessful
• Rif susceptible treat as TB. Send 2nd sputum for microscopy
• Rif resistant treat as MDR TB refer to treating unit, collect sputum
for M/C/DST for R/H/a/F
• Rif unsuccessful – Start on regimen 1, send sputum for M&C / DST or
LPA
79. GXP POSITIVE/ RIF SENSITIVE
• MTB is present, and sensitive to Rifampicin
• XPert MTB/RIF is sensitive and specific for detection of TB and
Rifampicin resistance
• However this result does not exclude possibility of resistance to other
drugs.
80. GXP POSITIVE/ RIF RESISTANT
• MTB present
• Rifampicin resistance may be falsely positive (10%)
• Second sputum specimen must be sent for confirmatory culture and
DST
81. GXP POSITIVE/ RIF INDETERMINATE
• MTB present
• Rifampicin resistance could not be assessed
• Repeat GXP
• A second sputum may be sent for TB culture and DST to confirm
susceptibility/ LPA
• Treat the patient as if they have drug-sensitive TB
82. ERROR
• The test failed
• Caused by problem with the cartridge, e.g. food particles
• Submit a second specimen for Xpert MTB/RIF
83. 6. CHEST X-RAY
• Common CXR findings:
• Cavitation
• Focal infiltrates in upper and hilar regions
• Hilar adenopathy
• Pleural or pericardial effusion
84. CHEST X-RAY IN DISSEMINATED TB
• The CXR is abnormal in most, but not all, cases of disseminated TB.
• Grieco & Chmel: 50% had “miliary” pattern
• Munt: 90% reported “miliary” pattern
• Overall, it appears that at the time of diagnosis, 85% of patients have
the characteristic radiographic findings of miliary tuberculosis
90. 7. TUBERCULIN SKIN TEST (PPD)
• Positive test
• TB infection
• Not necessarily active disease
• Negative test
• No TB
• Malnutrition
• HIV
• Severe viral infection
• Disseminated tuberculosis
92. 8. OTHER INVESTIGATIONS
• Adenosine Deaminase (ADA): especially in CSF, and other body fluids
such as in pleural effusion and ascites.
• Interferon gamma release assay (IGRA): unable to distinguish between
active & latent infection. Can be performed on a single visit.
• Polymerase chain reaction (PCR): GeneXpert system, Sputum LPA
• Antigen detection assays: poor sensitivity, based on detection of M.
lipoarabinomannan in urine of patients
• Antibody tests: difficult to tell between latent & active infection
94. CASE DEFINITION
• Based on
• Anatomical site
• Bacteriological results (including MDR, XDR)
• Hx of previous treatment
• HIV status of the patient
95. OLD CASE DEFINITION
• TB suspect
• Persons who present with symptoms of TB or contacts of TB /DR-TB
patients
• TB case
• Definite case of TB or patient in which HCW has decided to treat for TB
• Definite case of TB
• patient with M.TB isolated from a clinical specimen
96. NEW CASE DEFINITION
• Presumptive TB
• previously known as TB suspect
• Bacteriologically confirmed TB case
• i.e. GXP / Auramine stain/ TB culture positive results
• Clinically Diagnosed TB
• i.e. no bacteriological confirmation received, patient has features
suggestive of active TB and clinician decides to treat as TB.
• This includes patients diagnosed with CXR.
97. NEW CASE DEFINITION
• Smear positive patients
• Patient is smear +ve if one or more sputum samples +ve for AFB
• more likely to spread disease.
• Smear negative patients
• especially in PLWHA
• associated with higher mortality
98. DIAGNOSIS OF TB IN HIV-POSITIVE INDIVIDUALS
• Protocol for diagnosis of TB in HIV follows the same principles,
irrespective of whether the patient is HIV infected or not
• In HIV+ patients a higher degree of attention will be required
• Diagnosis of TB in HIV+ persons more difficult:
• There is increased frequency of sputum smear negative disease
(pulmonary or extra-pulmonary)
• There is increased atypical radiological manifestations
99. PRESENTATION OF TB IN HIV+ VS HIV-
• Extrapulmonary TB more common
• CXR atypical
• More commonly smear negative
• More rapid clinical deterioration
102. EXTRA PULMONARY TUBERCULOSIS (EPTB)
• More of a diagnostic problem than PTB.
• ? Less common
• ? Less familiar to clinicians
• EPTB involves relatively inaccessible sites
• Bacteriological confirmation of diagnosis more difficult
• Invasive procedures are required often
103. MOST COMMON SITES OF EXTRAPULMONARY TB
• Lymphadenitis
• Pleural
• Pericardial
• Abdominal
• Miliary / Disseminated
• CNS
• TBM
• Tuberculomas
104. DISSEMINATED TUBERCULOSIS
• Because of multisystem involvement, the clinical manifestations are
varied.
• Are usually non-specific and are dominated by systemic effects: fever,
weight loss, night sweats, anorexia and “weakness”.
• Productive cough ±
• Headache and changes in mental status ±
115. DRUG RESISTANT TB
• MDR TB is TB disease where there is in vitro resistance to both INH &
RIF with or without resistance to other TB drugs
• XDR TB is MDR TB and in vitro resistance to any of the
fluoroquinolones and any injectable i.e. Kanamycin OR Amikacin OR
Capreomycin
• TDR …. Total drug resistant TB!!
116. DRUG RESISTANT TUBERCULOSIS
• Mono Resistance : Resistance to one first line anti TB drug ONLY.
• Poly Resistance : Resistance to more than 1 first line anti TB drug
• Multidrug Resistance : Resistance to Rifampicin and Isoniazid
• Extensive DR (XDR) TB : MDR + R to any fluoroquinolone and at least
one of the 3 injectables i.e. Capreomycin (Polypeptide), Amikacin and
Kanamycin (Aminoglycosides)
117. MDR TB STATS
• Global epidemiology ~ 650 000 patients diagnosed worldwide in WHO
report of 2011, only 46000 ~7% started on therapy
• SA high burden country for both MDR TB and TB, ranking 5th & 3rd
respectively
• In 2010 report, 7386 lab diagnoses of MDR TB, 5313 patients treated.
• In 2008 cohort study, success rate of MDR TB therapy ~48% - causes for
this multifactorial.
118. XDR TB STATS
• 741 patients diagnosed in 2010, 615 started on therapy
• In April 2011, 2500 beds available for in hospital care of all DR TB
patients.
• Needless to say SA struggling with escalating burden of DR TB
119. CHALLENGES IDENTIFIED BY NDOH
• Not enough beds in TB facilities
• High default rate
• Half of newly diagnosed DR TB patients not started on therapy or delay to start therapy
• Long waiting lists to start admissions
• Socioeconomic impact of diagnosis
• Clinicians outside of facilities often ignorant of treatment guidelines
• Poor infection control measures
• Poor outcome
120. LOGIC FOR DECENTRALISED CARE
• Start therapy as soon as diagnosis made by clinician
• Patient to be managed closer to home, more likely to improve
adherence to therapy and improve outcome
• Guidelines provided by NDOH on management of these patients in
community
• Training of clinicians in the community
121. DECENTRALISATION OF SERVICES IN DR TB SINCE 2011
(I.E. AMBULATORY RX
• MDR-TB smear negative patients: can be started on ambulatory
treatment
• MDR-TB smear positive, stable patient without extensive disease:
admit in the decentralised MDR TB unit until 2 smear neg sputa
• Sick MDR TB with extensive disease & XDR TB patients: admit in
central MDR TB unit until 2 successive sputum cultures are neg.
122. DECENTRALISATION OF SERVICES IN DR TB SINCE 2011
(I.E. AMBULATORY RX)
• Every unit needs to adopt a policy to prevent the spread of any TB
(possibly MDR TB) among ambulatory patients or patients admitted
into hospital on an open medical or surgical ward.
• The resources are often spread very thin but we still need to be pro
active in preventing the spread of disease since a lot of patients are
being managed from home
123. REFERRAL OF THE MDR TB PATIENT
• Initiate therapy ASAP after baseline tests to review for comorbid states
CUE,LFT, etc
• Telephonic discussion with Empilweni or Jose Pearson for inpatient
admission and a registration number if patient requires protracted
admission in DNH.
• Ensure samples are taken for culture to confirm diagnosis.
• Patient with R&H resistance will have DST for 2nd line drugs i.e. F & A
125. OLD MDR REGIMEN
• Group A (Fluoroquinolones): Levofloxacin, Moxifloxacin, Gatifloxacin
• Group B (2nd line Injectable agents): Amikacin, Capreomycin, Kanamycin (streptomycin)
• Group C (Other core 2nd line agents): Ethionamide/prothionamide,
Cycloserine/Terizodone, Linezoid, Clofazimine
• Group D (Add-on agents)
• D1: Pyrazinamide/Ethambutol/high dose Isoniazide
• D2: Bedaquiline/ Delaminid
• D3: Imipenem, Meropenem, Augmentin
126. OLD STANDARD MDR REGIMEN
• (A + B + 2C + D1)
• Moxifloxacin 400mg (children 7.5mg – 10mg/kg)
• Kanamycin 750mg to 1g IMI (15 – 20mg/kg)
• Terizidone 750mg to 1000mg (15-20mg/kg)
• Ethionamide 500mg to 750mg (15 – 20mg/kg)
• Pyrazinamide 1750mg to 2500mg (30-40mg/kg)
127. NEW (SHORT) BEDAQUILINE REGIMEN FOR DR-TB
• Bedaquiline (Group D2 – previously an add-on, now forms the bedrock of the new
regimen)
• Levofloxacin (Group A drugs – fluoroquinolones are still vital parts of the regimen)
• Clofazimine & Ethionamide (Both group C drugs)
• Isoniazid HD, Ethambutol & Pyrazinamide (Previously from the group D1. 3 drugs now
used instead of 1)
• NB!! No room for injectables or aminoglycosides in this new regimen
128. NEW (SHORT) BEDAQUILINE REGIMEN FOR DR-TB
ADVANTAGES
• Short course
• 4 – 6 months of intensive phase and 5 months of continuation phase
• Bedaquiline is used for a minimum of 6 months
• No injectables in the new regimen
• Better adherence and less loss to follow up
• Higher cure rates and greater success in the roll out phases
129. NEW (SHORT) BEDAQUILINE REGIMEN FOR DR-TB
MEDICINE WEIGHT
<33 kg 33 – 50 kg > 50 kg
BEDAQUILINE 400mg daily for 2 weeks, then 200mg 3 times per week
LEVOFLOXACIN 750 mg 750 mg 1000 mg
ETHIONAMIDE 250 mg 500 mg 750 mg
ISONIAZID (HD) 600 mg 600 mg 900 mg
CLOFAZIMINE 50 mg 100 mg 100 mg
ETHAMBUTOL 800 mg 800 mg 1200 mg
PYRAZINAMIDE 1500 mg 1500 mg 2000 mg