There are nearly 100 viruses of the herpes group that infect many different animal species.
Official name of herpesviruses that commonly infect human is Humans herpesvirus (HHV)
herpes simplex virus types 1 (HHV 1)
Herpes simplex virus type 2 (HHV 2)
Varicella-zoster virus (HHV 3)
Epstein-Barr virus, (HHV 4)
Cytomegalovirus (HHV 5)
Human herpesvirus 6 (HHV 6)
Human herpesvirus 7 (HHV 7)
Human herpesvirus 8 (HHV 8) (Kaposi's sarcoma-associated herpesvirus).
Herpes B virus of monkeys can also infect humans
hELMINTHS#corona virus#Aspergillosis#BUGANDO#CUHAS#CUHAS#CUHAS
Tuberculosis is caused by the bacterium Mycobacterium tuberculosis and usually affects the lungs. It remains a major global health problem, with around 10 million new cases and 1.5 million deaths per year worldwide according to the WHO. Tuberculosis flourishes in conditions of poverty, crowding and immunosuppression. Clinical manifestations vary depending on whether the infection is primary or secondary, and can include cough, fever, weight loss, or disseminated disease. Diagnosis involves smear, culture and radiography. Standard treatment is 6 months of multiple antitubercular drugs. Effectiveness of treatment is assessed by repeat smears and cultures after 2 and 5 months.
This presentation includes introduction, properties, transmission, epidemiology, pathogenesis, mechanism of infection, immunity and hypersensitivity, clinical manifestations, diagnosis, treatment, prevention and control of MYCOBACTERIUM TUBERCULOSIS.
The document discusses Mycobacterium, the genus of bacteria that includes Mycobacterium tuberculosis, which causes tuberculosis. It covers the epidemiology, pathogenesis, diagnosis, and treatment of tuberculosis, noting that it remains a major public health problem, especially in Tanzania where the HIV epidemic has increased the burden of TB. It also discusses other medically important mycobacteria such as Mycobacterium leprae, which causes leprosy.
The document discusses Mycobacterium, the genus of bacteria that includes Mycobacterium tuberculosis which causes tuberculosis. It provides details on the epidemiology of tuberculosis, noting it is one of the top infectious disease burdens globally and in Tanzania specifically. It describes the pathogenesis and clinical presentation of tuberculosis as well as methods for diagnosis and treatment.
This document discusses tuberculosis (TB), including its definition, causative agents, spread, epidemiology, pathogenesis, signs and symptoms, diagnosis, and treatment. It notes that TB is caused by bacteria in the Mycobacterium tuberculosis complex that usually affect the lungs. Diagnosis involves tests like smear microscopy, culture, PCR and tuberculin skin testing. Standard treatment involves a combination of antibiotics over 6-9 months. Drug-resistant forms like multi-drug resistant TB and extensively drug-resistant TB require longer and more toxic treatment regimes.
This document summarizes different types and stages of tuberculosis infection and disease. It describes primary tuberculosis occurring in previously unexposed individuals, which may lead to fibrosis and healing or progressive primary disease. It also describes secondary or reactivation tuberculosis occurring in sensitized hosts, which typically involves the lung apices and may progress to cavitary lesions if not treated properly. The document discusses the pathology, microbiology, immunology and clinical manifestations of tuberculosis at different stages.
Pathophysiology and clinical management of tuberculosisSoujanya Pharm.D
Tuberculosis is caused by Mycobacterium tuberculosis and typically affects the lungs. It remains a major global health problem, especially in poorer countries. Risk factors include malnutrition, inadequate healthcare, poverty, and conditions that weaken the immune system. It is transmitted via airborne droplets from the lungs of infected individuals. Diagnosis involves tests like the Mantoux test and culturing sputum samples. Treatment requires a multi-drug regimen over a long period to prevent resistance. First-line drugs include isoniazid, rifampicin, pyrazinamide, and ethambutol.
1) Tuberculosis remains a major global health problem, causing millions of cases and deaths each year worldwide. It commonly affects the lungs but can spread to other sites.
2) The host immune response to TB involves both innate and acquired immunity. Innate responses include phagocytosis by macrophages and natural killer cells. Acquired responses are primarily cell-mediated, involving CD4 and CD8 T cells that secrete cytokines like IFN-γ.
3) Cytokines play an important role in the immune response, with IL-12 and IFN-γ promoting the protective Th1 response and TNF-α also contributing to immune and pathological responses to TB.
Tuberculosis is caused by the bacterium Mycobacterium tuberculosis and usually affects the lungs. It remains a major global health problem, with around 10 million new cases and 1.5 million deaths per year worldwide according to the WHO. Tuberculosis flourishes in conditions of poverty, crowding and immunosuppression. Clinical manifestations vary depending on whether the infection is primary or secondary, and can include cough, fever, weight loss, or disseminated disease. Diagnosis involves smear, culture and radiography. Standard treatment is 6 months of multiple antitubercular drugs. Effectiveness of treatment is assessed by repeat smears and cultures after 2 and 5 months.
This presentation includes introduction, properties, transmission, epidemiology, pathogenesis, mechanism of infection, immunity and hypersensitivity, clinical manifestations, diagnosis, treatment, prevention and control of MYCOBACTERIUM TUBERCULOSIS.
The document discusses Mycobacterium, the genus of bacteria that includes Mycobacterium tuberculosis, which causes tuberculosis. It covers the epidemiology, pathogenesis, diagnosis, and treatment of tuberculosis, noting that it remains a major public health problem, especially in Tanzania where the HIV epidemic has increased the burden of TB. It also discusses other medically important mycobacteria such as Mycobacterium leprae, which causes leprosy.
The document discusses Mycobacterium, the genus of bacteria that includes Mycobacterium tuberculosis which causes tuberculosis. It provides details on the epidemiology of tuberculosis, noting it is one of the top infectious disease burdens globally and in Tanzania specifically. It describes the pathogenesis and clinical presentation of tuberculosis as well as methods for diagnosis and treatment.
This document discusses tuberculosis (TB), including its definition, causative agents, spread, epidemiology, pathogenesis, signs and symptoms, diagnosis, and treatment. It notes that TB is caused by bacteria in the Mycobacterium tuberculosis complex that usually affect the lungs. Diagnosis involves tests like smear microscopy, culture, PCR and tuberculin skin testing. Standard treatment involves a combination of antibiotics over 6-9 months. Drug-resistant forms like multi-drug resistant TB and extensively drug-resistant TB require longer and more toxic treatment regimes.
This document summarizes different types and stages of tuberculosis infection and disease. It describes primary tuberculosis occurring in previously unexposed individuals, which may lead to fibrosis and healing or progressive primary disease. It also describes secondary or reactivation tuberculosis occurring in sensitized hosts, which typically involves the lung apices and may progress to cavitary lesions if not treated properly. The document discusses the pathology, microbiology, immunology and clinical manifestations of tuberculosis at different stages.
Pathophysiology and clinical management of tuberculosisSoujanya Pharm.D
Tuberculosis is caused by Mycobacterium tuberculosis and typically affects the lungs. It remains a major global health problem, especially in poorer countries. Risk factors include malnutrition, inadequate healthcare, poverty, and conditions that weaken the immune system. It is transmitted via airborne droplets from the lungs of infected individuals. Diagnosis involves tests like the Mantoux test and culturing sputum samples. Treatment requires a multi-drug regimen over a long period to prevent resistance. First-line drugs include isoniazid, rifampicin, pyrazinamide, and ethambutol.
1) Tuberculosis remains a major global health problem, causing millions of cases and deaths each year worldwide. It commonly affects the lungs but can spread to other sites.
2) The host immune response to TB involves both innate and acquired immunity. Innate responses include phagocytosis by macrophages and natural killer cells. Acquired responses are primarily cell-mediated, involving CD4 and CD8 T cells that secrete cytokines like IFN-γ.
3) Cytokines play an important role in the immune response, with IL-12 and IFN-γ promoting the protective Th1 response and TNF-α also contributing to immune and pathological responses to TB.
This document provides an overview of tuberculosis (TB), including its definition, causative agents, types, risk factors, pathophysiology, clinical presentation, differential diagnosis, investigation, and treatment. TB is an infectious disease caused mainly by the bacterium Mycobacterium tuberculosis that typically affects the lungs. It can be transmitted through airborne droplets when an infected person coughs or sneezes. There are two main types - pulmonary TB affecting the lungs and extra-pulmonary TB affecting other organs. Risk factors include contact with infected individuals, immunosuppression, and lifestyle factors like drug/alcohol misuse. Treatment involves a two-phase drug regimen over 6-10 months with first-line antibiotics like rifampin,
Mycobacterium are acid-fast, non-motile, non-spore forming bacteria. They include pathogens like M. tuberculosis which causes tuberculosis, M. leprae which causes leprosy, and non-tuberculous mycobacteria (NTM) which can sometimes cause opportunistic infections. M. tuberculosis is transmitted via airborne droplets and causes pulmonary or extrapulmonary infection. Diagnosis involves microscopy, culture, PCR and tuberculin skin testing. Treatment involves a combination of antibiotics over several months. Drug resistant strains like MDR and XDR present a challenge. NTM live in the environment and can cause localized infection, especially in immunocompromised individuals.
1. Tuberculosis is caused by the bacterium Mycobacterium tuberculosis and mainly affects the lungs. It is observed that 10 million active TB cases occur globally each year, with India reporting approximately 2.3 million cases.
2. Tuberculosis is transmitted when people inhale droplets from the coughs or sneezes of people with active pulmonary or laryngeal TB. It can also occur through ingesting milk from cows with bovine tuberculosis.
3. Granulomatous inflammation is the body's protective response to chronic infections or foreign material like tuberculosis bacteria. It forms structures called granulomas that wall off the pathogen to prevent spread while also destroying tissue over time.
Tuberculosis is a chronic infectious disease caused by the bacterium Mycobacterium tuberculosis. It typically affects the lungs but can affect any part of the body. Risk factors include poverty, crowding, illnesses that weaken the immune system like HIV, and malnutrition. There are two main types - primary tuberculosis occurs in those never exposed before while secondary tuberculosis occurs from reactivation of a previous infection. Diagnosis involves physical exam, sputum tests, chest x-rays, and culture of bacteria. Treatment requires a combination of antibiotics taken for several months. Preventive measures include isolation during early treatment, ventilation, cough hygiene, and masks.
Mycobacterium tuberculosis by Sikander ali Sumalanisikandarsikandar3
This document provides an overview of Mycobacterium tuberculosis, the bacteria that causes tuberculosis (TB). It discusses the morphology, culture, acid-fast staining, and species of mycobacteria. M. tuberculosis is transmitted through respiratory droplets and causes TB, which remains a major global health threat. The pathogenesis of TB involves inhalation and interaction with macrophages, inflammatory cell recruitment, granuloma formation to contain bacteria, and potential reactivation from latent infection. Risk factors, signs and symptoms, diagnosis using tests like tuberculin skin test and sputum analysis, and multi-drug treatment approaches are summarized.
This document discusses several pathogenic microorganisms and infectious diseases. It begins with an overview of tetanus caused by Clostridium tetani, describing the toxin produced and how it causes symptoms. Next, it covers tuberculosis caused by Mycobacterium tuberculosis, outlining transmission, pathogenesis in the lungs, symptoms, diagnosis including the Mantoux test, and treatment including antibiotics and the BCG vaccine. Finally, it provides details on the H1N1 influenza virus, including its structure, proteins, replication, and common symptoms.
1. Tuberculosis is caused by the bacterium Mycobacterium tuberculosis and usually attacks the lungs. It spreads through airborne droplets when people with active TB cough, sneeze or speak.
2. The pathogenesis of TB begins when M. tuberculosis enters macrophages and avoids destruction by inhibiting phagolysosome fusion. This allows the bacteria to replicate within macrophages. The immune system eventually mounts a TH1 response to activate macrophages to contain the infection.
3. Primary TB develops in those exposed for the first time and causes the formation of granulomas in the lungs and lymph nodes. Without treatment, the infection can spread throughout the body and cause secondary pulmonary TB or miliary TB.
1. Mycobacterium tuberculosis enters macrophages and replicates within phagosomes, inhibiting phagolysosome fusion.
2. A TH1 immune response is mounted after 3 weeks of infection to activate macrophages. IFN-γ is critical for macrophage activation.
3. Granulomatous inflammation forms caseating and non-caseating tubercles containing central necrosis, epithelioid cells, and lymphocytes. Tuberculosis may not elicit granulomas in immunosuppressed individuals.
Tuberculosis is an ancient disease caused by Mycobacterium tuberculosis. It spreads through airborne droplets when people with active TB cough, sneeze, or speak. TB is the second leading infectious killer worldwide after COVID-19. Treatment involves a multi-drug regimen administered under direct observation to cure the infection and prevent drug resistance. Diagnosis involves sputum smear microscopy, culture, and drug susceptibility testing to identify drug-resistant strains.
The document provides an overview of tuberculosis in pediatrics. It defines tuberculosis as a disease caused by Mycobacterium tuberculosis that usually affects the lungs. Risk factors include defects in cell-mediated immunity. Clinical presentation varies from latent asymptomatic infection to primary pneumonia or disseminated disease affecting multiple organs. Symptoms depend on the site of infection and may include fever, weight loss, night sweats, and abnormalities found on imaging or laboratory tests.
The document summarizes information about tuberculosis (TB). It describes TB as affecting mainly the lungs and causing symptoms like cough, weight loss, and fatigue. The causative agent is identified as Mycobacterium tuberculosis bacteria. The pathogenesis involves the bacteria being inhaled and surviving inside immune cells in the lungs, eventually forming nodules that can spread infection. Diagnosis involves tests like chest x-rays and detecting the bacteria in sputum. Treatment consists of a combination of antibiotics taken for several months.
Tuberculosis is an infectious disease caused by the Mycobacterium tuberculosis bacteria which most commonly affects the lungs. It spreads through the air when people with active TB cough or sneeze. Common symptoms include cough, fever, night sweats and weight loss. Diagnosis involves chest x-ray and sputum culture. Treatment requires taking multiple antibiotic drugs daily for 6-9 months. Directly observed treatment short course chemotherapy (DOTS) involves health workers directly observing patients take their medications to ensure compliance. Tuberculosis remains a major global health issue and India has a high burden of cases.
This document provides an overview of tuberculosis in children. It defines TB, notes its global burden, and describes the etiology and pathogenesis of the disease. Key aspects of diagnosis are outlined, including presentations, investigations, and diagnostic criteria. Treatment recommendations are presented, including regimens for new and retreatment cases. The management of exposed children and important considerations like hospitalization and steroid therapy are also covered. Potential side effects of anti-TB drugs are reviewed.
This document provides an overview of tuberculosis (TB), including its classification, pathogenesis, forms, diagnosis and treatment. It describes how TB is caused by various mycobacterium species, especially Mycobacterium tuberculosis. TB most commonly affects the lungs but can spread to other organs. Diagnosis involves tests like chest x-rays, sputum smears, cultures and the Mantoux skin test. Treatment involves use of antibiotics like isoniazid, rifampin, pyrazinamide and ethambutol, either as primary treatment or for drug-resistant cases. Immunization with BCG vaccine provides some protection.
Pulmonary tuberculosis is caused by Mycobacterium tuberculosis and remains a major global health problem. It is transmitted through inhaling airborne droplets from infected individuals. There are two types - primary tuberculosis occurs when a person is initially infected, while post-primary tuberculosis is a reactivation of a latent infection. Primary tuberculosis involves the lungs and lymph nodes, and may spread to other organs. Post-primary tuberculosis occurs in the upper lungs and causes more extensive damage like cavitation. Untreated tuberculosis can spread throughout the body.
Tuberculosis is a chronic infectious disease caused by the bacterium Mycobacterium tuberculosis, which most commonly affects the lungs. It is one of the top 10 causes of death worldwide. The disease is transmitted through the air when people who are sick with TB expel bacteria into the air, for example by coughing. Common symptoms include cough with sputum and blood at times, fever, night sweats, and weight loss. Diagnosis involves tests such as chest X-rays, sputum smear microscopy, and culture. Treatment involves a combination of antibiotics over a period of 6-9 months. The Revised National Tuberculosis Control Programme aims to reduce mortality and transmission of TB in India through improved case detection and
The document summarizes tuberculosis (TB), caused by the bacterium Mycobacterium tuberculosis. It primarily affects the lungs and is a major public health problem worldwide, especially in developing countries. Factors like malnutrition, poverty, and HIV increase risk. The bacterium is transmitted via airborne droplets when infected people cough, sneeze, or speak. It can spread locally or via the bloodstream and lymphatics to other organs. Primary TB occurs in those never exposed, while secondary TB is a reactivation of a previous infection. Untreated, it can cause serious lung damage or spread.
This document provides an overview of tuberculosis (TB), including:
- TB is caused by various Mycobacterium species, most commonly M. tuberculosis. It most often affects the lungs but can spread to other organs.
- Untreated TB can be fatal within 5 years. It is one of the top infectious killers worldwide. Risk factors include living in areas with high TB rates, poor healthcare access, and immunocompromised status.
- M. tuberculosis infects alveolar macrophages and forms lesions called tubercles. The immune response tries to wall off the bacteria in structures called granulomas. Latent TB occurs when infection is controlled, while active TB results if the immune response is overwhelmed.
This document discusses tuberculosis (TB), including its causative agents, modes of transmission, types, pathogenesis, and clinical manifestations. It describes how Mycobacterium tuberculosis is usually responsible for causing TB, which spreads primarily through inhalation of infectious droplets. TB is classified as primary or secondary pulmonary TB, and can also affect extra-pulmonary sites. Primary TB involves the formation of granulomas in the lungs and lymph nodes, while secondary TB results from reactivation of a prior infection and causes cavitary lesions in the upper lungs. Immunocompromised individuals like those with HIV are more susceptible to disseminated miliary TB.
This document discusses tuberculosis (TB), including its epidemiology, causative agent, pathogenesis, diagnosis, and treatment. Some key points:
- TB is caused by the bacterium Mycobacterium tuberculosis and spreads through airborne droplets when infected individuals cough, sneeze, talk or spit. It can infect the lungs (pulmonary TB) or other organs (extra-pulmonary TB).
- Diagnosis involves microscopic examination of sputum samples for acid-fast bacilli, culture testing, and more recently PCR and gene-based tests. India's Revised National Tuberculosis Control Programme (RNTCP) is based on the WHO DOTS strategy to improve cure rates and case detection.
Electrolyte and fluid balance in elderly.pptxMkindi Mkindi
The body maintains electrolyte and fluid balance through carefully regulated input and output. As people age, the kidneys undergo changes that impair this regulation. There is a 20-25% loss of renal mass and decline in glomerular filtration rate. This impairs the kidneys' ability to concentrate and dilute urine. As a result, elderly people are more prone to fluid and electrolyte disorders like hyponatremia, hypernatremia, and hypertension. Close monitoring of fluid, sodium, and medication intake is needed to prevent issues from imbalances.
Approach to disease in elderly.pptx elderlyMkindi Mkindi
This document provides an overview of the approach to disease in elderly patients. Key points include:
- Elderly patients are defined as those aged 65 and over, and their numbers are growing rapidly worldwide. They experience physiological declines that increase disease susceptibility.
- A comprehensive geriatric assessment evaluates physical and mental health, functional status, social circumstances, and screens for issues like elder abuse. This helps develop individualized care plans.
- Common geriatric syndromes like frailty, falls, and delirium are assessed. Polypharmacy is a major risk, so medication reviews are important. Nutritional status also declines with age and disease.
- Discharge planning must consider living situation and need for home care assistance after leaving hospital
This document provides an overview of tuberculosis (TB), including its definition, causative agents, types, risk factors, pathophysiology, clinical presentation, differential diagnosis, investigation, and treatment. TB is an infectious disease caused mainly by the bacterium Mycobacterium tuberculosis that typically affects the lungs. It can be transmitted through airborne droplets when an infected person coughs or sneezes. There are two main types - pulmonary TB affecting the lungs and extra-pulmonary TB affecting other organs. Risk factors include contact with infected individuals, immunosuppression, and lifestyle factors like drug/alcohol misuse. Treatment involves a two-phase drug regimen over 6-10 months with first-line antibiotics like rifampin,
Mycobacterium are acid-fast, non-motile, non-spore forming bacteria. They include pathogens like M. tuberculosis which causes tuberculosis, M. leprae which causes leprosy, and non-tuberculous mycobacteria (NTM) which can sometimes cause opportunistic infections. M. tuberculosis is transmitted via airborne droplets and causes pulmonary or extrapulmonary infection. Diagnosis involves microscopy, culture, PCR and tuberculin skin testing. Treatment involves a combination of antibiotics over several months. Drug resistant strains like MDR and XDR present a challenge. NTM live in the environment and can cause localized infection, especially in immunocompromised individuals.
1. Tuberculosis is caused by the bacterium Mycobacterium tuberculosis and mainly affects the lungs. It is observed that 10 million active TB cases occur globally each year, with India reporting approximately 2.3 million cases.
2. Tuberculosis is transmitted when people inhale droplets from the coughs or sneezes of people with active pulmonary or laryngeal TB. It can also occur through ingesting milk from cows with bovine tuberculosis.
3. Granulomatous inflammation is the body's protective response to chronic infections or foreign material like tuberculosis bacteria. It forms structures called granulomas that wall off the pathogen to prevent spread while also destroying tissue over time.
Tuberculosis is a chronic infectious disease caused by the bacterium Mycobacterium tuberculosis. It typically affects the lungs but can affect any part of the body. Risk factors include poverty, crowding, illnesses that weaken the immune system like HIV, and malnutrition. There are two main types - primary tuberculosis occurs in those never exposed before while secondary tuberculosis occurs from reactivation of a previous infection. Diagnosis involves physical exam, sputum tests, chest x-rays, and culture of bacteria. Treatment requires a combination of antibiotics taken for several months. Preventive measures include isolation during early treatment, ventilation, cough hygiene, and masks.
Mycobacterium tuberculosis by Sikander ali Sumalanisikandarsikandar3
This document provides an overview of Mycobacterium tuberculosis, the bacteria that causes tuberculosis (TB). It discusses the morphology, culture, acid-fast staining, and species of mycobacteria. M. tuberculosis is transmitted through respiratory droplets and causes TB, which remains a major global health threat. The pathogenesis of TB involves inhalation and interaction with macrophages, inflammatory cell recruitment, granuloma formation to contain bacteria, and potential reactivation from latent infection. Risk factors, signs and symptoms, diagnosis using tests like tuberculin skin test and sputum analysis, and multi-drug treatment approaches are summarized.
This document discusses several pathogenic microorganisms and infectious diseases. It begins with an overview of tetanus caused by Clostridium tetani, describing the toxin produced and how it causes symptoms. Next, it covers tuberculosis caused by Mycobacterium tuberculosis, outlining transmission, pathogenesis in the lungs, symptoms, diagnosis including the Mantoux test, and treatment including antibiotics and the BCG vaccine. Finally, it provides details on the H1N1 influenza virus, including its structure, proteins, replication, and common symptoms.
1. Tuberculosis is caused by the bacterium Mycobacterium tuberculosis and usually attacks the lungs. It spreads through airborne droplets when people with active TB cough, sneeze or speak.
2. The pathogenesis of TB begins when M. tuberculosis enters macrophages and avoids destruction by inhibiting phagolysosome fusion. This allows the bacteria to replicate within macrophages. The immune system eventually mounts a TH1 response to activate macrophages to contain the infection.
3. Primary TB develops in those exposed for the first time and causes the formation of granulomas in the lungs and lymph nodes. Without treatment, the infection can spread throughout the body and cause secondary pulmonary TB or miliary TB.
1. Mycobacterium tuberculosis enters macrophages and replicates within phagosomes, inhibiting phagolysosome fusion.
2. A TH1 immune response is mounted after 3 weeks of infection to activate macrophages. IFN-γ is critical for macrophage activation.
3. Granulomatous inflammation forms caseating and non-caseating tubercles containing central necrosis, epithelioid cells, and lymphocytes. Tuberculosis may not elicit granulomas in immunosuppressed individuals.
Tuberculosis is an ancient disease caused by Mycobacterium tuberculosis. It spreads through airborne droplets when people with active TB cough, sneeze, or speak. TB is the second leading infectious killer worldwide after COVID-19. Treatment involves a multi-drug regimen administered under direct observation to cure the infection and prevent drug resistance. Diagnosis involves sputum smear microscopy, culture, and drug susceptibility testing to identify drug-resistant strains.
The document provides an overview of tuberculosis in pediatrics. It defines tuberculosis as a disease caused by Mycobacterium tuberculosis that usually affects the lungs. Risk factors include defects in cell-mediated immunity. Clinical presentation varies from latent asymptomatic infection to primary pneumonia or disseminated disease affecting multiple organs. Symptoms depend on the site of infection and may include fever, weight loss, night sweats, and abnormalities found on imaging or laboratory tests.
The document summarizes information about tuberculosis (TB). It describes TB as affecting mainly the lungs and causing symptoms like cough, weight loss, and fatigue. The causative agent is identified as Mycobacterium tuberculosis bacteria. The pathogenesis involves the bacteria being inhaled and surviving inside immune cells in the lungs, eventually forming nodules that can spread infection. Diagnosis involves tests like chest x-rays and detecting the bacteria in sputum. Treatment consists of a combination of antibiotics taken for several months.
Tuberculosis is an infectious disease caused by the Mycobacterium tuberculosis bacteria which most commonly affects the lungs. It spreads through the air when people with active TB cough or sneeze. Common symptoms include cough, fever, night sweats and weight loss. Diagnosis involves chest x-ray and sputum culture. Treatment requires taking multiple antibiotic drugs daily for 6-9 months. Directly observed treatment short course chemotherapy (DOTS) involves health workers directly observing patients take their medications to ensure compliance. Tuberculosis remains a major global health issue and India has a high burden of cases.
This document provides an overview of tuberculosis in children. It defines TB, notes its global burden, and describes the etiology and pathogenesis of the disease. Key aspects of diagnosis are outlined, including presentations, investigations, and diagnostic criteria. Treatment recommendations are presented, including regimens for new and retreatment cases. The management of exposed children and important considerations like hospitalization and steroid therapy are also covered. Potential side effects of anti-TB drugs are reviewed.
This document provides an overview of tuberculosis (TB), including its classification, pathogenesis, forms, diagnosis and treatment. It describes how TB is caused by various mycobacterium species, especially Mycobacterium tuberculosis. TB most commonly affects the lungs but can spread to other organs. Diagnosis involves tests like chest x-rays, sputum smears, cultures and the Mantoux skin test. Treatment involves use of antibiotics like isoniazid, rifampin, pyrazinamide and ethambutol, either as primary treatment or for drug-resistant cases. Immunization with BCG vaccine provides some protection.
Pulmonary tuberculosis is caused by Mycobacterium tuberculosis and remains a major global health problem. It is transmitted through inhaling airborne droplets from infected individuals. There are two types - primary tuberculosis occurs when a person is initially infected, while post-primary tuberculosis is a reactivation of a latent infection. Primary tuberculosis involves the lungs and lymph nodes, and may spread to other organs. Post-primary tuberculosis occurs in the upper lungs and causes more extensive damage like cavitation. Untreated tuberculosis can spread throughout the body.
Tuberculosis is a chronic infectious disease caused by the bacterium Mycobacterium tuberculosis, which most commonly affects the lungs. It is one of the top 10 causes of death worldwide. The disease is transmitted through the air when people who are sick with TB expel bacteria into the air, for example by coughing. Common symptoms include cough with sputum and blood at times, fever, night sweats, and weight loss. Diagnosis involves tests such as chest X-rays, sputum smear microscopy, and culture. Treatment involves a combination of antibiotics over a period of 6-9 months. The Revised National Tuberculosis Control Programme aims to reduce mortality and transmission of TB in India through improved case detection and
The document summarizes tuberculosis (TB), caused by the bacterium Mycobacterium tuberculosis. It primarily affects the lungs and is a major public health problem worldwide, especially in developing countries. Factors like malnutrition, poverty, and HIV increase risk. The bacterium is transmitted via airborne droplets when infected people cough, sneeze, or speak. It can spread locally or via the bloodstream and lymphatics to other organs. Primary TB occurs in those never exposed, while secondary TB is a reactivation of a previous infection. Untreated, it can cause serious lung damage or spread.
This document provides an overview of tuberculosis (TB), including:
- TB is caused by various Mycobacterium species, most commonly M. tuberculosis. It most often affects the lungs but can spread to other organs.
- Untreated TB can be fatal within 5 years. It is one of the top infectious killers worldwide. Risk factors include living in areas with high TB rates, poor healthcare access, and immunocompromised status.
- M. tuberculosis infects alveolar macrophages and forms lesions called tubercles. The immune response tries to wall off the bacteria in structures called granulomas. Latent TB occurs when infection is controlled, while active TB results if the immune response is overwhelmed.
This document discusses tuberculosis (TB), including its causative agents, modes of transmission, types, pathogenesis, and clinical manifestations. It describes how Mycobacterium tuberculosis is usually responsible for causing TB, which spreads primarily through inhalation of infectious droplets. TB is classified as primary or secondary pulmonary TB, and can also affect extra-pulmonary sites. Primary TB involves the formation of granulomas in the lungs and lymph nodes, while secondary TB results from reactivation of a prior infection and causes cavitary lesions in the upper lungs. Immunocompromised individuals like those with HIV are more susceptible to disseminated miliary TB.
This document discusses tuberculosis (TB), including its epidemiology, causative agent, pathogenesis, diagnosis, and treatment. Some key points:
- TB is caused by the bacterium Mycobacterium tuberculosis and spreads through airborne droplets when infected individuals cough, sneeze, talk or spit. It can infect the lungs (pulmonary TB) or other organs (extra-pulmonary TB).
- Diagnosis involves microscopic examination of sputum samples for acid-fast bacilli, culture testing, and more recently PCR and gene-based tests. India's Revised National Tuberculosis Control Programme (RNTCP) is based on the WHO DOTS strategy to improve cure rates and case detection.
Electrolyte and fluid balance in elderly.pptxMkindi Mkindi
The body maintains electrolyte and fluid balance through carefully regulated input and output. As people age, the kidneys undergo changes that impair this regulation. There is a 20-25% loss of renal mass and decline in glomerular filtration rate. This impairs the kidneys' ability to concentrate and dilute urine. As a result, elderly people are more prone to fluid and electrolyte disorders like hyponatremia, hypernatremia, and hypertension. Close monitoring of fluid, sodium, and medication intake is needed to prevent issues from imbalances.
Approach to disease in elderly.pptx elderlyMkindi Mkindi
This document provides an overview of the approach to disease in elderly patients. Key points include:
- Elderly patients are defined as those aged 65 and over, and their numbers are growing rapidly worldwide. They experience physiological declines that increase disease susceptibility.
- A comprehensive geriatric assessment evaluates physical and mental health, functional status, social circumstances, and screens for issues like elder abuse. This helps develop individualized care plans.
- Common geriatric syndromes like frailty, falls, and delirium are assessed. Polypharmacy is a major risk, so medication reviews are important. Nutritional status also declines with age and disease.
- Discharge planning must consider living situation and need for home care assistance after leaving hospital
Approach to disease in elderly.pptx bwire bwireMkindi Mkindi
This document provides an overview of the approach to disease in elderly patients. Key points include:
- Elderly patients are defined as those aged 65 and over, and their numbers are increasing globally. They experience physiological declines that increase disease susceptibility.
- A comprehensive geriatric assessment evaluates physical and mental health, functional status, social circumstances, and screens for issues like elder abuse. This helps develop individualized care plans.
- Common geriatric syndromes like frailty, falls, and delirium are assessed. Polypharmacy is a major risk, so medication reviews are important. Nutritional status also declines with age and disease.
- Discharge planning must consider living situation and need for home care assistance after leaving hospital.
01-INVESTIGATIONS IN KDInvesting ckd bugando cuhasMkindi Mkindi
This document discusses investigations used in kidney disease. It begins with an introduction to kidney anatomy and physiology. Laboratory tests discussed include urine analysis, renal function tests measuring creatinine and GFR, electrolytes, and blood work including markers for glomerular diseases. Imaging options like ultrasound, CT, MRI, and angiography are outlined. Kidney biopsy procedures and their utility are also summarized.
Arterial thrombi in details#MkindiArterial thrombi#Mkindi Arterial thrombi#M...Mkindi Mkindi
Unexplained arterial thrombosis can occur due to underlying hypercoagulable states or prothrombotic conditions. The authors provide an approach to diagnosis of unexplained arterial thrombosis that involves obtaining a thorough medical history, performing laboratory tests to identify underlying hypercoagulable states or prothrombotic conditions, and long-term anticoagulation therapy for identified conditions while further evaluating those without an identified cause.
This document outlines the components and utility of urinalysis. It discusses the importance of urinalysis as a non-invasive diagnostic tool that can provide information about renal and systemic health issues. The key components of urinalysis covered are physical examination of attributes like color and specific gravity, microscopic examination of sediment and crystals, and chemical analysis to detect substances like glucose, proteins, ketones and others. Together, urinalysis provides valuable insights into conditions affecting the kidneys, urinary tract, and other body systems.
This document discusses selective toxicity and the mechanisms of action of antiparasitic drugs. It begins by defining three types of human parasitism and noting that antiparasitic agents are cytotoxic, exhibiting cytocidal or cytostatic effects. It then explores various ways drugs can selectively target parasites over human cells, including qualitative, quantitative, and distributional selectivity. The rest of the document delves into specific mechanisms of selective toxicity, such as inhibiting cell wall synthesis, nucleic acid synthesis, mitosis, protein synthesis, and energy metabolism in parasites. It provides examples of drugs that act through each of these mechanisms.
A case-control study compares individuals with a disease or condition (cases) to individuals without that disease or condition (controls) to determine whether exposure to a particular agent is associated with the disease. It begins with identifying cases who have the disease and controls who do not, then measuring and comparing past exposure to potential risk factors between the two groups. Case-control studies are useful for rare diseases, identifying new risk factors, and when prospective cohort studies are not possible due to time or cost constraints. However, they are prone to biases like recall and selection bias.
Gout and pseudogout are crystal-induced arthropathies caused by the deposition of urate crystals or calcium pyrophosphate dihydrate crystals in the joints respectively. Gout results in painful flares typically affecting the big toe and is characterized by periods of acute inflammation. Pseudogout causes intermittent arthritis that may be asymptomatic and is detected by chondrocalcinosis on x-rays. Both can be diagnosed by identifying the characteristic crystals in synovial fluid under polarized microscopy. Treatment involves management of symptoms during acute flares and reducing crystal deposition long-term.
1. Malabsorption syndromes can involve defects in digestion or absorption of nutrients and present with symptoms of nutrient deficiencies.
2. Celiac disease is an immune-mediated disorder triggered by ingestion of gluten that results in damage to the small intestine and malabsorption. It is diagnosed through small bowel biopsy and treatment is a lifelong gluten-free diet.
3. Tropical sprue is a malabsorption syndrome of the small intestine seen in tropical regions, whose cause is thought to be an infectious agent. It resembles celiac disease and improves with antibiotic treatment.
This document provides an overview of viral hepatitis, focusing on hepatitis B. It discusses the epidemiology, virology, transmission, natural history, diagnosis, and treatment of hepatitis B. Key points include that hepatitis B virus is estimated to cause nearly 900,000 deaths annually worldwide, has several genotypes that impact treatment and disease progression, and follows a natural history over decades from initial infection to potential chronic infection, liver damage, and liver cancer. Non-invasive blood tests and transient elastography can assess liver fibrosis without a biopsy.
3. Ananthakrishnan - Management of Severe UC and Pouch-Related Complications....Mkindi Mkindi
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বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
2. A 46 years old male pt who was admitted from home
with history of coughing blood on two different
occasions in the past two weeks associated with fever,
profuse nocturnal sweating, loss of appetite,
significance weight loss of 8 kg in less than a month and
easy fatiguability. POSITIVE hx of IV drug use.
On Physical examination, He was Ill looking, cachexic,
febrile T- 39.6, PR- 110 Bpm, RS- 20 bpm, BP- 130/76,
SPO2- 98%
RR; Unilateral right side crepitation, more on the upper
lobes
Initial chest x-ray; infiltration on the right upper lobe
with a sign of Cavitation.
3.
4. Provisional diagnosis.?? Ddx??
Other investigation that we can order?
Mostly likely organism?
Pathogenesis/Immunology of the disease?
Is the patient high risk or low risk patient?
Most likely co- infection?
Initial treatment?
Prevention and prophylaxis measures
6. Presentation outline
Introduction
Structural differences between Tb and other bacteria
Transmission
Pathogenesis / Immunology
Clinical presentation of different forms of Tb.
Diagnostic tools/methods and challenges
Treatment and resistance challenges
MDR/XDR
MDR Treatment
Tb vaccination
Prevention and Prophylaxis
Discussion
7. INTRODUCTION
Tuberculosis. Describes as a chronic infectious
disease with broad range of clinical illness caused
by Mycobacterium tuberculosis complex.
In humans the commonest cause is Mycobacterium
tuberculosis.
other mycobacterium spp such as;
• Mycobacterium bovis,
• Mycobacterium avium complex (MAC),
• Mycobacterium canetti and
• Mycobacterium Africanum may rarely cause TB,
8. Introduction
Tuberculosis is primarily the disease of the lungs
however it can affect other organs e.g. meninges,
lymph nodes, brain, kidney, GIT, bones and joints etc
Humans are the only known
reservoir for Mycobacterium
tuberculosis
9. epidemiology
Over 30% of people in the world are
infected with TB
Majority of TB patients (80%) are in
22 high burden countries
Tanzania has an incidence of (253/100,000) is ranked 14th
out of 30 (Source: WHO report 2020)
10. TB Prevalence in Tanzania
In year 2018, a total of 75,845 cases of all forms were
notified, which is an increase of 6,205 cases or 9%
compared to the year 2017. New and relapse TB cases
notified were 74,692 among them, 48% were
bacteriological confirmed TB cases, 79% were pulmonary
TB cases (NTLP 2018)
14. Microbiology of TB
Mycobacterium tuberculosis was discovered by Robert
Koch in 1882.
They are Obligate aerobic, non spore forming acid fast
bacilli
Called acid fast bacillus because the resist
decolourisation with acid or alcohol after being stained
by carbofuschin dye.
They have cell wall made of mycolic acid which
contributes to pathogenicity also have waxy layer which
help to survive in adverse conditions
15. Microbiology cont
M. Tuberculosis can be differentiated
from other mycobacteria:-
Grow slowly and lack pigment
Produce niacin
Reduce nitrates
Produce heat sensitive catalase (
inactivated by heating to 68C at pH of
7.0)
Other mycobacteria produce large
amount of heat stable catalase
16. Transmission
Transmission is from human with active disease through
aerosal droplets.
Transmission occurs significantly while coughing,
sneezing, singing, talking or spiting
At this time, they expel infectious aerosol droplets 0.5 to 5
µm in diameter.
Avoid prolonged, frequent and intense contact with
active Tb patients especially for immunocompromised
non Tb infected people.
17. Pathogenesis
About 90% of those infected with M.tuberculosis have
asymptomatic, latent TB infection.
With only a 10% lifetime chance that a latent infection
will progress to TB disease.
TB infection begins when the mycobacteria reach the
pulmonary alveoli, where they invade and replicate
within the endosomes of alveolar macrophages.
18. Pathogenesis cont
In the few weeks (4-6wks) the body has
almost no immune defense against
infection with M. tuberculosis.
Bacterial multiplication proceeds for
weeks both in the initial focus and
lymphohematogenous metastatic foci
until the development of
hypersensitivity and cellular immunity
Lymphocytes, mostly CD4+ cells bearing
the alpha form of the T cell receptor
are capable of recognizing mycobacteria
that have been processed and presented
by macrophage
21. Pathogenesis cont
When lymphocytes encounter antigen in
association with MHC class II molecule on
the macrophage surface it is activated
and proliferates producing a clone of
reactive lymphocytes
T cells produce many lymphokines which
attract, retain and activate macrophage
at the site of antigen
Activated macrophage accumulate high
concentrations of lytic enzymes and
reactive metabolites that
mycobactericidal
22. Pathogenesis cont
Alveolar macrophage secrete a number
of cytokines
Interleukin I contribute to fever
IL -6 contributes to hyperglobulinemia
Tumor necrotic factor alpha (TNF-
alpha)contributes :
• Killing of mycobacteria
• Formation of granulomas
• Systemic symptoms such as fever and
weight loss
23. Pathogenesis cont
Qualitative and quantitative defect of CD4+ T
cells explain inability of HIV +ve pt to contain
mycobacteria proliferation
When the population of activated
lymphocytes reach a certain size, cutaneous
delayed reactivity to tuberculin becomes
manifest
The pathological features of tuberculosis are
the result of the degree of hypersensitivity
and the local concentration of antigen
24. Pathogenesis cont
Necrosis in tuberculosis tend to be
incomplete resulting in solid or semisolid
acellular and amorphous material known
as caseous necrosis
The chemical environment and low
oxygen tension inhibit microbial
multiplication
The primary site of infection in the lungs
is called the Ghon focus, and is generally
located in either the upper part of the
lower lobe, or the lower part of the upper
lobe.(commonly at the subpleural)
29. Pathogenesis cont
Macrophages, T lymphocytes, B lymphocytes and
fibroblasts are among the cells that aggregate to form a
granuloma, with lymphocytes surrounding the infected
macrophages.
30. Pathogenesis cont
The granuloma functions not only to prevent
dissemination of the mycobacteria, but also
provides a local environment for communication
of cells of the immune system.
Within the granuloma, T lymphocytes secrete
cytokines such as interferon gamma, which
activates macrophages to destroy the bacteria
with which they are infected.
Cytotoxic T cells can also directly kill infected
cells, by secreting perforin and granulysin.
Mycobacteria are not always eliminated within the
granuloma, but can become dormant, resulting in
a latent infection.
31. Pathogenesis cont
Another feature of the granulomas of human
tuberculosis is the development of cell death,
also called necrosis, in the center of
tubercles
To the naked eye this has the texture of soft
white cheese and was termed caseous
necrosis.
If TB bacteria gain entry to the bloodstream
from an area of damaged tissue they spread
through the body and set up many foci of
infection, all appearing as tiny white
tubercles in the tissues.
32.
33. Pathogenesis cont
This severe form of TB disease is most common in
infants and the immunocompromised pts, elderly and is
called miliary tuberculosis.
Patients with this disseminated TB have a fatality rate
of approximately 20%, even with intensive treatment.
Tissue destruction and necrosis are balanced by healing
and fibrosis.
Affected tissue is replaced by scarring and cavities
filled with cheese-like white necrotic material.
During active disease, some of these cavities are joined
to the air passages bronchi and this material can be
coughed up.
34. Natural history
After 5 years 50% of pulmonary disease will die of the
disease.
25% will be self cured(health)
Another 25% will be ill with chronic infectious disease
35. Types of tuberculosis
I. Pulmonary tuberculosis
II. Extra- Pulmonary tuberculosis
Pulmonary tuberculosis
Clinical features
Typical symptoms of pulmonary TB include a
productive cough, fever, and weight loss.
Occasionally, patients may present with
hemoptysis or chest pain.
Other systemic symptoms include anorexia,
fatigue, or night sweats.
36. Extrapulmonary tuberculosis
Tuberculous meningitis
Patients may present with a
headache that is either intermittent
or persistent for 2-3 weeks.
Subtle mental status changes may
progress to coma over a period of
days to weeks.
Fever may be low-grade or absent.
37. Extrapulmonary cont
Skeletal TB
The most common site of involvement is the
spine (Pott disease).
Symptoms include back pain or stiffness.
Lower extremity paralysis occurs in as many as
half the patients with undiagnosed Pott’s
disease.
Tuberculous arthritis usually involves only 1
joint.
Although any joint may be involved, the hip or
the knee is affected most commonly, followed
by the ankle, elbow, wrist, and shoulder.
Pain may precede radiographic changes by
weeks to months.
38. Extrapulmonary cont
Tuberculous lymphadenitis
The most common site is in the
neck along the sternocleidomastoid
muscle.
It usually is unilateral, with little or
no pain.
Advanced disease may suppurate
and form a draining sinus.
39. Gastrointestinal TB
Any site along the gastrointestinal tract may become infected.
Symptoms are referable to the site infected, including the following:
Non healing ulcers of the mouth or anus
Difficulty swallowing with esophageal
disease
Abdominal pain mimicking peptic ulcer
disease with stomach or duodenal infection
Malabsorption with infection of the small
intestine
Pain, diarrhea, or hematochezia with
infection of the colon.
40. Genital urinary TB
Reported symptoms include flank pain,
dysuria, or frequency.
In men, genital TB may manifest as
epididymitis or a scrotal mass.
In women, genital TB may mimic pelvic
inflammatory disease.
TB causes approximately 10% of sterility
in women worldwide and approximately
1% in industrialized countries.
41. Cutaneous TB
Direct inoculation may result in an
ulcer or wartlike lesion.
Contiguous spread from an infected
lymph node typically results in a
draining sinus.
Hematogenous spread may result in
a reddish brown plaque on the face
or extremities (lupus vulgaris) or
tender nodules or abscesses.
43. Diagnosis of TB
The diagnosis of TB starts with proper history and physical examination.
Laboratory examinations
AFB microscopy for sputum and aspirates
Culture - sputum, aspirates for EPT
Histological examination - Biopsy tissue
Gene Xpert (NAA test, RIF/MTB, LPA)
Interferon Gamma Release Assay
Radiological test, although alone NOT reliable
Chest X ray or CT scan
For patients unable to produce any sputum
(eg, children), early morning gastric aspirate
may produce a good specimen.
44. Sputum smear
It is the gold standard investigation for PTB
Standard 2: All patients (adults,
adolescents, and children who are
capable of producing sputum)
suspected of having pulmonary TB
should have at least two, and
preferably three, sputum specimens
obtained for microscopic examination.
When possible, at least one early
morning specimen should be obtained.
45. Sputum smear cont
Direct smears of unconcentrated sputum are common
worldwide
They are fast simple and cheap
Ziehl Neelsen stain with Carbofuschin dye is more
common
47. Chest X ray
People with chest X ray suggestive of PTB should submit their sputum for
microscopy
48. Culture
Available culture methods use either solid or liquid media
A sample of sputum or tissue require initial liquefication
and decontamination
Mostly used is N-acetyl –L-cysteine as a mucolytic in 1% NaCl
This kills other organisms, M.tb are protected by their fatty
acid rich cell wall
The sample is then neutralized, centrifuged and the
sediment is inoculated in the media
Uncontaminated fluid or normally sterile tissues should not
be contaminated as some loss mycobacterial viability
49. Culture cont
Solid culture media are of two general types:
Agar bases e.g Middlebrook 7H11
Egg based e.g Lowenstein Jensen
The BACTEC radiometric system for culturing
mycobacteria
It is a liquid system which uses radioactive
palmitate as a sole carbon source
Inclusion of p-nitro-alpha-acetylamino- -
hydroxypropiophenone in the incubation media
inhibit the growth of M.Tb complex (including M.
bovis and M. africunum
But does not inhibit mycobacteria other than
tuberculosis
50. Pleural, cerebrospinal, peritoneal, and pericardial fluids
should be analyzed for protein and glucose (compared
with simultaneous blood glucose).
Cell and differential counts should be obtained.
A high protein (> 50% of the serum protein
concentration), lymphocytosis, and a low glucose are
usually found in tuberculous infections, but neither
their presence nor their absence is diagnostic.
For pleural tuberculosis the diagnostic yield can be
increased by obtaining pleural tissue for histologic study
and culture by needle biopsy at the time of diagnostic
thoracentesis.
Peritoneal biopsies are best obtained via laparoscopy.
51. Mantoux tuberculine skin test
Used for screening especially for children
Can also be used for high risk individuals
A purified protein derivative is injected intradermal in
the forearm (0.1ml)
The induration is read after 48 to 72 hrs
Induration > 10mm in children less than 4 yrs a/c risk of
disemminated disease
Induration >15mm in children more than 4 yrs is also
significant
52. False positive TST
Prior infections/exposures to non tuberculous
mycobacterium
Recent BCG vaccination
53. TB AND HIV
TB is the third highest cause of
morbidity and mortality in Tanzania
after HIV/AIDS and malaria
Immune compromised people are
very prone to develop TB, including
PLHIV
TB is the leading cause of death for
PLHIV
HIV frequently co-exists with TB
54. TB AND HIV
14 million people are co-infected world wide
9% of TB cases are attributable to HIV world wide
Infection after exposure10-20% vs
5,10%
Progressive primary disease after
infection 30% vs 5 -10%
Reactivation of latent infection 5-
10% annual vs 5-10% lifetime
55. TB in HIV Infection
In pre HIV era 80-85% of TB infection presented as PTB.
Up to 15% as EPTB
5% mixture of PTB and EPTB
While in HIV era 60-70% PTB,while EPTB 50-60%
PTB presentation depends on HIV progression
In low CD4 PTB presents with high fever,dyspnoea and
wt loss
In low CD4 sputum smear often –ve,no typical chest x
ray findings of PTB(cavitation or infiltates in lung apex)
56.
57. Treatment of tuberculosis
It is important with the aim of curing the patient and
preventing the spread of the disease to the community.
Case definition in TB treatment
New case: a patient who has never had treatment for
TB before or has been on treatment for not more than 4
weeks
Relapse: a patient declared cured or treatment
completed who reports back to health services and is
found to be AFB positive
Failure: a patient who, while on treatment, is AFB
positive at 5-months or later during the course of
treatment
58. Case definition cont
Return after default: a patient who returns to
treatment bacteriological positive, after having
interrupted treatment for 2-months or more and who
had been on RX for more than 4 weeks
Transfer-in: a registered TB patient on Rx received
from another region
Other: any TB patient who does not fit in one of the
above definitions
59. TB treatment regimen
There are two TB treatment phases: initial phase
(intensive) and continuation phase
During initial phase:
There is rapid killing of the TB bacilli
Initial phase takes 2months with 4 drugs
Patients mostly become non-infectious after about 2
weeks
During continuation phase:
Drugs kill the persisters
Prevent relapse after completion of treatment
Continuous phase takes 2 drugs for 4 or 6 months
60. Treatment regimen cont
1st line drugs-
isoniazid,rifampicin,rifapentine,rifabutin,ethambutol
and pyrazinamide
2nd line drugs –
cycloserine,ethionamide,levofloxacine,moxifloxacin,gat
ifloxacine,P aminosalicylic
acid,streptomycin,amikacin/kanamycin,capreomycin
62. Reasons for combination
therapy
the biological different populations of
the bacteria needs specific metabolic
acting drugs.
combination therapy reduces resistance.
In each population there are spontaneous
mutations of resistant bacteria which
would be selected under inadequate
therapy.
combination therapy reduces the toxicity
of the different substances.
63. Side effects of first line ant
tuberculosis drugs
Isoniazid:-mild LFT elevation or hepatitis-
peripheral neuritis-hypersensitivity
Rifampin:-orange colored secretions-
hepatitis or thrombocytopenia-OCP may
be ineffective
Pyrazinamide-hepatotoxicity-
hyperuricemia
Ethambutol-optic neuritis (usually
reversible)-decreased red-green color
discrimination-GI tract disturbances-
hypersensitivity
64. Treatment of extrapulmonary
TB
Most of extrapulmonary TB can be treated for 6
months,except TB of bone and joints can be treated for
6 to 9 months,Tb meningitis for 9 to 12 months.
65. Drug Resistant TB
This is a form of TB in which first-line anti-TB drugs have little or
no effect against M. tuberculosis. The diagnosis is confirmed
through molecular tests and culture and DST of M.
tuberculosis strains.
Four different categories of drug resistance have been identified:
• Mono resistant TB: Resistance to any single first-line anti-TB
drug.
• MDR TB: Resistance to at least both isoniazid and rifampicin.
• XDR TB: This is multidrug resistance, with additional resistance
to any fluoroquinolones (ofloxacin, levofloxacin, moxifloxacin)
and at least one of the three injectable drugs (amikacin,
kanamycin, capreomycin).
66. TB drug resistance
Multidrug resistance(MDR-TB)-resistance to at least
Isoniazid and Rifampicin.
It is a man made phenomenon due to inadequate
treatment regimen or poor adherence to treatment
It common to people with HIV and Tb coinfection
It causes pts to use 2nd line drugs with longer treatment
duration,more toxicity and expensive
67. Former MDR TB REGIMENS TANZANIA
Group Drugs
Group A – Fluoroquinolones Levofloxacin (Lfx), Moxifloxacin (Mfx),
Group B – Injectable agents Kanamycin (Km), Amikacin (Am) ; Capreomycin (Cm)
Group C – Other core second-line
agents
Ethionamide (Eto), Protionamide (Pto), Cycloserine (Cs), Linezolid (Lzd),
Clofazimine (Cfz)
Group D - Add-on agents
(not part of the core MDR-
TB regimen)
D1 Pyrazinamide (Z), Ethambutol (E),
High-dose isoniazid (Hh)
D2 Bedaquiline (Bdq), Delamanid (Dlm)
D3 p-aminosalicylic acid (PAS)
Amoxicillin-clavulanate (Amx-Cl)
Grouping of anti-TB agents used to treat DR-TB
68. Former MDR TB REGIMENS TANZANIA (phasing out)
Standardised short regimen
4-6 Km, Mfx, Pto, Cfz, E, Z, H(h)
5 Mfx Cfz E Z
Individualized Long MDR TB Regimen;
MDR TB
8 Km/Cm, Cs, Lfx, Eto, Z,
12 Cs, Eto, Z, Lfx
Individualized Long MDR TB Regimen;
XDR TB
12Cm Lfx, Bdq, Dlm6 , Lzd, Cfz, PAS.
12 Lfx, Lzd, Cfz, PAS
❑DR-TB is generally treatable, however,
extensive treatment - 9 months up to
24 months
❑Using eligibility criteria patients can be
started on;
• Standardized shorter regimen (9-11
months)
• Individuslized Long regimen (20
months) - MDR-TB patients
• Individualised Long regimen (24
months) - XDR-TB patients
69. SECOND LINE ANTI TB MEDICINES STOCKS
Currently existing stock of recommended second line drugs and MOS
Group A SOH MOS Group B SOH MOS Group C SOH MOS
Lfx 500mg 65,800 7 Cfz 100mg 50,000 4 E 400mg 100,800 8
Bdq 100mg 22,550 12 Cs 250mg 0 - Dlm 50mg 2,016
Lzd 600mg 23,050 12 Z 500mg 443,520 11
PASER 1,2600 7
ETO 250mg 28,400 2
PTO 184,400 5
70. Proposed regimens - Tanzania
1. Long regimen adults (routine)
6 Lfx - Bdq - Lzd - Cfz – Cs / 12 Lfx - Cfz - Cs
Substitute; E, Eto, PAS, Z, Dlm
2. Short regimen adults (Operational Research);
6 Bdq – Lzd – Lfx – Cfz – Cs – Z / 3-5 Lfx – Cfz – Cs – Z
6 Bdq – Dlm– Lfx – Cfz – Cs – Z / 3-5 Lfx – Cfz – Cs – Z
3. Short Regimen children (routine)
6 Lfx – Bdq – Lzd – Cs / 3 Lfx – Lzd – Cs
Substitute; PAS, Dlm, E, Eto, Z, Mfx
BQD not used for children <6yrs, Delanamid <3yrs
Treatment prolonged (12-15 mths)in selected cases ; meningitis, TB bone, Spine
72. Extensive drug resistance TB
It is MDR plus resistance to floroquinolones and one of
the 3 second line
injectables.kanamycin,amikacin,capreomycin
South Africa has reported the number of XDR-TB
It is common in HIV pts
98% dies with an avarage of 25 days since admission
74. Anti-TB resistance
Primary drug-resistance: “New Cases”
Drug resistance in a patient who has never
been treated for tuberculosis or received
less than one month of therapy
Secondary (acquired) drug-resistance:
“Previously Treated Cases”
Drug resistance in a patient who has
received at least one month of anti-TB
therapy
75. Prophylaxis and vaccination
All infant born to smear +ve mother are
given INH 5mg/kg for six months.
Isoniazid Preventive Therapy (IPT)
Can be given to people with HIV who have a high TB risk and
have been screened to exclude active TB
Adults: 300 mg daily for 6 to 9 months
76. vaccination
Many countries use Bacillus Calmette-Guérin (BCG)
vaccine as part of their TB control programs, especially
for infants.
The protective efficacy of BCG for preventing serious
forms of TB (e.g. meningitis) in children is greater than
80%
77. references
Principles and practice of infectious diseaes 4th ed by
Mandell L et al.
Medical microbiology 19th ed by Jawetz et al.
Harrison’s Principles of Internal medicine 16th ed by
Kasper et al.
National guideline for management of HIV and TB latest
edition.