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Tuberculosis
- 1. MD DANISH RIZVI DEPT.COMMUNITY MD DANISH RIZVI
- 2. Definition 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 : - Round nodule/Swelling - Condition “Tubercle” “Osis” MD DANISH RIZVI
- 3. Causative Organisms Mycobacterium tuberculosis Human MycobacteriumBovis Animals MD DANISH RIZVI
- 4. Other causative organisms Mycobacterium africanum Mycobacterium microti Non-Mycobacterium Genus Mycobacterium leprae Mycobacterium avium Mycobacteriumasiaticum M. africanum M. Bovis M. Canetti M. microti M. tuberculosis complex MD DANISH RIZVI
- 5. Discovered in1882 by RobertKoch. MD DANISH RIZVI
- 6. Classification Pulmonary TB - PrimaryDisease - Secondary Disease 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 MD DANISH RIZVI
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- 8. In 2011,therewereanestimated 8.7million incidence cases of TB globally. Its equivalent to 125 cases in 1,00,000population. Asian : African : 59% 26% Eastern Mediterranean Region: 7.7% The European Region : 4.3% Region of theAmerica : 3% MD DANISH RIZVI
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- 11. Incidence of Tuberculosis MDDANISH RIZVI
- 12. Spread of Tuberculosis MDDANISH RIZVI
- 13. Severe Symptoms Persistentcough Chest pain Coughingwith bloodysputum Shortness of breath Urine discoloration Cloudy & reddish urine Fever with chills. Fatigue MD DANISH RIZVI
- 14. Based on typesof TB MD DANISH RIZVI
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- 16. Types 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. 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. MD DANISH RIZVI
- 17. B} Extra PulmonaryTB :- 20% of patients of TB Patient Affected sites in body are :- 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 PrimaryTB and results from penetration of tubercle bacilli intopleural space. MD DANISH RIZVI
- 18. 3) TB ofUpper airways:- Involvement of larynx, pharynx and epiglottis. Symptoms :- Dysphagia, chronic productive cough 4) Genitourinary TB :- • 15% of all Extra pulmonary cases. • Any part of the genitourinary tract get infected. • Symptoms :- Urinary frequency, Dysuria, Hematuria. 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, diarrhea, weight loss MD DANISH RIZVI
- 19. 7) TB Meningitis& Tuberculoma :- 5% of All Extra pulmonaryTB Results from Hematogenous spead of 10 & 20 TB. 8) TB Pericardiatis :- • 1- 8% of All Extra pulmonary TBcases. • Spreads mainly in mediastinal or hilarnodes or from lungs. 9) Miliary or disseminated TB:- • Results from Hematogenous spread of TubercleBacilli. •Spread isdue toentry of infection into pulmonaryvein producing lesions in different extra pulmonarysites. 10) Less common Extra PulmonaryTB uveitis, panophthalmitis, painfull Hypersensitivity related phlyctenularconjuctivis. MD DANISH RIZVI
- 20. Diagnosis 1.Bacteriological test: a. Zeihl-Neelsenstain b. Auramine stain(fluorescence microscopy) 2. Sputum culturetest: a. Lowenstein –Jensen(LJ) solid medium: 4-18 weeks b. Liquid medium : 8-14 days c. Agar medium : 7 to 14days MD DANISH RIZVI
- 21. 3.Radiography: Chest X-Ray(CXR) 4.Nucleic acidamplification: Species identification ; several hours Low sensitivity, high cost Most useful for the rapid confirmation of tuberculosis in persons with AFB-positive sputa Utility AFB-negative pulmonary tuberculosis Extra pulmonary tuberculosis MD DANISH RIZVI
- 22. 5.Tuberculin skin test(PPD) Injection of fluid into the skin of the lower arm. 48-72 hours later – checked for a reaction. Diagnosis is based on the size of the wheal. 1 dose = 0.1 ml contains0.04µg Tuberculin PPD. MD DANISH RIZVI
- 23. Tuberculin test interpretation MDDANISH RIZVI
- 24. Pathogenesis of tuberculintest MD DANISH RIZVI
- 25. 6. Other biologicalexaminations Cell count(lymphocytes) Protein(Pandy and Rivalta tests) – Ascites,pleural effusion and meningitis. MD DANISH RIZVI
- 26. Preventive measures 1) Mask 2)BCG vaccine 3) Regular medical follow up 4) Isolation of Patient 5) Ventilation 6) Natural sunlight 7) UV germicidal irradiation MD DANISH RIZVI
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- 28. BCG vaccine BacilleCalmette Guerin(BCG). First used in 1921. Onlyvaccine available today forprotectionagainst tuberculosis. It is mosteffective in protecting children from thedisease. Given 0.1 ml intradermally. Duration of Protection 15 to 20years Efficacy 0 to80%. Should begiven toall healthy infantsas soonas possibleafterbirth unless thechild presented with symptomatic HIV infection. MD DANISH RIZVI
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- 30. Drugs MOA Diagram IsoniazidInhibits mycolic acidsynthesis. RIFAMPICIN Blocks RNA synthesis by blocking DNA dependent RNA polymerase PYRAZINAMIDE •Bactericidal-slowly metabolizing organism within acidic environment of Phagocyte or caseous granuloma. MD DANISH RIZVI
- 31. Drugs MOA Diagram ETHAMBUTOL•Bacteriostatic •Inhibition of Arabinosyl Transferase STREPTOMYCIN •Inhibition of Protein synthesis by disruption of ribosomal function MD DANISH RIZVI
- 32. ADRs and itsManagement MD DANISH RIZVI
- 33. Dosage regimen Intensivephase + continuationphase HREZ (2 months) + HRE (4 months) MD DANISH RIZVI
- 34. Treatment regimen accordingto WHO ISONIAZID (H) RIFAMPICIN (R) PYRAZINAMIDE (Z) ETHAMBUTOL (E) STREPTOMYCIN (S) MD DANISH RIZVI
- 35. DOTS DOTS - Directlyobserved treatment,short-course DOT means that a trained health care worker or other designated individual provides the prescribed TB drugsand watches the patient swallow everydose. MD DANISH RIZVI
- 36. Multi-Drug Resistance TB TBcaused bystrains of Mycobacterium tuberculosis that are resistant toat least isoniazid and rifampicin, the most effective anti- TBdrug. Globally, 3.6% are estimated to haveMDR-TB. Almost 50% of MDR-TB cases worldwideare estimated to occur in China andIndia. MD DANISH RIZVI
- 37. MDR-TB among newTB cases MD DANISH RIZVI
- 38. MDR-TB in previouslytreated cases MD DANISH RIZVI
- 39. Extensively drug resistanceTB Extensively drug-resistant TB (XDR-TB) is aform of TB caused by bacteria that are resistant to isoniazid and rifampicin (i.e. MDR-TB) as well asany fluoroquinolone and any of the second-line anti-TB injectable drugs (amikacin, kanamycin orcapreomycin). MD DANISH RIZVI
- 40. Tuberculosis and HIV Worldwidethe numberof people infected with both HIV and TB isrising. The HIV virusdamages the body’s immunesystemand accelerates the speed at which TB progresses from a harmless infection toa life threatening condition. Theestimated 10% activationof dormantTB infection overthe life span of an infected person, is increased to 10% activation in one year, if HIV infection is superimposed. It is theopputunistic infection that most frequently kills HIV-positivepeople. MD DANISH RIZVI
- 41. Epidemiological Impact Reactivationof latent infection- People who are infected with both HIV and TB are 25 to 30 times more likely to develop TB again than people only infected with TB. Primary Infection- New tubercular infection in peoplewith HIV can progress toactivediseasevery quickly. Recurring infection- in peoplewhowerecured of TB. MD DANISH RIZVI
- 42. Diagnosis of TBin people with HIV HIV positive people with pulmonary TB may have a higher frequency of having sputum negativesmears. The tuberculin test often fails to work, because the immune system has beendamaged by HIV; It may not even showa responseeven though the person is infected withTB. ChestXraywill show lesscavitation. Casesof Extra pulmonaryTB are morecommon. MD DANISH RIZVI
- 43. Thank you! MD DANISHRIZVI