TUBERCULOSIS.pptx888888888888888888888888888888888

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1. TUBERCULOSIS DRUG RESISTANT AND SENSITIVITY INTERNAL MEDICINE Lecturer: Dr Martin

2. INTRODUCTION Tuberculosis (TB) is one of the most prevalent infections of humans and contributes to illness and deaths around the world. It is spread by inhailing tiny droplets of saliva from coughs or sneezes of an infected person. It is a slowly spreading, chronic, granulomatous bacteria infection, characterized by gradual weight loss.

3. DEFINITION Tuberculosis is an infectious disease primarily affecting lung parenchyma is most often caused by mycobacterium Tuberculosis. It may spread to any part of the body including meninges , kidneys, bones. And lymph nodes.

4. RISK FACTORS Close contact with someone who has active TB Immuno compromised status Drug abuse and alcholism People lacking adequate health care Pre existing medical conditions Health care workers

5. CLINICAL MANIFESTATION CONSTITUTIONAL SYMPTOMS Anorexia Low grade fever Night sweats Fatigue Weight loss

6. CONT’ PULMONARY SYMPTOMS Dyspnea Non resolving bronchopneumonia Chest tightness Non productive cough Mucopurulent sputum with haemoptysis Chest pain EXTRA PULMONARY SYMPTOMS Pain Inflammation

7. ASSESSMENT AND DIAGNOSIS History collection Physical exams Clubbing of fingers and toes Swollen or tender lymph nodes in neck and other places Pleural effusion Unusual breath sounds (crackles) IF MILIARY TB Swollen liver Swollen spleen

8. TESTS Biopsy of affected tissue Bronchoscopy Chest X-ray Chest CT scan Quantiferon gold test Sputum examination and culture Thoracocentesis Tuberculosis skin test

9. MEDICAL MANAGEMENT Pulmonary TB is treated primarily with antituberculosis agents for 6-12 months, FIRST LINE MEDICATIONS Streptomycin 15mg/kg/day Isoniazid 5mg/kg (300mg max/day) Rifampicin 10mg/kg/day Pyrazinamide 15-30 mg/kg/day Ethambutol 15-25 mg/kg/day

10. CONT’ SECOND LINE Capreomycin 12-15mg/kg Ethionamide 15mg/kg Para- aminosalycilate sodium 200-300 mg/kg Cycloserine 15mg/kg THIRD LINE Rifambutin Macrolides Linezolid Thioacetazone Thioridazine Arginine

11. MULTIPLE DRUG THERAPY Means taking several antituberculosis drugs at the same time. The standard treatment is to take isoniazid , rifampicin , ethambutol , and pyrazinamide for 2 months. Treatment is then continued for at least 4 months with fewer medications.

12. MULTI DRUG RESISTANT TUBERCULOSIS MDR-TB

13. DEFINITION MDR-TB is caused by strains of mycobacterium tuberculosis resistant to both rifampicin and isomiazid with or without resistance to other drugs. Single isoniazid or rafampicin is not MDR-TB MDR TB is a laboratory diagnosis.

14. BASIC CONCEPT PRIMARY RESISTANCE This occurs when TB patients who has not received any previous treatment become resistant to drugs. SECONDARY RESISTANCE This occurs when a TB patient becomes resistant to drugs because of inappropriate drug use.

15. WHEN TO SUSPECT MDR TB Re-treatment patients who’s sputum smear remains positive after three months of intensive therapy Treatment failure and interruption cases Close contact of MDR TB cases Positive diagnosis with; TB culture and susceptibility testing.

16. EXTENSIVE DRUG RESISTANT TB XDR TB This is a relatively rare type of MDR TB. XDR TB is defined as TB which is resistant to rifampicin and isoniazid , plus resistant to any fluoroquinolones and at least one of the three injectable second line drugs ( ie , amikacin , kanamycin , or capreomycin ).

17. WHY XDR TB A GRAVE CONCERN Because XDR TB is resistant to first line and second line drugs, patients are left with treatment options that are less effective. XDR TB is of special concern for persons with HIV or other conditions that can weaken the immune system.

18. Factors contributing to development and spread of MDR and XDR TB Weak TB programs Low completion/ cure rates Lack of treatment follow up and patient support Unreliable drug support Diagnostic delay Absent or inadequate infection control Uncontrolled use of 2 nd line drugs Fluroquinolones

19. DRUG SENSITIVE TUBERCULOSIS DS TB

20. DRUG SENSITIVE TB This is a case where an infected person is susceptible to all first line anti TB drugs. It means that all the first line drugs will be effective as long as they are taken properly and regularly. This type of TB has the best prognosis and the shortest treatment duration. Patients diagnosed with TB are considered to be drug sensitive, till such time they are detected with resistance to any anti TB drug.

21. Treatment of tuberculosis has two phases The intensive (initial) phase : combination of 3 or more drugs is given for 2months. In the re-treatment regimen it continued for 3 months. This is to decrease the bacterial load and make the patient non-infectious rapidly. Continuation phase : Two or three drugs used for 4 -5 months . This phase follows the intensive phase and the aim is to achieve complete cure.

22. DEFINITION DST is recommended for all new cases for all first line drugs with specimens taken before initial treatment. Accuracy is more important than speed DRUG SUSCEPTIBILITY TESTING Assessment of drug inhibition on solid media containing various dilutions of the drug, in comparison with the test strains As the method depend on observation of growth, results are not available until several weeks after isolation of the organism.

23. Detection of Rifampicin Drug susceptibility testing is more important Early identification of mycobacterium growth as M tuberculosis complex and the identification of rifampicin resistance should be the first priority as rifampicin resistance invalidates standard 6 month short course therapy and is useful marker in most countries for MDR TB.

24. Secondary drug testing Ofloxacin Ethionamide Kanamycin Capreomycin

25. THANK YOU