Tuberculosis (TB): clinical background,diagnosis and management

Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as brain, bone, the kidney and. In 2017, the incidence of TB among population in Yemen is 48 cases per 100,000 people.

1. Tuberculosis (TB)
Abdulsalam Halboup
M. Pharm (Clinical)

3. Lect. Outline
Tuberculosis (TB)
Clinical presentation and diagnosis
Treatment
Treating Latent Infection
Treating Active Disease
Drug resistance
Special populations:
Tuberculous Meningitis and Extrapulmonary Disease
Children
Pregnant Women
Renal Failure
Bone TB









TB
Active TB Latent TB

4. Tuberculosis (TB)
•Tuberculosis (TB) :is a communicable infectious disease caused by
Mycobacterium tuberculosis. a rod-shaped thin aerobic bacterium.

•It presents either as LTBI or as progressive active disease.
In 2017, 10.0 million people around the world became sick with TB
disease. There were 1.3 million TB-related deaths worldwide.
in 2016, 10.4 million people are infected and roughly 1.7 million people die Worldwide.
M. tuberculosis is transmitted from person to person by coughing or
sneezing.
Close contacts of TB patients are most likely to become infected.

5. CLINICAL PRESENTATION AND DIAGNOSIS
Clinical presentations of TB
weight loss,
fatigue,
a productive cough, that last more than 3 weeks or longer.
 Low grade fever, and night sweats
Frank hemoptysis
The most widely used screening method for tuberculous infection is
the tuberculin skin test, which uses purified protein derivative (PPD).

6. The Mantoux method of PPD administration consists of the
intracutaneous injection of PPD containing five tuberculin units. The
test is read 48 to 72 hours after injection by measuring the diameter of
the zone of induration.

Some patients may exhibit a positive test 1 week after an initial negative
test; this is referred to as a booster effect.

Confirmatory diagnosis of a clinical suspicion of TB must be made via chest
radiograph and microbiologic examination of sputum smear or other infected
material to rule out active disease.

7. When active TB is suspected, attempts should be made to
 isolate M. tuberculosis from the infected site.
 Daily sputum collection over three consecutive days is
recommended.

Tests to measure release of interferon-γ release assay (IGRA) in the
patient’s blood in response to TB antigens may provide quick (24 hour)
and specific results for identifying M. tuberculosis.

9. TREATMENT
Goals of Treatment:
resolute signs and symptoms
Eradicate pathogen, thus ending isolation,
adherence to the treatment regimen by the patient,
Drug treatment is continued for at least 6 months and up to 2 years for
some cases of multidrug-resistant TB (MDR-TB).

Patients with active disease should be isolated to prevent spread of the
disease.

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12. 
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13. Active TB
Isoniazid
(INH)
Rifampin
(RIF)
Pyrazinamide
(PZA)
Ethambutol
(EMB)
Standard ttt
isoniazid and rifampin for 4 months
(Total duration of treatment is 6 month)
for 2 months
followed by
Initial Phase
Continuation Phase

14. Patients who :
remain culture positive at 2 months of treatment,
 those with cavitary lesions on chest radiograph,
HIV-positive patients

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16. SPECIAL POPULATIONS :
Treatment for extrapulmonary TB is the same as for pulmonary
disease. Patients with CNS TB( Tuberculous Meningitis ) usually are
treated for 12 months.

TB of the bone (TB osteomyelitis) is typically treated for 9 months,
occasionally with surgical debridement.

17. Children:
TB in children may be treated with regimens similar to those
used in adults, although some physicians still prefer to extend
treatment to 9 months.
Pregnant Women:
The usual treatment of pregnant women is isoniazid, rifampin,
and ethambutol for 9 months.
Isoniazid or ethambutol is relatively safe when used during
pregnancy.
Supplementation with B vitamins is particularly important during
pregnancy why ?

18. Rifampin has been rarely associated with birth defects.
Pyrazinamide has not been studied in a large number of pregnant
women, but unreliable information suggests that it may be safe.
Ethionamide may be associated with
premature delivery,
congenital deformities,
Down syndrome

19. Streptomycin has been associated with hearing impairment in the
newborn, including complete deafness and must be reserved for
critical situations where alternatives do not exist.

Cycloserine is not recommended during pregnancy.

Fluoroquinolones should be avoided in pregnancy and during
nursing.

20. Renal Failure:
In nearly all patients, isoniazid and rifampin do not require dose
modifications in renal failure.

Pyrazinamide and ethambutol typically require a reduction in
dosing frequency from daily to three times weekly (Table 49–6).
Drugs need to be given
1)Before or
2)after dialysis?

21. Special Populations
Special
Populations
CNS TB
12 months
TB osteomyelitis
9 months,
soft tissues TB
6 month

TB
in children
6 or 9 month
Pregnant women
9 months

23. Evaluation of therapeutic outcomes and patient monitoring
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