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Unformatted text preview: Tuberculosis Tuberculosis Definition of Tuberculosis Definition
Tuberculosis (TB) is a chronic infection Tuberculosis cause by the bacteria Mycobacterium tuberculosis. It usually involves the lungs. tuberculosis. Today tuberculosis tends to be concentrated Today among inner city dwellers, ethnic minorities and recent immigrants from areas of the world where the disease is still common still Tuberculosis Tuberculosis In In 1882 Koch published “ The Etiology of Tuberculosis” and clarified the infectious nature of the disease. nature Because of chronic nature, was widely TB Because believed to be inherited Tuberculosis Tuberculosis 1900 12% of all deaths were due the tuberculosis Most adults in large European cities infected with Miliary Tuberculosis By 1921, a viable attenuated vaccine had been developed by Albert Calmette and Camille Guérin; it protects against severe forms of tuberculosis in newborns but does not prevent pulmonary tuberculosis in adults. 1993 World Health Organization declares tuberculosis a global emergency Tuberculosis Tuberculosis In 1943, The first tuberculostatic drug was developed by Selman Waksman In 1998, the genome of Mycobacterium tuberculosis was sequenced, providing the blueprint for the development of an improved vaccine and new drugs. Tuberculosis Tuberculosis Tuberculosis Tuberculosis can occur anywhere, and no one is exempt from the infection one TB is caused from a germ that is TB transmitted from person to person by airborne droplets airborne It is passed on as a result of very close It contact contact Tuberculosis Tuberculosis Alcoholics, Alcoholics, who are often malnourished, and people infected with HIV, are high risk of developing disease The vast majority of people who have TB The germs in their bodies do not have an active case of the disease active TB in children often occurs with childhood TB diseases diseases Tuberculosis Tuberculosis Although Although the body may harbor the TB bacteria, the immune system can prevent the person from becoming sick. Therefore there is distinction between there TB TB INFECTION: This condition sometimes called latent TB causes no symptoms and is not contagious Active TB: This condition makes you sick, Active spread to others, however the infection may be asymptomatic for years • Symptoms of Tuberculoses Symptoms TB TB mainly effects the lungs and coughing is often the only indication often The The cough last 3 or more weeks and may produce discolored or bloody sputum discolored Unintended weight loss Fatigue Slight fever Night sweats Chills Loss off appetite Pain with breathing or coughing Symptoms of Tuberculoses Symptoms The The first symptoms are common and dismissed as the effect of flu or cold which goes away by itself: itself: Get tired Feel slightly feverish Cough frequently In the people with disease it comes back with: Sharp Fever Loss Loss pain in the chest of appetite Weight loss and night sweats Diagnose of Tuberculosis
A simple skin test is available to detect simple individuals who have been or infected with the TB germ the Infected persons will have a reaction Infected where the skin becomes swollen where A positive reaction to TB test does not positive mean the person is ill or contagious mean 10% of those infected with TB develop 10% disease disease Diagnose of Tuberculosis Diagnose
Often TB is diagnosed with a simple skin test, but other testing options Often are available. are Mantoux test is more accurate, a small amount of a substance called PPD tuberculin is injected within the skin of your inside forearm A blood test Called QuantiFeron-TB Gold (QFT) QuantiFeron-TB Microscopic-observation drug-susceptibility (MODS) assay and relies on sputum samples Chest X-ray Culture tests. Treatment of Tuberculosis Treatment
With treatment the chances of good With recovery is good recovery Several treatment protocol are in wide use Several by specialist but generally share three principles principles
The The regimen must include several drugs to which the organisms are susceptible the The patient must take medication a regular basis Therapy must continue for sufficient time Therapy Treatment Treatment Treating TB infection preventive preventive drug therapy to destroy dormant bacteria that might become active in the future might a daily dose of the TB medication isoniazid (INH) for 6 daily months. To decrease side effect No acetaminophen( tynenol) or alcohol acetaminophen( Treating active TB disease (6-12 month) taking taking four medications - isoniazid, rifampin (Rifadin, Rimactane), ethambutol (Myambutol) and pyrazinamide. Rimactane), Rifapentine (Priftin), which is taken just once a week Rifapentine during the last four months of therapy. during Treatment Treatment The The most common keystones drugs for TB are:
Isoniazid (INH) Rifampin (RIF) Because Because of increasing resistance to these two, the following are added to regimens two,
Pyrazinamide (PZA) Streptomycin sulfate Ethambutol (HCL) • The CDC recommends TB testing for people who Have Have HIV or other condition that puts them at the risk for TB at Live with a person who have active TB Live disease, which can be spread others disease, Inject illegal drugs Born in part of the world where TB is Born common, Latin America, Caribbean, Africa common, Live or work in nursing home, camps, Live prisons, homeless shelters Isolation rooms Isolation Isolation rooms are special negative pressure hospital rooms that keep patients with certain medical conditions separate from other people while they receive medical care Reporting for TB, Local requirements All All cases of TB are reported to the local or state health department, because the disease can spread to others and cause outbreaks. Major health authorities keep track of TB outbreaks and encourage early testing for people who are at risk for developing the disease. Tuberculosis, Few Facts Tuberculosis, Today 2 million deaths annually due to tuberculosis 30% of global population infected with M. tuberculosis 15 million co-infected with HIV and M. tuberculosis 50 million infected with multidrug-resistant M. tuberculosis Unfortunately after a full century, TB remain a major global threat Each year there are more than 8 million new cases and 2 million deaths from Tuberculosis TB Prevention in Mexican Immigrants Immigrants N.R. Kandula, M.S. Dworkin Tuberculosis Prevention in Mexican Immigrants Mexican 2004
Limitations of Short-Course Therapy Limitations Tuberculosis Prevention in Mexican Immigrants Mexican Research Research has been done to describe the feasibility and outcomes of using RIF/PZA for TB prevention during a tuberculosis outbreak in a Mexican immigrant community, community, 23 adults and 11 children were treated 23 with RIF/PZA between August 2001 and October 2001. October Background: Background: Two Two months of Rifampin and Pyrazinamide (RIF/PZA) for tuberculosis prevention has been advocated as a way to improve adherence in mobile populations, such as recent immigrants. However, RIF/PZA requires intensive However, patient and laboratory monitoring for Hepatotoxicity. Hepatotoxicity. METHODES METHODES Retrospective Retrospective chart review and interviews with health department employees were conducted to assess completion rates, hepatotoxicity, cost, and feasibility of monitoring. monitoring. RESULTS RESULTS Ten Ten (91%) children and 13 (57%) adults completed RIF/PZA. One child (9%) and four adults (17%) One developed drug-induced hepatitis. Cultural barriers affected care. The adults Cultural resisted the biweekly blood draw, believing it would “drain them of energy.” RIF/PZA, plus monitoring, was twice as RIF/PZA, costly as 4 months of Rifampin. costly CONCLUSIONS CONCLUSIONS RIF/PZA was associated with: significant hepatotoxicity, poor completion, and poor cultural barriers to monitoring, and cultural was more costly than standard therapy. Tuberculosis Tuberculosis prevention must address potential clinical, cultural, and economic barriers to completion and monitoring of short-course therapy in immigrants. short-course ...
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This note was uploaded on 11/30/2009 for the course HP 400m at USC.