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Topic 17 - Tuberculosis 1 1 History of TB In developed...

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Topic 17 1 17. Tuberculosis: 1. History of TB: In developed countries, as living conditions improved, the incidence of tuberculosis began to decline for the following reasons: Discovery of a cure in the 1950s Development of inexpensive screening tests (skin tests & chest X-rays) Public health programs aimed at eliminating TB were initiated and aggressively pursued Widespread screening of population identified with the disease A person diagnosed was required by law to take treatment In developing countries, Tb remains a major cause of death because: Poor living conditions reporting of cases and deaths in developing countries is incomplete poor patient compliance with therapy failure to carefully control drug supplies and therapy emergence of drug-resistant organisms Reasons number of new cases continued to increase in the U.S and Europe: In the 1970s, most of the anti-TB programs were dismantled and funds were redirected. Increase of immigrants coming to the U.S from areas with TB endemic Transmission of TB in congregate settings, correctional facilities, and homeless shelters The association of TB with AIDS epidemic Deterioration of Healthcare infrastructure Development of multi-resistant strains and lack of development of new drugs by pharmaceutical community 2. Unique cell wall: The cell wall of mycobacterium consists not only of peptidoglycan but also of a number of unusual glycolipids including mycolic acid, lipoarabinomannan (LAM), and arabinogalactan- lipid complex. Unique cell wall makes the organisms resistant to effects of phagolysomal contents and to environment chemical agents and drying. Acid fast refers to the cell’s resistance to decolorization with 3% hydrochloric acid and 95% alcohol once it is stained by treatment with red dye and steam. The cell wall property that accounts for this is the high concentration of lipids. 3. Freud’s complete adjuvant: an antigen solution that is safe and effective in stimulating cell-mediated immunity and may lead to the potentiation of the production of certain immunoglobulins >>(not relevant for TB). The adjuvant for TB contains mycobacterial cell components that are highly stimulatory to the mammalian immune system.
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