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TB_HIV_UNC_Mar2010

TB_HIV_UNC_Mar2010 - TB and HIV Co-Infection A Deadly Duo...

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TB and HIV Co-Infection: A Deadly Duo Carol D. Hamilton, MD, MHS Senior Scientist, Family Health International Professor of Medicine, Duke University
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Why does Tuberculosis STILL Plague the World? We KNOW a LOT about TB! We know the cause We have drugs to cure TB We know what TB “looks like” 50% fatality rate without treatment Motivation for treatment should be high TB vaccine (BCG vaccine) is the most commonly administered vaccine in the WORLD
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Why does Tuberculosis STILL Plague the World? TB 101 – what we know
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Basics of Tuberculosis (TB) Caused by a bacteria, Mycobacterium tuberculosis (M.Tb) Contagious by respiratory exposure 90% of healthy adults who have TB INFECTION (latent TB) NEVER develop active TB DISEASE Opportunity for prevention intervention
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Tuberculosis: Caused by a Bacteria •Bacteria, Mycobacterium tuberculosis •M. Tb can be seen under the microscope •M. Tb can be grown in laboratory, slowly Mycobacterium tuberculosis, cording, fluorescent stain (left); Kinyoun stain (right)
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•1882 Robert Koch announced his discovery of Mycobacterium tuberculosis as the cause of tuberculosis •Aerobic, slow growing bacteria •Koch’s postulates: •Organism cultured from tuberculous patient •Grown in culture •When inoculated in relevant animal model, caused recognizable tuberculous disease Discoveries
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Tuberculosis is Contagious: Respiratory Spread
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Causes Pneumonia in most Adults Coughing: 78-80% Usually chronic, worsening over time Wet, productive, rattling cough Losing weight, no appetite, no energy Fever: 80% night sweats Coughing up blood Chest pain, short of breath Barnes et al, Chest 1988;94:316-320
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Which 10%? Cough! A medicine (Isoniazid) reduces to 1-2% TB Infection 90% of people NEVER get TB
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TB Through History
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Case 1: Ancient 50 year old male From upper middle class family, Peru Cachexia, back pain, increasing LE weakness Preceded by intermittent bouts of “pleurisy” and cough Eventually died without diagnosis or treatment
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Case 1 Mummy from Peru circa 900 AD TB identified, described 1992/4 (Lombardi) PCR identified M.Tb
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Case 2: Pre-TB Chemotherapy 27 yo Caucasian female, London Cough, cachexia, fevers Family history: Mother died weeks earlier “cough, unknown cause” Brother Branwell died with chronic cough and sister Emily both died within preceding year with cachexia, fevers. Diagnosed with “advanced consuption” by Dr.
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