CHAPTER:1 TUBERCULOSIS. BY Mrs. K.SHAILAJA., M. PHARM., LECTURER DEPT OF PHARMACY PRACTICE, SRM COLLEGE OF PHARMACY

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1 CHAPTER:1 TUBERCULOSIS BY Mrs. K.SHAILAJA., M. PHARM., LECTURER DEPT OF PHARMACY PRACTICE, SRM COLLEGE OF PHARMACY

2 GLOBAL EMERGENCY: * Tuberculosis kills 5,000 people a day! * 2.3 million die each year!

3 DISTRIBUTION STATISTICS 1/3 of world s population is infected with TB 8 Million people develop active TB every year TB kills more young women than any other disease More than 100,000 children will die from TB this year Hundreds of thousands of children will become TB orphans

4 * TB is an infectious disease that affects mainly the lungs (pulmonary TB or PTB) but can also attack any part of the body (extra-pulmonary TB or EPTB) * A person with PTB is infectious to others! * TB is an ancient infectious disease caused by Mycobacterium tuberculosis. * It has been known since 1000 B.C., so it not a new disease. Since TB is a disease of respiratory transmission, optimal conditions for transmission include: overcrowding poor personal hygiene poor public hygiene

5 * With the increased incidence of AIDS, TB has become more a problem in the U.S., and the world. * It is currently estimated that 1/2 of the world's population (3.1 billion) is infected with Mycobacterium tuberculosis. *Mycobacterium avium complex is associated with AIDS related TB.

6 TRANSMISSION Pulmonary tuberculosis is a disease of respiratory transmission. Patients with the active disease (bacilli) expel them into the air by: coughing, sneezing, shouting, or any other way that will expel bacilli into the air.

7 * Once inhaled by a tuberculin free person, the bacilli multiply 4-6 weeks and spreads throughout the body. * The bacilli implant in areas of high partial pressure of oxygen: lung renal cortex reticulo endothelial system

8

9 TRANSMISSION Lungs Inhalation of droplet nuclei Coughing: 3000 droplet nuclei/cough Talking: 5 minutes Sneezing: BEST

10 Risk of infection Exposure to TB bacilli Duration of exposure to a person with PTB Intensity of exposure Untreated AFB smear positive PTB cases are the most infectious

11 Risk factors for disease Development of disease depends on individual susceptibility HIV increases the risk of getting TB disease 10% Life time risk of TB in HIV negative 10% Annual risk of TB in HIV positive

12 TB PRESENTATION: TB can present as an active infection with the symptoms of Fever ( evening), sweating Cough (productive) Weight loss Haemoptysis

13 It can be also present as a latent infection with no clinical features in persons with normal immunity, Once the immunity is hampered it gets active as manifest as active tuberculoses. 10% latent infections turns to active TB in non immunocompromised in life time. 10% of turns to active TB in HIV patients each year.

14 Complications Pulmonary TB can cause permanent lung damage if not treated early. Medicines used to treat TB may cause side effects, including liver problems. Other side effects include: Changes in vision Orange- or brown-colored tears and urine Rash A vision test may be done before treatment so your doctor can monitor

15 cervical

16 Supra clavicular

17 Potts spine

18 Axillary tuberculosis

19 DIAGNOSIS: Clinical history Signs of fever, pleural rub, crackles Investigations: Intradermal PPD Mountax test ZN staining PCR DNA probing

20 Tests may include: Biopsy of the affected tissue (rare) Bronchoscopy Chest CT scan Chest x-ray Interferon-gamma blood test such as the QFT-Gold test to test for TB infection Sputum examination and cultures Thoracentesis Tuberculin skin test (also called a PPD test)

21 CLASSIFICATION OF DRUGS 3 Groups depending upon the degree of effectiveness and potential side effects First Line: (Primary agents) are the most effective and have lowest toxicity. Isoniazid, Rifampicin Second Line: Less effective and more toxic effects include (in no particular order): p-amino salicylic acid, Streptomycin, Ethambutol Third Line: are least effective and most toxic. Amikacin, Kanamycin, Capreomycin, Kanamycin, Cycloserine

22 CDC recommended regimes : * Daily 4 drugs INH. RIF, PZA, EMB for 8 weeks followed by INH/RIF or INH/ Rifapentene for 18 weeks. * Daily 4 drug therapy for 2 weeks followed by 2 times per week for 6 weeks with INH/RIF for 18 weeks * Three times weekly 4 drugs for 8 weeks, RIF/INH for 18 weeks. * More prolonged therapy in immunocompromised. * Treatment to be given by DOTS.

23 DRUG INTERACTION: Competition between Isoniazid and Phenytoin (anticonvulsant). They both compete for drug metabolism enzymes. Phenytoin interferes with metabolism of isoniazid by reduction in excretion or enhancement of effect of isoniazid.

24 WARNING! Rifampicin and Isoniazid are the most effective drugs for the treatment of TB. These 2 drugs should never be given alone! They are always used in combination because resistance occurs to one drug alone very rapidly. They are used in combination with each other initially as well as other drugs. Bacilli must become resistant to two drugs in order to remain viable..

25 PREVENTION Early detection Education and screening Engineering controls Personal hygiene and isolation of infected cases.

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