CHAPTER I: INFECTIOUS DISEASES

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1 CHAPTER I: INFECTIOUS DISEASES Pharmacotherapeutics -II Sub:Pharmacotherapeutics -II Code: T Dr.Muralidhar Naidu Pharm.D Assistant Professor Department of Pharm.D Krishna Teja Pharmacy College, Tirupati.

2 Infectious diseases are disorders caused by organisms such as bacteria, viruses, fungi or parasites. Many organisms live in and on our bodies. They're normally harmless or even helpful, but under certain conditions, some organisms may cause disease. Some infectious diseases can be passed from person to person. Some are transmitted by bites from insects or animals. And others are acquired by ingesting contaminated food or water or being exposed to organisms in the environment. Symptoms Each infectious disease has its own specific signs and symptoms. General signs and symptoms common to a number of infectious diseases include: Fever Diarrhea Fatigue Muscle aches Coughing

3 Tuberculosis HIV & AIDS Sexually Transmitted Diseases (STD) Meningitis Endocarditits Respiratory Tract Infection Urinary Tract Infection Gastroenteritis Malaria

4 TUBERCULOSIS

5 Tuberculosis is defined as an infectious disease caused by a bacterium; that most commonly affects the lungs. It can also be a crippling and deadly disease, and is on the rise in both developed and developing worlds. Globally, it is the leading cause of deaths resulting from a single infectious disease. Currently, it kills three million people a year and could claim up to 30 million lives if not controlled. Latent TB - the bacteria remain in the body in an inactive state. They cause no symptoms and are not contagious, but they can become active. Active TB - the bacteria do cause symptoms and can be transmitted to others.

6 Aristotle was the first to say that tuberculosis is an airborne disease able to be passed from one person to another. Although his theory was correct scientists continued to search for different causes and treatment of TB. In 1865 Jean Antoine Villemin, put out the idea that TB was genetically inherited. This gave a sound piece of mind for all, until 1882 when Robert Koch proved her wrong by discovering a round shaped bacterium that was the cause of the disease. This excited the scientific world as it brought the possibility to cure humanity's deadliest enemy.

7 Mycobacterium which is carried by humans. Mycobacterium T.B. can present it self in the human body in different forms effecting any where from the intestines, bones, joints, skin, and the genitourinary, lymphatic, and nervous systems.

8 Avian which is carried by birds transmitted by ingestion and inhalation of aerosolized infectious organisms from feces. Oral ingestion of food and water contaminated with feces is the most common method of infection. Once ingested, the organism spreads throughout the bird's body and is shed in large numbers in the feces. If the bacterium is inhaled, pulmonary lesions and skin invasions may occur transmission of avian TB is from bird to human not from human to human.

9 Bovine tuberculosis is carried by cattle. people contract Bovine TB today,by eating food that has been contaminated by the bacteria or from drinking un-pasteurized milk from cows that are infected with the virus. Bovine TB is most likely going to effect the joints and bones.

10 The primary stage of the disease may be symptom-free, or the individual may experience a flu-like illness. This is called the inactive stage. Within the active stage of the disease, there might be a slight fever, night sweats, weight loss, fatigue. The symptoms my vary depending on what type of tuberculosis you contract.

11 This is an example of tuberculosis of the skin it is normally referred to as Warty T.B. and someone will only contract this type of tuberculosis if they have had prior exposure to tuberculosis.

12 PATHO PHYSIOLOGY

13 When someone comes into contact with tuberculosis or feels as if they become infected by tuberculosis, they should call a doctor and order a skin test. The doctor will inject a small amount of tuberculin under the skin. If a person has been exposed to tuberculosis a swelling will develop around the spot where the skin test is given.

14 If your T.B skin test comes back positive your doctor will take one of several treatments to treat you. Your doctor may prescribe a medicine called isoniazid to prevent the tuberculosis infection from developing into the active disease and making you feel sick. If you contract TB of the abdominal or of the extra- pulmonary you may have the choice of a mainstay therapy that takes a course of 9-12 months in order to complete. Surgery is generally reserved for patients with obstruction of vital organs.

15 Continued No treatment at all since most people develop an immune response and warts go away by themselves. If your warts don't disappear, or if uncomfortable, first-choice remedy should be over-the-counter medication in liquid, gel, pad or ointment form. If over-the-counter treatment fails, your doctor can remove a wart by: freezing it with liquid nitrogen, burning it off with electricity or a laser, excising it (a minor surgical procedure), dissolving it by wrapping it in a plaster patch impregnated with salicylic acid.

16 PHARMACOTHERAPY OF TUBERCULOSIS MANAGEMENT MANAGEMENT OF PULMONARY TUBERCULOSIS (PTB) 6-monthr egimen consisting of 2months of EHRZ (2EHRZ) followed by 4months ofhr(4hr) is recommended for newly-diagnosed PTB Pyridoxine 10-50mg Daily Needs To be added if isoniazid is prescribed. Daily treatment is the preferred regimen. Drug ANTITUBERCULOSIS DOSE Dose (range) in mg/kg body weight Daily Dose (range) in mg/kg body weight 3X a week Dose (range) in mg/kg body weight Dose (range) in mg/kg body weight Isoniazid (H) 5 (4-6) (8-12) 900 Rifampicin (R) 10 (8-12) (8-12) 600 Pyrazinamide (Z) 25 (20-30) (30 40)* 3000* Ethambutol (E) 15 (15-20) (25 35)* 2400* Streptomycin (S) 15 (12-18) (12 18)* 1500* *daily therapy is recommended for intensive phase

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18 MANAGEMENT OF EXTRAPULMONARY TUBERCULOSIS (EPTB) DURATION OF EPTB TREATMENT -NICE RECOMMENDATION MeningealTB 2 months S/EHRZ+10HR* Peripheral lymph node TB should normally be stopped after 6 months Bone & joint TB 6 months Pericardial TB 6 months. Regimen should contain 6 months of rifampicin : 2HRZE/4HR* DurationoftreatmentforTBmeningitisis9-12months&bone&jointTBis9months DURATION OF EPTB TREATMENT -WHO RECOMMENDATION Regimenshouldcontain6monthsofrifampicin:2HRZE/4HR* DurationoftreatmentforTBmeningitisis9-12months&bone&jointTBis9months CORTICOSTEROIDS IN EPTB CorticosteroidtherapymaybenefitpatientswithsomeformsofEPTB. TB PERICARDITIS

19 STANDARD MDR-TB REGIMEN Consist of 4 second-line antitbdrugs that are most likely to be effective in the intensive phase Regimens should include: Fluoroquinolone* Parenteralagent(aminoglycosides) Ethionamide& Either cycloserineor PAS(if cycloserinecannot be used) & Pyrazinamide later-generation fluoroquinolone(e.g. levofloxacin& moxifloxacin) should be used

20 MONITORING Monthly sputum smears & culture suntil smear& culture conversion occur Conversion 2 consecutive negative smears & cultures taken 30 days apart Monthly monitoring by clinician until sputum conversion, then every 2-3 monthly. At each visit, patient sweight & side effects to anti TB drugs should be monitored. DURATION OF TREATMENT Newly MDR-TB (i.e. not previously treated for MDR-TB), a total treatment duration is 20 months for most patients. May be modified according to the response to treatment based on patient s cultures, smears, C-XR & clinical status.

21 What causes TB? Review, Review! bacterium; that most commonly affects the lungs. How many people can it affect if not controlled? three million people How does it spread? airborne disease able to be passed from one person to another Name one type of tuberculosis? Avian, Bovine and Mycobacterium Name two non- physical symptoms of TB. slight fever, night sweats, weight loss, fatigue

22 08 Feb A Brief History of Tuberculosis. NJMS National Tuberculosis Center. 12 Oct 2004 < Tuberculosis (TB). McKinley Health Center. 04 Nov 2004 < About... Bovine Tuberculosis and Whitetail Deer. Indiana State Department of health. 12 Oct 2004 < "Avian Tuberculosis." Avian Biotech. 19 Nov < Pathe, Susan. Telephone interview. 8 Dec Rom, William N., and Stuart M. Garay. Tuberculosis. 2nd ed. Philadelphia: Lippincott Williams & Wilkins, Silverstein, Virginia, and Robert Silverstein. Tuberculosis. Berkeley Heights: Enslow Publishers, Inc., What you need to know about tuberculosis. NYC Department of Health Clinics. 02 Oct 2004 <