Tuberculosis

)

Tuberculosis (TB)(Mycobacterium Tuberculosis

By Muhammad Iqbal

260110142002Tan Mei Lee

260110142014

Epidermiology• WHO declared TB a global emergency in

1993• Worldwide, one third of the population has

been infected M. Tuberculosis• About 8 million people develop disease

every year• It kills more than 3 million people annual.

Yet is completely curable and (relatively) inexpensive to cure

• Countries : Africa, China, India, Indonesia, Pakistan, Russia

Etiology

• TB is caused by an organism called Mycobacterium tuberculosis (tubercle bacilli) that spread from person to person through air

• Some characterictics of M. Tuberculosis slightly curved rod shaped bacilli thick lipid cell wall aerobic non- motile multiply / grow slowly ( about every 20

hours)

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.”

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.

Avian which is carried by birds

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.

Bovine tuberculosis is carried by cattle.

PathophysiologyGerms coughed / sneezed ( aerosol through droplet nuclei inborne)

Inhaled organ (person) healthy

Attached to the airway / lung

Located / breed cytoplasm makroflag

Bronchopneumonia develops in the lung tissue

Primary infection (eruption of coughing, formation of lesions)

Respiratory tract inflammation ( Lymphangitis regional )

Primary complex

Recovery Scar heal in a period time Complication

Left :Healthy lungsRight : Lungs infected with Mycobacterium Tuberculosis

General Symptoms

• lack of appetite and weight loss• a high temperature (fever)• night sweats• extreme tiredness or fatigue• Cough ( 2-3 weeks or more )• Cough up blood• Chest pains

However, TB can also cause additional symptoms depending on which part of the body is infected.

TB infection vs. TB disease

• TB infectionTB germs stay in your lungs but do not multiply or make you sick

• TB diseaseTB germs stay in your lungs or move to other parts of your body, multiply and make you sick ( can pass the TB germs to other people )

Pulmonary TB

Most infections affect the lungs, which can cause:• a persistent cough that lasts more than three

weeks and usually brings up phlegm, which may be bloody

• breathlessness that gradually gets worse

Extrapulmonary TBLess commonly, TB infections develop in areas outside the lungs ( patients who infected HIV)

Symptoms of extrapulmonary TB vary, but can include:

• persistently swollen glands• abdominal (tummy) pain• pain and loss of movement in an affected bone or

joint• confusion• a persistent headache• seizures (fits)

Clinical Biochemistry Parameters(Lab scale)

Clinical testPhysical exam → lymph nodes for swelling and use a stethoscope to listen → sounds of lungs

false(+)→ BCG vaccine Skin test false(-) → children, older or AIDS people

Blood test → active tuberculosis Imaging test → CT scan > X-rays (white spot) Rapid sputum (phlegm) test → drug- resistant strains test TB PCR (polymerase chain reaction) test → DNA TB BACTEC test Serology test → IgG antibody

Risk factor• HIV/AIDS• Diabetes• End-stage kidney disease (ESRD)• Certain cancers• Cancer treatment, such as chemotherapy• Drugs to prevent rejection of transplanted

organs• Some drugs used to treat rheumatoid

arthritis, Crohn's disease and psoriasis• Malnutrition• Very young or advanced age

Clinical Manifestation

Relatively large of patients

year Inslusion criteria country Type of medical

center

• AcutePrimary infection

(rapid clinical course)

More common than acute disease

• Subacute• chronic

Treatment- multiply drug therapy

First line medications:Isoniazid

Rifampicin Pyrazinamide

EthambutolStreptomycin

Second line medications:

FluoroquinolonesCycloserineEthionamide

Aminoglycosides p-amino salicylic acid

New TB drugs:(drug-resistant combination treatment)

BedaquilineDelamanid

PA-824LinezolidSutezolid

Side effect:• Nausea or vomiting• Loss of appetite• A yellow color to your skin (jaundice)• Dark urine• A fever that lasts three or more days and has no obvious cause

Treatment periods6-12months

Monitoring

Sputum Test

-examine mucous characteristic of TB -active pulmonary (lung) tuberculosis disease.-regular intervals

Complications-Permanent damage to the lungs-Spread to other organs and organ damage-Development of strains of TB bacteria that are resistant to typical drugs-Death

Side Effect Of Medications

-liver inflammation -changes in vision rarely, kidney or nerve damage

ReferencesDr. V.K Vijayan. 2002. Indian Journal of Clinical Biochemistry Pg96-Pg100. University of Delhi, IndiaJoseph T. Dipiro, Robert L. Talbert, Gary C. Yee, Gary R. Matzke, Barbara G. Wells, L. Michael Posey. 2008. Pharmacotheraphy A Pathopysiologic Approach Ed.7 Pg1839-Pg1843. Mc GrowHill Medical, New YorkM. Monir Madkaur, A. Al Saif, M. Al Sahsed. 2003. Tuberculosis Pg456. Springer Publication. GermanyMartin M. Zdanowicz. 2002. Essential of Pathophysiology of Pharmacy Pg137-Pg138. CRC Press, New YorkV.C Cheng, W.C Yam, F.N Hung, C.Y Woo, K.P Lau, K,Y Yuen. 2004. Journal Clinical Pathology : Clinical evaluation of the polymerase chain reaction for the rapid diagnosis of tuberculosis. US National Library of Medicine National Institute of Health. USAWHO Disease and injury country estimates. World Health Organization. 2004. Retrieved 13 October 2015.