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Definition
Multisystemic disease caused by various strains
of
mycobacteria,
usually
Mycobacterium
tuberculosis.
Intrapulmonary (85%)
Extrapulmonary - TB lymphadenitis, pleural effusion,
genitourinary, bones/joints, military TB, meningitis
TB
Mycobacterium Tuberculosis
Etiology
Obligate aerobe
nonspore-forming
nonmotile
Rods shaped slender or
slightly curve
size 2-4 m x 0.2-0.5 m
Intaracellular
parasite
(monocyte/macrophaes)
Weak gram postive
Grow slowly (15-20 hrs)
Optimum T : 37 C
The
bacilli
cannot
be
decolorized by acid alcohol;
this characteristic justifies
their classification as acidfast bacilli
Transmission
spread primarily as an airborne
aerosol from an individual who is
in the infectious stage of TB
The following factors help to
determine whether a TB infection
is likely to be transmitted:
1.
2.
3.
4.
Risk Factor
HIV infection
Intravenous (IV) drug abuse
Alcoholism
Diabetes mellitus (3-fold risk increase)
Immunosuppressive therapy
Cancer of the head and neck
Hematologic malignancies
End-stage renal disease
Low body weight - In contrast, obesity in elderly patients has
been associated with a lower risk for active pulmonary TB
Smoking - Smokers who develop TB should be encouraged to
stop smoking to decrease the risk of relapse [24]
Age below 5 years
Pathogenesis
Diagnosis
Clinical
- Sign and symptoms
Radiological (CXR)
Bacteriological evidence (Lab)
Mantoux test
Symptoms
Chest x-ray
Sputum
Specimen collection
Best specimen comes from the lung, cough deeply from the
chest
Saliva or nasal secretions are unsatisfactory
3 sample required : spot morning - spot
Quality of
sputum
% AFB
SALIVA
4.9
SALIVA + MUCUS
7.7
MUCOPURULENT
19.2
PURULENT
39.1
Mantoux test
Suspect PTB
3x AFB sputum
AFB result
+++
++-
AFB result
+ --
AFB result
---
worsenin
g
Improvin
g
3x AFB sputum
AFB result
+++
+++--
AFB result
--CXR
PTB
NOT PTB
Treatment Regimen
New
- Never had treatment for TB or taken anti-TB drug < 1 month
Relapse
- Declared cured > AFB +ve
Failure
- On treatment 5th month AFB still +ve
- On treatmen After 2 month AFB ve > +ve
Default
- Stop taking anti-TB treatment for > 2 month
Chronic
Fail category 2 treatment
2.
.
.
.
.
.
RECOMMENDED ANTITB
DRUGS
DRUG
RECOMMENDED DOSES
Daily
3X a week
Dose
Maximum Dose
Maximum
(range) in in mg
(range) in in mg
mg/kg
mg/kg
body
body
weight
weight
5 (4 - 6)
300
10 (8 - 12)
900
Isoniazid
(H)
Rifampicin 10 (8 - 12)
(R)
Pyrazinami
25 (20 de (Z)
30)
Ethambuto
15 (15 l (E)
20)
600
10 (8 - 12)
600
2000
35 (30
40)*
30 (25
35)* 17
3000*
1600
2400*
Weight
(kg)
Intensive phase (2
month)
Akurit 4
(H 75mg + R 150mg + Z
400mg + E 275mg)
Maintenance phase (4
month)
Akurit Tablet
(H 75mg + R 150mg)
30 - 39
2 tablet daily
2 tablet daily
40 - 54
3 tablet daily
3 tablet daily
55 - 70
4 tablet daily
4 tablet daily
> 70
5 tablet daily
5 tablet daily
Phase
Intensive phase
- In 2 weeks no more transmission
- In 2 months; AFB +ve > -ve
Maintenance phase
- Kill dormant bacteria
- To prevent relapse
Category
Category 1
- 2RHZE/4(RH)3
- New case and extrapulmonary
Category 2
- 2 RHZES/RHZE/5(RHE) 3
- relapse, failure, default
RHZE + 1 month
CURED
Repeat AFB
Previously
AFB ve > +ve
AFB -ve
FAILURE
Continue to
Maintanance
phase
CATEGORY 2
5 MONTH
FAILURE
Repeat AFB
AFB +ve
AFB -ve
Repeat AFB
AFB -ve
RHZE + 1 month
Continue to
Maintanance
phase
Drug Sensitivity
Test
7 MONTH
CHRONIC/ MDR-TB
Repeat AFB
AFB +ve
CURED
AFB -ve
Side effect
Drugs responsible
MINOR
Management
CONT. TB DRUG
Anorexia, nausea,
abdominal pain
H,R,Z
Joint pains
Pyrazinamide
Aspirin or PCM
Burning, numbness
sensation in the
hand/feet
Isoniazide
Pyrodixine 50-75mg
OD
Orange/red urine
Rifampicin
Reassurance.
MAJOR
STOP TB DRUG
Ethambutol
Jaundice, hepatitis
H,R,Z
Rifampicin
H,R,Z,S
TO START OR NOT?
Interruption in intensive phase:
If 14 days, to restart from beginning
i.e. Day 1.
If <14 days, to continue form last dose.
24
TO START OR NOT?
Interruption in maintenance phase:
If interruption occurs after patient receives
80% of total planned doses, treatment may be
stopped if sputum AFB smear was negative at
initial presentation. If sputum AFB smear was
positive, treatment should be continued to
achieve total number of doses.
If total doses <80% & interruption lapse is 2
months, restart treatment from beginning.
If total doses is <80% & interruption lapse is
<2 months, continue treatment from date it
stops to complete full course.
25
EPTB Treatment
Latent TB
Latent TB is defined as infection with Mycobacterium tuberculosis complex,
where the bacteria may be alive but in the state of dormancy and not
currently causing any active disease/symptoms.
Diagnosis
Close contact with Mantoux test > 10mm
no active symptoms
normal CXR
SAFB negative
Referral criteria