Dr. Nasr Ibrahim Dafalla Ass Prof & Consultant of Clinical Pharmacy

1. Dr. Nasr Ibrahim Dafalla Ass Prof & Consultant of Clinical Pharmacy.

TB is one of most difficult to treat infectious diseases worldwide.

احدى المشاكل الأساسية في علاج مرض السل هي طول مدة العلاج اللازمة للشفاء. يُعتقد أن تعنت المتفطرة السلية (MTB) للقضاء عليها ناتج عن تحقيق الجرثومة لحالة خاملة و لا تتكاثر في المضيف. نظرًا لأن جميع فئات المضادات الحيوية تقريبًا تتطلب تكاثرًا بكتيريًا لعملها، يُعتقد أن الحالة غير المتضاعفة تجعل MTB مقاومة ظاهريًا للمضادات الحيوية المبيدة للجراثيم..

MBT is found most of the times in the lungs?. Qustion.

TB is the infection caused by Mycobacterium Tuberculosis Strict aerobes Acid fast bacteria.

6. [image] MYCOBACTERIUM TUBERCULOSIS (TB) WAXY CELL WALL from MYCOLIC ACID "ACID-FAST" ZIEHL-NEELSEN STAIN -1 BRIGHT RED ROD-SHAPED NEEDS OXYGEN STRICT AEROBES.

From 1953 to 1984= cases ↓5.6% From 1985 to 1992 = cases ↑ 20%.

25,313 cases reported in 1993 Since 1993, cases are steadily declining.

HIV Epidemic Increased immigration from high-prevalence countries.

Transmission of TB in congregate settings (prisons, home care) Deterioration of the public health care infrastructure.

سهولة الانتقال عبر الهواء Spread person to person through airborne particles.

12. Transmission and Pathogenesis of TB.

Caused by Mycobacterium tuberculosis (M. tuberculosis).

Transmission occurs when an infectious person: Coughs, Sneezes, Laughs, Or Sings.

Pulmonary TB occurs in the lungs. It accounts for 85% TB cases Extrapulmonary TB occurs in places other than the lungs, including the:.

Larynx Lymph nodes Brain and spine Kidneys Bones and Joints.

Miliary TB: Deadly type of TB Occurs when tubercle bacilli enter the bloodstream and are carried to all parts of the body.

Miliary TB السل الدخني (الملياري ) هو شكل قاتل محتمل من السل المنتشر عن طريق الدم و الذي يتميز بتكوين ورم حبيبي يشبه بذور الدخن في مختلف الأعضاء.

Extrapulmonary TB patients are Not infectious. 19.

Persons more likely to have been recently infected include Close contacts to persons with infectious TB Skin test converters (within past 2 years) Recent immigrants from TB-endemic areas (within 5 years of arrival to the U.S.) Children ≤ 5 years with a positive TST Residents and employees of high-risk congregate settings (e.g. correctional facilities, homeless shelters, healthcare facilities).

21. Latent TB Infection (LTBI). Occurs when person breathes in bacteria and it reaches the air sacs (alveoli) of lung Immune system keeps bacilli contained and under control.

22. TB Disease. Occurs when immune system cannot keep bacilli contained Bacilli begin to multiply rapidly Person develops TB symptoms.

LTBI vs. TB Disease. LTBI TB Disease Tubercle bacilli in the body TST or QFT-Gold® result usually positive Chest x-ray usually normal Chest x-ray usually abnormal Sputum smears and cultures negative Symptoms smears and cultures positive No symptoms Sputum such as cough, fever, weight, loss Not infectious Often infectious before treatment Not a case of TB A case of TB.

Use Mantoux tuberculin skin test 0.1 mL of 5-TU of purified protein derivative (PPD) solution injected intradermally Use a 27 gauge needle Produce a wheal that is 6-10mm in diameter.

Read within 48-72 hours Measure induration, not erythema Positive reactions can be measured accurately for up to 7 days Negative reactions can be read accurately for only 72 hours.

5 mm of induration is positive in: HIV-infected persons Close contacts to an infectious TB case Persons who have chest x-ray findings consistent with prior untreated TB.

5 mm of induration is positive in: Organ transplant recipients Persons who are immunosuppressed (e.g., those taking the equivalent of >15 mg/d of prednisone for 1 month or those taking TNF-α antagonists).

10 mm induration is positive in: Recent immigrants (within last 5 years) from a high-prevalence country Injection drug users Persons with other high-risk medical conditions.

10 mm induration is positive in: Residents or employees of high-risk congregate settings Mycobacteriology laboratory personnel Children < 4 years of age; infants, children, and adolescents exposed to adults at high risk.

15 mm induration is positive in: Persons with no known risk factors for TB.

A strategy for differentiating between boosted reactions and reactions caused by recent TB infection Use two-step testing for initial (baseline) skin testing of adults who will be re-tested periodically 2nd skin test given 1-3 weeks after baseline.

If the 1st TST is positive, consider the person infected If the 1st TST is negative, administer 2nd TST in 1-3 weeks If the 2nd TST is positive, consider the person infected If the 2nd TST is negative, consider the person uninfected at baseline.

Patients should be considered infectious if they: Are undergoing cough-inducing procedures Have sputum smears positive for acid-fast bacilli (AFB) and: Are not receiving treatment.

Have just started treatment, or Have a poor clinical or bacterial response to treatment Have cavitary disease.

Patients are not considered infectious if they meet all these criteria: Received adequate treatment for 2-3 weeks Favorable clinical response to treatment 3 consecutive negative sputum smears results from sputum collected on different days.

Instruct patient to: Cover mouth when coughing or sneezing Wear mask as instructed Open windows to assure proper ventilation.

Do not go to work or school until instructed by physician Avoid public places Limit visitors Maintain home or hospital isolation as ordered.

38. Evaluation for TB. Medical history Physical examination Mantoux tuberculin skin test Chest x-ray Bacteriologic exam (sputum smear and culture).

Productive prolonged cough* Chest pain* Hemoptysis* Fever and chills Night sweats Fatigue Loss of appetite Weight loss *Commonly seen in cases of pulmonary TB.

Obtain chest x-ray for patients with positive TST results or with symptoms suggestive of TB Abnormal chest x-ray, by itself, cannot confirm the diagnosis of TB but can be used in conjunction with other diagnostic indicators.

Sputum specimens are essential to confirm TB Specimens should be from lung secretions, not saliva Collect 3 specimens on 3 different days Spontaneous morning sputum more desirable than induced specimens Collect sputum before treatment is initiated.

Strongly consider TB in patients with smears containing acid-fast bacilli (AFB) Use subsequent smear examinations to assess patient’s infectiousness and response to treatment.

Used to confirm diagnosis of TB Culture all specimens, even if smear is negative Initial drug isolate should be used to determine drug susceptibility.

Daily Isoniazid therapy for 9 months Monitor patients for signs and symptoms of hepatitis and peripheral neuropathy Alternate regimen – Rifampin for 4 months.

Include four 1st-line drugs in initial regimen Isoniazid (INH) Rifampin (RIF) Pyrazinamide (PZA) Ethambutol (EMB).

Adjust regimen when drug susceptibility results become available or if patient has difficulty with any of the medications Never add a single drug to a failing regimen Promote adherence and ensure treatment completion.

Health care worker watches patient swallow each dose of medication DOT is the best way to ensure adherence Should be used with all intermittent regimens Reduces relapse of TB disease and acquired drug resistance.

Instruct patients taking TB medications to immediately report the following: Rash Nausea, loss of appetite, vomiting, abdominal pain Persistently dark urine Fatigue or weakness Persistent numbness in hands or feet.

Primary - infection with a strain of M. tuberculosis that is already resistant to one or more drugs Acquired - infection with a strain of M. tuberculosis that becomes drug resistant due to inappropriate or inadequate treatment.

Stigma Extensive duration of treatment Adverse reactions to medications Concerns of toxicity Lack of knowledge about TB and its treatment.