Tuberculosis Treatment Symposia - The CRUDEM Foundation presented in Milot, Haiti at Hôpital Sacré Coeur. CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.

1. Tuberculosis Treatment Greg Schumaker, MD Assistant Professor of Medicine Pulmonary, Critical Care & Sleep Division Tufts Medical Center

7. Progression to TB Disease People Exposed to TB Not TB Infected Latent TB Infection (LTBI) Not Infectious Positive TST or QFT-G test result Latent TB Infection May go on to develop TB disease Not Infectious Negative TST or QFT-G test result No TB Infection

8. LTBI vs. TB Disease Latent TB Infection (LTBI) TB Disease (in the lungs) Inactive , contained tubercle bacilli in the body Active , multiplying tubercle bacilli in the body TST or blood test results usually positive TST or blood test results usually positive Chest x-ray usually normal Chest x-ray usually abnormal Sputum smears and cultures negative Sputum smears and cultures may be positive No symptoms Symptoms such as cough, fever, weight loss Not infectious Often infectious before treatment Not a case of TB A case of TB

9. Diagnosis of Latent TB

25. Treatment of LTBI

27. LTBI Treatment Regimens MMWR/CDC 2003; 52 (No. 31) RIF/ PZA RIF and PZA combinations generally should not be offered for treatment of LTBI

31. Treatment of TB Disease

45. Is specimen collected at end of initial phase (2 months) culture positive? NO YES Place patient on initial-phase regimen: INH, RIF, EMB, PZA for 2 months Give continuation-phase treatment of INH/RIF daily or twice weekly for 4 months Culture-Positive TB Patients CDC High clinical suspicion for active TB

46. Give continuation-phase treatment of INH/RIF daily or twice weekly for 7 months Give continuation- phase treatment of INH/RIF daily or twice weekly for 4 months NO YES Was there cavitation on initial CXR? NO YES Is the patient HIV positive? Culture-Positive TB Patients (Continued) Give continuation- phase treatment of INH/RIF daily for 7 months CDC

55. Common Adverse Reactions to Drug Treatment (1) Caused by Adverse Reaction Signs and Symptoms Any drug Allergy Skin rash Ethambutol Eye damage Blurred or changed vision Changed color vision Isoniazid, Pyrazinamide, or Rifampin Hepatitis Abdominal pain Abnormal liver function test results Fatigue Lack of appetite Nausea Vomiting Yellowish skin or eyes Dark urine

56. Common Adverse Reactions to Drug Treatment (2) Caused by Adverse Reaction Signs and Symptoms Isoniazid Peripheral neuropathy Tingling sensation in hands and feet Pyrazinamide Gastrointestinal intolerance Arthralgia Arthritis Upset stomach, vomiting, lack of appetite Joint aches Increased Uric Acid, Gout (rare) Streptomycin Ear damage Kidney damage Balance problems Hearing loss Ringing in the ears Abnormal kidney function test results

61. Special Treatment Situations