The document defines various types of drug-resistant tuberculosis (DR-TB) including mono-resistant TB, poly-resistant TB, multidrug-resistant TB (MDR-TB), extensively drug-resistant TB (XDR-TB), and total drug resistance. It provides details on the mechanisms of drug resistance in M. tuberculosis and factors responsible for the development of drug resistance. Complications of pulmonary TB are described along with diagnostic methods for DR-TB including line probe assays, Xpert MTB/RIF, and liquid culture tests. Special considerations for treating MDR-TB in pregnant or HIV-positive individuals are also outlined.
The document provides an overview of tuberculosis (TB), including its history, transmission, drug resistance, pathogenesis, and progression from latent TB infection to active TB disease. It discusses how TB was historically known as consumption and was a death sentence until discoveries in the 1800s proved it was contagious and identified the causative bacterium. The development of drug treatments in the 1940s-1950s dramatically reduced TB rates, though drug resistance and other factors led to a resurgence in the 1980s. TB spreads via airborne droplets and its pathogenesis involves an initial containment by the immune system that can break down and allow bacterial multiplication and disease. Progression from latent to active TB is more likely in the first two years after infection or
Infection control practices to prevent TB in healthcare workers, Dr. D.J Chri...ohscmcvellore
This document discusses tuberculosis (TB) among healthcare workers. It notes that TB infects one third of the world's population and kills over 2 million people annually. Healthcare workers are at high risk of contracting TB due to exposure to infected patients. A study in India found over 50% of healthcare trainees had latent TB, which increased to over 90% for those with longer exposure. The annual risk of infection for these trainees was 8 times higher than the national average. The document recommends annual TB screening of all healthcare workers and trainees, as well as infection control measures in healthcare settings to reduce transmission. Proper administrative controls, environmental controls, and personal protective equipment can help lower the risk of TB among healthcare workers.
Influenza, commonly known as the flu, is a viral infection that affects the nose, throat, bronchi and occasionally the lungs. Common symptoms include fever, sore throat, muscle pains, coughing and fatigue. The influenza virus is classified into types A, B and C. Types A and B are responsible for seasonal flu epidemics and pandemics. The virus undergoes antigenic drift and shift, requiring new vaccines each year. At risk groups like the elderly are recommended for annual flu vaccination to prevent severe complications.
Meningitis is an inflammation of the meninges, which are the protective membranes that cover the brain and spinal cord. Bacteria can reach the meninges through the bloodstream, direct contact from a site of infection like the sinuses or ears, or iatrogenically through procedures like lumbar puncture. Symptoms include fever, headache, neck stiffness, and altered mental status. Diagnosis involves analyzing cerebrospinal fluid obtained via lumbar puncture for signs of infection like increased white blood cells. The most common causes of bacterial meningitis are Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae.
This document discusses post-COVID 19 syndromes, their features, and management. It covers a wide range of potential sequelae affecting the lungs, heart, brain, kidneys, endocrine system, and other organs. Management involves monitoring for and treating persistent symptoms through specialized post-COVID clinics with a multidisciplinary care approach. Common long-term issues include fatigue, respiratory symptoms, cardiac involvement, neurological or psychiatric symptoms, and general functional decline.
This document summarizes various respiratory pathologies organized into categories including congenital anomalies, infections, obstructive/restrictive diseases, and tumors. Key points include descriptions of common conditions such as emphysema, chronic bronchitis, asthma, and pulmonary embolism. Specific pathological features and classifications are provided for different disease types.
This document provides guidelines for the case definition, triage, and infection control procedures for patients with Middle East Respiratory Syndrome (MERS). It defines suspected, probable and confirmed cases of MERS and outlines the triage process to rapidly identify patients. It also provides recommendations for standard, contact and airborne precautions based on the patient's condition. Personal protective equipment and environmental cleaning procedures are described to prevent the transmission of MERS in healthcare settings.
The document provides an overview of tuberculosis (TB), including its history, transmission, drug resistance, pathogenesis, and progression from latent TB infection to active TB disease. It discusses how TB was historically known as consumption and was a death sentence until discoveries in the 1800s proved it was contagious and identified the causative bacterium. The development of drug treatments in the 1940s-1950s dramatically reduced TB rates, though drug resistance and other factors led to a resurgence in the 1980s. TB spreads via airborne droplets and its pathogenesis involves an initial containment by the immune system that can break down and allow bacterial multiplication and disease. Progression from latent to active TB is more likely in the first two years after infection or
Infection control practices to prevent TB in healthcare workers, Dr. D.J Chri...ohscmcvellore
This document discusses tuberculosis (TB) among healthcare workers. It notes that TB infects one third of the world's population and kills over 2 million people annually. Healthcare workers are at high risk of contracting TB due to exposure to infected patients. A study in India found over 50% of healthcare trainees had latent TB, which increased to over 90% for those with longer exposure. The annual risk of infection for these trainees was 8 times higher than the national average. The document recommends annual TB screening of all healthcare workers and trainees, as well as infection control measures in healthcare settings to reduce transmission. Proper administrative controls, environmental controls, and personal protective equipment can help lower the risk of TB among healthcare workers.
Influenza, commonly known as the flu, is a viral infection that affects the nose, throat, bronchi and occasionally the lungs. Common symptoms include fever, sore throat, muscle pains, coughing and fatigue. The influenza virus is classified into types A, B and C. Types A and B are responsible for seasonal flu epidemics and pandemics. The virus undergoes antigenic drift and shift, requiring new vaccines each year. At risk groups like the elderly are recommended for annual flu vaccination to prevent severe complications.
Meningitis is an inflammation of the meninges, which are the protective membranes that cover the brain and spinal cord. Bacteria can reach the meninges through the bloodstream, direct contact from a site of infection like the sinuses or ears, or iatrogenically through procedures like lumbar puncture. Symptoms include fever, headache, neck stiffness, and altered mental status. Diagnosis involves analyzing cerebrospinal fluid obtained via lumbar puncture for signs of infection like increased white blood cells. The most common causes of bacterial meningitis are Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae.
This document discusses post-COVID 19 syndromes, their features, and management. It covers a wide range of potential sequelae affecting the lungs, heart, brain, kidneys, endocrine system, and other organs. Management involves monitoring for and treating persistent symptoms through specialized post-COVID clinics with a multidisciplinary care approach. Common long-term issues include fatigue, respiratory symptoms, cardiac involvement, neurological or psychiatric symptoms, and general functional decline.
This document summarizes various respiratory pathologies organized into categories including congenital anomalies, infections, obstructive/restrictive diseases, and tumors. Key points include descriptions of common conditions such as emphysema, chronic bronchitis, asthma, and pulmonary embolism. Specific pathological features and classifications are provided for different disease types.
This document provides guidelines for the case definition, triage, and infection control procedures for patients with Middle East Respiratory Syndrome (MERS). It defines suspected, probable and confirmed cases of MERS and outlines the triage process to rapidly identify patients. It also provides recommendations for standard, contact and airborne precautions based on the patient's condition. Personal protective equipment and environmental cleaning procedures are described to prevent the transmission of MERS in healthcare settings.
This document provides information about pneumonia, including its diagnosis and treatment. It discusses:
1. Community-acquired pneumonia is a common disorder that can range from mild to fatal in severity. Mortality rates are under 1% for outpatients but 10-12% for hospitalized patients.
2. Diagnosis involves assessing symptoms like fever, cough, dyspnea, and signs of lung consolidation on exam and chest x-ray. Risk stratification tools like CURB-65 are used to determine need for hospitalization.
3. Treatment depends on severity and involves antibiotics, oxygen supplementation, and management of complications. Goals are to eradicate the pathogen and minimize morbidity.
Tuberculosis is a chronic infectious disease caused by the bacterium Mycobacterium tuberculosis that primarily affects the lungs. It spreads through the air and is one of the top infectious killers worldwide. Those at highest risk include those with weakened immune systems, living in areas with high TB rates, abusing alcohol or tobacco, or living with an infected individual. The bacteria are inhaled, travel to the lungs, and can spread throughout the body. Most infections remain latent without symptoms, but active disease can cause coughing, weight loss, fever and other signs. Diagnosis involves sputum tests, chest imaging and tuberculin skin tests. Treatment requires multiple antibiotic drugs over several months to prevent drug resistance. New vaccines and drug
This document provides an overview of COVID-19, including its aetiology, epidemiology, clinical features, diagnosis, management, and prevention. It describes how COVID-19 is caused by a novel coronavirus, SARS-CoV-2, which likely originated in animals. It summarizes the symptoms of COVID-19 and outlines recommendations for preventing and treating both mild and severe cases. The document also discusses differential diagnoses and provides references for further information.
Classification and prophylactics of tuberculosisALAUF JALALUDEEN
Tuberculosis is a widespread infectious disease caused by mycobacteria that typically affects the lungs. It spreads through airborne droplets when infected people cough, sneeze or speak. Symptoms include fever, night sweats, and weight loss. While most infections are latent and asymptomatic, active disease can be fatal if left untreated. Tuberculosis is treated with a combination of antibiotics taken for at least six months.
Hospital acquired pneumonia remains an important cause of mortality. It includes healthcare associated pneumonia and ventilator associated pneumonia. The document discusses the definition, epidemiology, etiology, pathogenesis, diagnosis and treatment of hospital acquired pneumonia. Effective preventive strategies and prompt initiation of appropriate antibiotic therapy based on local microbiology patterns are important for management.
The document presents information on tuberculosis (TB) including its definition, epidemiology, pathophysiology, risk factors, clinical features, treatment guidelines, and nursing interventions. It provides data on the TB burden in Ethiopia and discusses the country's TB control strategies. The presentation aims to increase understanding of TB for health professionals.
This document compares and contrasts tuberculosis and pneumonia. Both are infectious lung diseases, but tuberculosis is caused by the bacterium Mycobacterium tuberculosis while pneumonia can be caused by bacteria, viruses, or aspiration of material into the lungs. Typical symptoms of tuberculosis include a moderate fever and persistent cough producing sputum, while pneumonia is characterized by a high fever, cough, and chest indrawing. Both diseases require treatment with antibiotics, though tuberculosis requires a multi-drug regimen over several months. Without proper treatment, tuberculosis can be fatal within 5 years while pneumonia is usually treatable with antibiotics within 2-3 weeks.
The document summarizes tuberculosis (TB) pathology. It describes the bacteriology of Mycobacterium tuberculosis and M. bovis, which are common causes of TB. The pathogenesis of TB involves an initial inflammatory response followed by macrophage infiltration and formation of granulomas containing epithelioid cells and Langhans giant cells. TB lesions can be either productive or exudative depending on the organ involved. Microscopic findings include caseous necrosis surrounded by epithelioid and giant cells. TB can spread locally, via lymphatics or bloodstream to cause extrapulmonary or miliary disease. Organ involvement and response depends on factors like bacterial load, host immunity, and previous exposure.
Carlo Urbani was the first to identify SARS as a new and contagious disease while working in Bangkok, Thailand in 2003. His early warning to the WHO helped trigger a large response that likely saved millions. SARS is caused by a coronavirus that leads to respiratory illness. An outbreak between 2002-2003 spread to over 30 countries and caused over 800 deaths. Symptoms include fever and pneumonia. Diagnosis involves testing for the virus or antibodies. Treatment is supportive and isolation is key to prevention.
This document discusses various respiratory tract infections, including upper and lower respiratory tract infections. It covers topics such as otitis media (ear infection), pharyngitis (sore throat), sinusitis, bronchitis, bronchiolitis, and pneumonia. For each condition, it discusses etiology, clinical manifestations, diagnosis, treatment goals, and specific treatment options. Risk factors, pathogenesis, and monitoring of treatment response are also covered for some conditions. The document provides an overview of common respiratory infections seen in clinical practice.
The document discusses lung abscess, defining it as a pus-containing lesion in the lung parenchyma that forms a cavity due to tissue necrosis. It covers the causes, types, pathophysiology, clinical manifestations, diagnostic evaluation, and medical, surgical, and nursing management of lung abscess. Treatment involves long-term antibiotic therapy as well as coughing techniques, chest physiotherapy, nutrition, and possible surgery if antibiotics are ineffective. Nursing care focuses on improving breathing patterns, managing pain and anxiety, and addressing other issues like impaired gas exchange.
Rhinovirus is the most common cause of the common cold, accounting for about half of all cases. It is a non-enveloped virus with a positive-sense RNA genome that primarily infects and replicates in the upper respiratory tract at temperatures between 33-35°C. Rhinovirus binds to ICAM-1 receptors on respiratory cells, triggering an immune response and symptoms like runny nose and cough. There is no vaccine for rhinovirus due to the large number of serotypes, but some antiviral drugs are being researched.
Delamanid for multidrug resistant pulmonary tuberculosisHaroon Rashid
Delamanid is a new drug that inhibits mycolic acid synthesis in Mycobacterium tuberculosis. This randomized controlled trial evaluated the safety and efficacy of Delamanid (100 mg or 200 mg twice daily) plus background regimen compared to placebo plus background regimen in 481 patients with multidrug-resistant pulmonary tuberculosis over 2 months. Patients receiving Delamanid had higher rates of sputum culture conversion at 2 months compared to placebo, indicating Delamanid enhances treatment options for multidrug-resistant tuberculosis. However, the short 2-month treatment period was a limitation.
Meningitis is a severe CNS pathology and early and appropriate intervention is needed to prevent adverse outcome including mortality and long term complications. This presentation focuses on the different types of meningitis and the appropriate management options
Chikungunya- a short PPT.
This tells in brief about the infection.
The neurological complications is the main focus.
The management and other related issues are also discussed.
Meningitis is always cerebrospinal infection. Meningitis is a rare infection that affects the delicate membranes -- called meninges -- that cover the brain and spinal cord.There are several types of this disease, including bacterial, viral, and fungal.
This document discusses definitions of chronic obstructive pulmonary disease (COPD) from various medical organizations over time. It describes COPD as a progressive lung disease characterized by persistent airflow limitation. The definitions have evolved to emphasize COPD as an inflammatory condition caused by long-term exposure to noxious particles or gases. Exacerbations and comorbidities contribute to COPD severity and impact quality of life. The document also contrasts COPD and asthma, noting their different causes, inflammatory profiles, and treatment responses.
This document discusses the principles of managing multidrug-resistant tuberculosis (MDR-TB). It begins by grouping anti-TB drugs into five categories. It then discusses the magnitude of the MDR-TB problem globally and in India. It covers the molecular basis of drug resistance for various first- and second-line drugs. Finally, it outlines the general principles for treating MDR-TB, including using at least four likely effective second-line drugs during the intensive phase, with an injectable, fluoroquinolone, ethionamide/prothionamide, and cycloserine or para-aminosalicylic acid.
This document summarizes Entamoeba histolytica, the causative agent of amoebiasis. It causes infection via fecal-oral transmission or oral sex. Virulence is determined by strain characteristics and host immunity. The parasite infects the intestine, where it may cause lesions and ulceration. It can spread to other organs like the liver to cause abscesses. Liver abscesses typically appear as solitary masses in the right lobe and contain anchovy sauce-like pus. The parasite may also infect the brain, skin or urogenital tract in rare cases.
Influenza viruses are enveloped viruses with segmented, single-stranded RNA genomes that cause influenza in humans and some animals. There are four main types of influenza viruses: A, B, C, and D. Types A and B cause seasonal epidemics in humans. Influenza A viruses bind to host cells using hemagglutinin and release from cells using neuraminidase. They replicate in the nucleus and bud from the cell surface. Seasonal epidemics are driven by antigenic drift, while pandemics arise through antigenic shift. Influenza spreads through respiratory droplets and causes fever, cough, and muscle aches. Diagnosis is through viral culture, rapid tests, or PCR. Vaccination and antiv
The bacteria that cause tuberculosis (TB) can develop resistance to the antimicrobial drugs used to cure the disease. Multidrug-resistant TB (MDR-TB) is TB that does not respond to at least isoniazid and rifampicin, the 2 most powerful anti-TB drugs.
The 2 reasons why multidrug resistance continues to emerge and spread are mismanagement of TB treatment and person-to-person transmission. Most people with TB are cured by a strictly followed, 6-month drug regimen that is provided to patients with support and supervision. Inappropriate or incorrect use of antimicrobial drugs, or use of ineffective formulations of drugs (such as use of single drugs, poor quality medicines or bad storage conditions), and premature treatment interruption can cause drug resistance, which can then be transmitted, especially in crowded settings such as prisons and hospitals.
In some countries, it is becoming increasingly difficult to treat MDR-TB. Treatment options are limited and expensive, recommended medicines are not always available, and patients experience many adverse effects from the drugs. In some cases even more severe drug-resistant TB may develop. Extensively drug-resistant TB, XDR-TB, is a form of multidrug-resistant TB with additional resistance to more anti-TB drugs that therefore responds to even fewer available medicines. It has been reported in 117 countries worldwide.
Drug resistance can be detected using special laboratory tests which test the bacteria for sensitivity to the drugs or detect resistance patterns. These tests can be molecular in type (such as Xpert MTB/RIF) or else culture-based. Molecular techniques can provide results within hours and have been successfully implemented even in low resource settings.
New WHO recommendations aim to speed up detection and improve treatment outcomes for MDR-TB through use of a novel rapid diagnostic test and a shorter, cheaper treatment regimen. At less than US$ 1000 per patient, the new treatment regimen can be completed in 9–12 months. Not only is it less expensive than current regimens, but it is also expected to improve outcomes and potentially decrease deaths due to better adherence to treatment and reduced loss to follow-up.
Solutions to control drug-resistant TB are to:
cure the TB patient the first time around
provide access to diagnosis
ensure adequate infection control in facilities where patients are treated
ensure the appropriate use of recommended second-line drugs.
In 2015, an estimated 480 000 people worldwide developed MDR-TB, and an additional 100 000 people with rifampicin-resistant TB were also newly eligible for MDR-TB treatment. India, China, and the Russian Federation accounted for 45% of the 580 000 cases. It is estimated that about 9.5% of these cases were XDR-TB.
MDR/XDR TB poses a serious global public health threat. MDR TB is resistant to rifampicin and isoniazid, while XDR TB is also resistant to fluoroquinolones and second-line injectable drugs. Factors contributing to drug resistance include improper treatment, non-compliance, and exposure to drug-resistant TB patients. Diagnosis and treatment of drug-resistant TB is challenging due to long turnaround times for drug susceptibility testing and toxic second-line drug regimens of up to 2 years. Proper diagnosis, treatment monitoring, and surgical intervention where needed are critical to control the spread of drug-resistant TB.
This document provides information about pneumonia, including its diagnosis and treatment. It discusses:
1. Community-acquired pneumonia is a common disorder that can range from mild to fatal in severity. Mortality rates are under 1% for outpatients but 10-12% for hospitalized patients.
2. Diagnosis involves assessing symptoms like fever, cough, dyspnea, and signs of lung consolidation on exam and chest x-ray. Risk stratification tools like CURB-65 are used to determine need for hospitalization.
3. Treatment depends on severity and involves antibiotics, oxygen supplementation, and management of complications. Goals are to eradicate the pathogen and minimize morbidity.
Tuberculosis is a chronic infectious disease caused by the bacterium Mycobacterium tuberculosis that primarily affects the lungs. It spreads through the air and is one of the top infectious killers worldwide. Those at highest risk include those with weakened immune systems, living in areas with high TB rates, abusing alcohol or tobacco, or living with an infected individual. The bacteria are inhaled, travel to the lungs, and can spread throughout the body. Most infections remain latent without symptoms, but active disease can cause coughing, weight loss, fever and other signs. Diagnosis involves sputum tests, chest imaging and tuberculin skin tests. Treatment requires multiple antibiotic drugs over several months to prevent drug resistance. New vaccines and drug
This document provides an overview of COVID-19, including its aetiology, epidemiology, clinical features, diagnosis, management, and prevention. It describes how COVID-19 is caused by a novel coronavirus, SARS-CoV-2, which likely originated in animals. It summarizes the symptoms of COVID-19 and outlines recommendations for preventing and treating both mild and severe cases. The document also discusses differential diagnoses and provides references for further information.
Classification and prophylactics of tuberculosisALAUF JALALUDEEN
Tuberculosis is a widespread infectious disease caused by mycobacteria that typically affects the lungs. It spreads through airborne droplets when infected people cough, sneeze or speak. Symptoms include fever, night sweats, and weight loss. While most infections are latent and asymptomatic, active disease can be fatal if left untreated. Tuberculosis is treated with a combination of antibiotics taken for at least six months.
Hospital acquired pneumonia remains an important cause of mortality. It includes healthcare associated pneumonia and ventilator associated pneumonia. The document discusses the definition, epidemiology, etiology, pathogenesis, diagnosis and treatment of hospital acquired pneumonia. Effective preventive strategies and prompt initiation of appropriate antibiotic therapy based on local microbiology patterns are important for management.
The document presents information on tuberculosis (TB) including its definition, epidemiology, pathophysiology, risk factors, clinical features, treatment guidelines, and nursing interventions. It provides data on the TB burden in Ethiopia and discusses the country's TB control strategies. The presentation aims to increase understanding of TB for health professionals.
This document compares and contrasts tuberculosis and pneumonia. Both are infectious lung diseases, but tuberculosis is caused by the bacterium Mycobacterium tuberculosis while pneumonia can be caused by bacteria, viruses, or aspiration of material into the lungs. Typical symptoms of tuberculosis include a moderate fever and persistent cough producing sputum, while pneumonia is characterized by a high fever, cough, and chest indrawing. Both diseases require treatment with antibiotics, though tuberculosis requires a multi-drug regimen over several months. Without proper treatment, tuberculosis can be fatal within 5 years while pneumonia is usually treatable with antibiotics within 2-3 weeks.
The document summarizes tuberculosis (TB) pathology. It describes the bacteriology of Mycobacterium tuberculosis and M. bovis, which are common causes of TB. The pathogenesis of TB involves an initial inflammatory response followed by macrophage infiltration and formation of granulomas containing epithelioid cells and Langhans giant cells. TB lesions can be either productive or exudative depending on the organ involved. Microscopic findings include caseous necrosis surrounded by epithelioid and giant cells. TB can spread locally, via lymphatics or bloodstream to cause extrapulmonary or miliary disease. Organ involvement and response depends on factors like bacterial load, host immunity, and previous exposure.
Carlo Urbani was the first to identify SARS as a new and contagious disease while working in Bangkok, Thailand in 2003. His early warning to the WHO helped trigger a large response that likely saved millions. SARS is caused by a coronavirus that leads to respiratory illness. An outbreak between 2002-2003 spread to over 30 countries and caused over 800 deaths. Symptoms include fever and pneumonia. Diagnosis involves testing for the virus or antibodies. Treatment is supportive and isolation is key to prevention.
This document discusses various respiratory tract infections, including upper and lower respiratory tract infections. It covers topics such as otitis media (ear infection), pharyngitis (sore throat), sinusitis, bronchitis, bronchiolitis, and pneumonia. For each condition, it discusses etiology, clinical manifestations, diagnosis, treatment goals, and specific treatment options. Risk factors, pathogenesis, and monitoring of treatment response are also covered for some conditions. The document provides an overview of common respiratory infections seen in clinical practice.
The document discusses lung abscess, defining it as a pus-containing lesion in the lung parenchyma that forms a cavity due to tissue necrosis. It covers the causes, types, pathophysiology, clinical manifestations, diagnostic evaluation, and medical, surgical, and nursing management of lung abscess. Treatment involves long-term antibiotic therapy as well as coughing techniques, chest physiotherapy, nutrition, and possible surgery if antibiotics are ineffective. Nursing care focuses on improving breathing patterns, managing pain and anxiety, and addressing other issues like impaired gas exchange.
Rhinovirus is the most common cause of the common cold, accounting for about half of all cases. It is a non-enveloped virus with a positive-sense RNA genome that primarily infects and replicates in the upper respiratory tract at temperatures between 33-35°C. Rhinovirus binds to ICAM-1 receptors on respiratory cells, triggering an immune response and symptoms like runny nose and cough. There is no vaccine for rhinovirus due to the large number of serotypes, but some antiviral drugs are being researched.
Delamanid for multidrug resistant pulmonary tuberculosisHaroon Rashid
Delamanid is a new drug that inhibits mycolic acid synthesis in Mycobacterium tuberculosis. This randomized controlled trial evaluated the safety and efficacy of Delamanid (100 mg or 200 mg twice daily) plus background regimen compared to placebo plus background regimen in 481 patients with multidrug-resistant pulmonary tuberculosis over 2 months. Patients receiving Delamanid had higher rates of sputum culture conversion at 2 months compared to placebo, indicating Delamanid enhances treatment options for multidrug-resistant tuberculosis. However, the short 2-month treatment period was a limitation.
Meningitis is a severe CNS pathology and early and appropriate intervention is needed to prevent adverse outcome including mortality and long term complications. This presentation focuses on the different types of meningitis and the appropriate management options
Chikungunya- a short PPT.
This tells in brief about the infection.
The neurological complications is the main focus.
The management and other related issues are also discussed.
Meningitis is always cerebrospinal infection. Meningitis is a rare infection that affects the delicate membranes -- called meninges -- that cover the brain and spinal cord.There are several types of this disease, including bacterial, viral, and fungal.
This document discusses definitions of chronic obstructive pulmonary disease (COPD) from various medical organizations over time. It describes COPD as a progressive lung disease characterized by persistent airflow limitation. The definitions have evolved to emphasize COPD as an inflammatory condition caused by long-term exposure to noxious particles or gases. Exacerbations and comorbidities contribute to COPD severity and impact quality of life. The document also contrasts COPD and asthma, noting their different causes, inflammatory profiles, and treatment responses.
This document discusses the principles of managing multidrug-resistant tuberculosis (MDR-TB). It begins by grouping anti-TB drugs into five categories. It then discusses the magnitude of the MDR-TB problem globally and in India. It covers the molecular basis of drug resistance for various first- and second-line drugs. Finally, it outlines the general principles for treating MDR-TB, including using at least four likely effective second-line drugs during the intensive phase, with an injectable, fluoroquinolone, ethionamide/prothionamide, and cycloserine or para-aminosalicylic acid.
This document summarizes Entamoeba histolytica, the causative agent of amoebiasis. It causes infection via fecal-oral transmission or oral sex. Virulence is determined by strain characteristics and host immunity. The parasite infects the intestine, where it may cause lesions and ulceration. It can spread to other organs like the liver to cause abscesses. Liver abscesses typically appear as solitary masses in the right lobe and contain anchovy sauce-like pus. The parasite may also infect the brain, skin or urogenital tract in rare cases.
Influenza viruses are enveloped viruses with segmented, single-stranded RNA genomes that cause influenza in humans and some animals. There are four main types of influenza viruses: A, B, C, and D. Types A and B cause seasonal epidemics in humans. Influenza A viruses bind to host cells using hemagglutinin and release from cells using neuraminidase. They replicate in the nucleus and bud from the cell surface. Seasonal epidemics are driven by antigenic drift, while pandemics arise through antigenic shift. Influenza spreads through respiratory droplets and causes fever, cough, and muscle aches. Diagnosis is through viral culture, rapid tests, or PCR. Vaccination and antiv
The bacteria that cause tuberculosis (TB) can develop resistance to the antimicrobial drugs used to cure the disease. Multidrug-resistant TB (MDR-TB) is TB that does not respond to at least isoniazid and rifampicin, the 2 most powerful anti-TB drugs.
The 2 reasons why multidrug resistance continues to emerge and spread are mismanagement of TB treatment and person-to-person transmission. Most people with TB are cured by a strictly followed, 6-month drug regimen that is provided to patients with support and supervision. Inappropriate or incorrect use of antimicrobial drugs, or use of ineffective formulations of drugs (such as use of single drugs, poor quality medicines or bad storage conditions), and premature treatment interruption can cause drug resistance, which can then be transmitted, especially in crowded settings such as prisons and hospitals.
In some countries, it is becoming increasingly difficult to treat MDR-TB. Treatment options are limited and expensive, recommended medicines are not always available, and patients experience many adverse effects from the drugs. In some cases even more severe drug-resistant TB may develop. Extensively drug-resistant TB, XDR-TB, is a form of multidrug-resistant TB with additional resistance to more anti-TB drugs that therefore responds to even fewer available medicines. It has been reported in 117 countries worldwide.
Drug resistance can be detected using special laboratory tests which test the bacteria for sensitivity to the drugs or detect resistance patterns. These tests can be molecular in type (such as Xpert MTB/RIF) or else culture-based. Molecular techniques can provide results within hours and have been successfully implemented even in low resource settings.
New WHO recommendations aim to speed up detection and improve treatment outcomes for MDR-TB through use of a novel rapid diagnostic test and a shorter, cheaper treatment regimen. At less than US$ 1000 per patient, the new treatment regimen can be completed in 9–12 months. Not only is it less expensive than current regimens, but it is also expected to improve outcomes and potentially decrease deaths due to better adherence to treatment and reduced loss to follow-up.
Solutions to control drug-resistant TB are to:
cure the TB patient the first time around
provide access to diagnosis
ensure adequate infection control in facilities where patients are treated
ensure the appropriate use of recommended second-line drugs.
In 2015, an estimated 480 000 people worldwide developed MDR-TB, and an additional 100 000 people with rifampicin-resistant TB were also newly eligible for MDR-TB treatment. India, China, and the Russian Federation accounted for 45% of the 580 000 cases. It is estimated that about 9.5% of these cases were XDR-TB.
MDR/XDR TB poses a serious global public health threat. MDR TB is resistant to rifampicin and isoniazid, while XDR TB is also resistant to fluoroquinolones and second-line injectable drugs. Factors contributing to drug resistance include improper treatment, non-compliance, and exposure to drug-resistant TB patients. Diagnosis and treatment of drug-resistant TB is challenging due to long turnaround times for drug susceptibility testing and toxic second-line drug regimens of up to 2 years. Proper diagnosis, treatment monitoring, and surgical intervention where needed are critical to control the spread of drug-resistant TB.
The document discusses drug resistance mechanisms in Mycobacterium tuberculosis (Mtb) and treatment of drug-resistant tuberculosis (DRTB). It notes that drug resistance can be either intrinsic or acquired through mutations in response to antibiotic selection pressure. Key resistance mechanisms include impermeability of the cell envelope, drug efflux pumps, drug degradation/modification, and drug target modification. Treatment of DRTB involves long-term multidrug regimens and management of psychosocial issues to ensure adherence. Factors such as previous treatment history, resistance profiles, and confirmed drug susceptibility are considered when selecting regimens. Monitoring involves clinical, laboratory, microbiological and radiological assessments.
Drug resistance in Mycobacterium tuberculosis develops through both intrinsic and acquired resistance mechanisms. Intrinsic resistance is due to the structural barriers of the bacterial cell envelope and efflux pumps, while acquired resistance emerges from mutations in genes encoding drug targets or activation in response to antibiotic selection pressure. Effective treatment of drug-resistant TB requires long treatment durations, monitoring of patients for treatment response and side effects, and management of psychosocial issues that can lead to poor treatment adherence.
This document discusses the treatment of tuberculosis (TB). It outlines the main aims of TB treatment as curing TB to prevent morbidity/mortality while also interrupting transmission. Standard regimens involve an intensive bactericidal phase and continuation sterilizing phase. Directly observed treatment, short course (DOTS) involves administering drugs under direct supervision. First-line drugs include isoniazid, rifampicin, pyrazinamide, and ethambutol. Second-line drugs are used to treat drug-resistant TB. Treatment is monitored through smear microscopy and managing drug toxicity. Latent TB, drug-resistant TB, TB/HIV co-infection, and vaccination strategies are also summarized.
DRUG RESISTANT TUBERCULOSIS,DIAGNOSIS AND TREATMENTDr.Lalit Kumar
VERY USEFUL PRESENTATION TO LEARN THE BASICS OF MDR/XDR-TB AS WELL AS THEIR MANAGEMENT.MOST OF THE CONTENT ARE BASED ON THE RNTCP GUIDELINES AND WHO 2013 UPDATE....
Mycobacterium tuberculosis has intrinsic mechanisms that contribute to drug resistance, including an impermeable cell envelope, drug efflux pumps, and ability to degrade or modify drugs. Factors such as previous treatment history, exposure to drug-resistant strains, and socioeconomic conditions can increase risk of developing drug-resistant TB. Effective treatment and infection control measures are needed to prevent transmission and improve outcomes for patients with drug-resistant TB.
This document provides an outline and overview of the management of drug-resistant tuberculosis (DR-TB) using short treatment regimens. It defines various types of drug resistance and discusses the latest WHO recommendations for diagnosing and treating DR-TB/MDR-TB with a shorter 9-12 month regimen. It outlines patient eligibility criteria, subgroups for consideration, monitoring parameters, and concludes with emphasizing the importance of preventing DR-TB through regular, full-duration treatment with direct supervision and health education.
This document provides information on multi-drug resistant tuberculosis (MDR-TB). It discusses the epidemiology and definitions of drug-resistant TB. It describes how to diagnose DR-TB through tests like Xpert MTB/RIF, line probe assay, and culture and drug susceptibility testing. Treatment options for DR-TB are also outlined, including shorter standardized treatment regimens and longer regimens. Criteria for determining appropriate treatment regimens and defining treatment outcomes are also summarized.
MDR in Mycobacterium species by Parth AgarwalParth Agarwal
Introduction to MDR and MDR-TB. Types of MDR, History and Diagnostic methods, Antibiotics used and their Mechanism, Mechanism of resistance towards Antibiotics by the bacteria and Future Technologies
- In high TB burden countries, the rate of drug-resistant TB is higher than in low burden countries. Most DR-TB cases have a history of prior TB treatment. Risk factors include close contact to MDR-TB patients and young age. Poor access to healthcare and alcohol abuse can also increase DR-TB risk.
- DR-TB therapy consists of standard and individualized regimens. The decision depends on previous treatment history, local resistance patterns, patient factors, and proven susceptibility to regimen components. Long treatment durations increase challenges like poor adherence due to side effects and psychosocial issues.
Tuberculosis (TB) is caused by the bacterium Mycobacterium tuberculosis. It typically affects the lungs and can cause symptoms like cough, fever, weight loss, and night sweats. Risk factors include HIV/AIDS, drug use, and other conditions that weaken the immune system. Diagnosis involves tests of sputum, chest x-rays, and tuberculin skin tests. Treatment requires multiple antibiotic drugs taken for 6-9 months. Drug-resistant TB requires specialized treatment with second-line drugs.
This document discusses multi-drug resistant tuberculosis (MDR TB). It begins with an introduction to TB and definitions of key terms like MDR and XDR TB. It then describes first and second line anti-TB drugs, mechanisms of drug resistance, and factors contributing to acquired resistance. The document outlines methods for diagnosing drug resistance including genetic detection and drug sensitivity testing. It concludes with a brief overview of treatment approaches for MDR TB.
This document discusses multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB). It defines MDR-TB as tuberculosis resistant to at least isoniazid and rifampicin, and defines XDR-TB as MDR-TB additionally resistant to fluoroquinolones and injectable second-line drugs. It also discusses mechanisms of drug resistance development, clinical factors promoting resistance, testing methods, categories of antituberculosis drugs, and public health responsibilities regarding treatment and prevention of drug-resistant tuberculosis.
The document discusses the history and status of tuberculosis (TB) and drug-resistant TB globally. It notes that TB remains a major public health problem, with millions of cases and deaths each year. Drug-resistant forms of TB like multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) have emerged due to factors such as inadequate treatment and non-adherence to drug regimens. The development of drug resistance poses a serious challenge to effective TB treatment and control efforts.
The document provides guidelines for the prevention and management of drug resistant tuberculosis (DR-TB) in India. It discusses definitions of various types of DR-TB including multidrug resistant TB (MDR-TB) and extensively drug resistant TB (XDR-TB). It outlines the national strategy for DR-TB which includes expanding access to rapid molecular diagnostic tests, standardized treatment regimens based on drug susceptibility testing, and strengthening programmatic management. The guidelines describe diagnostic algorithms, treatment regimens, follow-up procedures, and outcomes for managing DR-TB cases according to national policies.
Catridge based nucleic acid amplification test(CBNAAT) / RIF assay gene xpert POWER PONT. other normal tests versus CBNAAT. issues for cbnaat by WHO & CONCLUSION.
While the world was focused on covid 19, WHO has made and issued consolidated guidelines making changes in how to prevent, diagnose and treat tuberculosis.
Multi Drug Resistance Assay: A new Dimension for Host Directed therapyCyril Jose
This presentation describes how many developing nations are failing to transcribe WHO guidelines while prescribing Anti-Tb medications. A failure which is observed as MDR.
Ähnlich wie Multi Drug Resistant - Tuberculosis (20)
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central19various
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions.
The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.
Kosmoderma Academy, a leading institution in the field of dermatology and aesthetics, offers comprehensive courses in cosmetology and trichology. Our specialized courses on PRP (Hair), DR+Growth Factor, GFC, and Qr678 are designed to equip practitioners with advanced skills and knowledge to excel in hair restoration and growth treatments.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Osteoporosis - Definition , Evaluation and Management .pdf
Multi Drug Resistant - Tuberculosis
1. DEFINITION
▪ DR-TB is a disease caused by M. tuberculosis
strains resistant to one or more anti-TB drugs.
▪ Mono-resistant:Resistance to a single 1st line
anti TB drug
▪ Poly-resistant:Resistance to more than one 1st
line anti TB drug, but not the combination of
isoniazid and rifampicin
▪ Isoniazid Resistant TB: A T.B patient who is
resistant to isoniazid but Susceptible to
rifampicin.
2. ▪ Multi-drug-resistant tuberculosis (MDR-TB) is
defined as resistance to rifampicin and
isoniazid,with or without resistance to other
first-line anti-TB drugs.
▪ Rifampicin Resistant T.B (RR-TB):ATB patient
whose biological specimen is resistant to
Rifampicin,detected by using phenotypic &
genotypic methods with or without resistance
to other anti TB drugs. It include any
resistance to R in the form of mono resistance,
poly resistance,MDR TB & XDR TB.
3. ▪ Extensively drug-resistant tuberculosis
(XDR-TB) is defined as esistance to
rifampicin,isoniazid,any
fluoroquinolone and resistance to one
or more of the following injectable
anti-TB drugs: kanamycin,amikacin
and capreomycin.
▪ Latent Tuberculosis : A state of
persistent immane response to
stimulation by Mycobacteria
tuberculosis antigens with no evidence
of clinically manifest active T.B.
4. ▪ Presumptive DR-TB:It refers to patient who is
eligible for rifampicin resistance screening at
the time of resistance or during the course of
treatment for DS-TB or H mono/poly DR-TB.
▪ Drug susceptibility testing (DST):It refers to in
vitro testing using either of the phenotypic
methods to determine susceptibility.
▪ Drug resistance testing (DRT):It refers to in-
vitro testing using genotypic methods
(molecular techniques) to determine
resistance.
5. ▪ WHO estimates that there were about 4,50,000 new(incident) mdr-tb cases in the world in
2012.
▪ Morethan onehalfofthese casesoccurred inCHINA,INDIA &the RUSSIAN FEDERATION.
▪ Enrolments on MDR-TB treatment in2012: were equivalent toone in four of themdr-tb
casesestimated tooccuramongpulmonaryTBpatientsnotifiedin the world.
▪ Treatment success:48%ofpatientswithMDR-TBenrolled ontreatment in 2010 were
reported tohavebeensuccessfullytreated
▪ WHO estimates that thereareabout650,000MDR-TBcasesintheworldatany
▪ onetime.
▪ Onlyasmallproportion ofthese casesaredetected and treated appropriately giventhatmany
lowandlowermiddle-incomecountries stilllacksufficient diagnostic capacity todetect
MDR/XDR-TB.
Epidemiology
6. MDR-TB
• Globally Prevalence of MDR- TB3.4% in new TB
patients20% in those previously treated
• By October 2011, 77 countries had reported at least one
case of XDR.
• Coverage is low particularly in the African continent as a
result of low capacity for testing for second-line
medicines.
• WHO estimate that some 5% of people with multidrug
resistant TB may actually have extensively drug
resistant
Problem Statement
7.
8.
9.
10. Durg resistancein Tb
▪ Drug-resistant TB is caused by M. tuberculosis
organisms t ha t are resistant t o the drugs normally
used t o treat the disease. Drug- resistant TB is
transmitted in the same way as drug-susceptible TB,
and is no more infectious than drug-susceptible TB.
However, delay in the recognition of drug resistance
or prolonged periods of infectiousness may
facilitate increased transmission and further
development of drug resistance.
11. ❑Drug resistant TB
❑ Mono resistance
❑ Poly resistance
❑ Multi Drug Resistant TB(MDR-TB)
❑ Extensive Drug Resistant TB (XDR-TB)
❑ Total Drug Resistance (TDR-TB)
12. •Mono Drug Resistance (Resistance to single first line ATT)
• Poly Drug Resistance (Resistance to two or more first line ATT except
MDR-TB)
• Multi-drug resistant tuberculosis (MDR TB) is defined as resistance to
isoniazid and Rifampicin (a laboratory diagnosis).
•Extensively drug resistant TB (XDR-TB) is MDR +resistance to any
fluoroquinolone + resistance to at least one 2nd-line injectable drug
(amikacin, kanamycin, or capreomycin
•Resistance to all first-line anti-TB drugs (FLD) and second-line anti-TB drugs
(SLD) that were tested.
13.
14. Mechanism of drug resistance
1)Cell wall: The cell wall of M. tuberculosis consists of complex lipids, an
d it acts as a permeability barrier from drugs.
2)Drug modifying & inactivating enzymes: The enzymes usually phospho
rylate, acetylate, or adenylate the drug compounds.
3)Drug efflux systems
4)Mutations: Spontaneous mutations in the M. tuberculosis genome can
give rise
to proteins that make the bacterium drug resistant, depending on the dru
g action.
15.
16. FACTORSRESPONSIBLEFOR
DEVELOPMENTOFDRUGRESISTANCE
▪ Clinical / Operational factors
▪ Unreliable treatment regimen by doctors
▪ Lesser number of drugs
▪ Inadequate dosage / duration
▪ Addition of a single drug in failing regimen
▪ Easy availability of drugs in private sector
▪ Poor drug supply
▪ Poor quality of drugs:poor bioavailability
17. Biological
factors
▪ Initial bacillary population
▪ •Local factors in host favourable
for multiplication of bacilli
▪ Presence of drug in insufficient
concentration
▪ Irregular intake
▪ inadequate duration
▪ Neglect of disease
▪ Ignorance
18. ▪ Most cases of acquired MDRTB are due to
inappropriate treatmentwith a single antiTB drug,
usuallyINH.This can occur due to a medical provider,
such as a doctor or nurse,improperlyprescribing,
ineffective treatment,but may also be due to the
patient not taking the medication correctly,whichcan
be due to a variety of reasons,including expenseor
scarcity of medicines,patientforgetfulness,or patient
stopping treatment early becausethey feel better.
19. WhoisatriskforgettingMDRTB?
▪ Drug resistance ismore common in people who:
▪ Do not take their TBmedicine regularly
▪ Do not take all of their TB medicinesas told by their doctor
or nurse Develop active TB disease again, after having
taken TB medicine in the past
▪ Come from areas of the world where drug-resistant TB is
common
▪ Have spent time with someone known to have drug-
resistant TB disease
24. The following diagnostic technologies are currently available under RNTCP and
recommended for diagnosis of MDR-TB .
MDR-TB diagnostic technology Choice.
First-Molecular DST [e.g. cartridge-based automated nucleic acid amplification test (CBNAAT) or
line probe assay (LPA)]
Second-Liquid culture isolation and LPA DST
Third-Solid culture isolation and LPA DST
Fourth-Liquid culture isolation and Liquid DST
Fifth-Solid culture isolation and DST
25. LineProbeAssays:
A DNA strip test that allows simultaneous molecular identification of
tuberculosis and the most common genetic mutations causing resistance to
rifampicin and isoniazid that is rpoB gene conferring rifampicin resistance and
mutations on the katG gene which is associated with higher levels of isoniazid
resistance and inhA gene mutations which is associated with lower levels of
isoniazid resistance.
These tests have been approved for direct testing on smear
positive specimens and on isolates from solid and liquid culture.
In 2008,theWHO issued a recommendation for the use of molecular LPA for the
rapid diagnosis of MDR-TB in high TB-burden,low-income settings.
The test that is available in the country is the Genotype MTBDRplus assay
which is a PCR based hybridisation assay.
26. Advantages of the test are that:
It detects MTB and resistance to RIF & INH at the same
time from one specimen.
It reduces time to diagnosis of MDR-TB to 7 days.
Cost-effective when compared with TB culture and DST.
They also demonstrated significant patient benefits, including early
targeted treatment of MDR-TB and the potential interruption of
transmission.
27. Thelimitations
ofthe test are:
It cannot be used for monitoring patientson treatment because it does not
distinguish between live and dead bacilli, therefore its use is limited to
diagnosis
It is dependent on smear results, can only be performed on smear positive or
culture-positive sputum specimen
Labour intensive
Prone to contamination and human error
Requires a lot of space - at least 3 separate rooms for the different steps.
A small proportion of resistance detected may not correlate with physiological
resistance.
NEW
Version 2 of the MTBDRplus which can be used on smear positive and
negative sputumspecimensis available and currently being validated in the
country.
MTBDRsl isavailable for second line testing. This test may be used as a rule
in test for XDR-TB in high risk groups.
28. This is a heterogeneousgroupof tests thatuse either the polymerasechainreaction
(PCR) techniqueor Transcription mediatedamplification (TMA)or other forms of
nucleicacid amplificationmethodsto detect mycobacterial nucleicacid.
These test vary in which nucleicacidsequencethey detect and vary in their
accuracy.
sensitivity92%
specificity99%
29. Xpert® MTB/RIF (CBNAAT)
The test is called Xpert MTB/RIF also called
as cartridge based nucleic acid amplification test .
The instrument is a GeneXpert (GXP).
GeneXpert is an automatedmolecular platform to
detect M. tuberculosis and rifampicin resistance
testing by targeting specific mutationsin the rpoB
gene. It is approved for use directlyon raw sputum
and resultsshould be available within 2 hours in the
laboratorybut available in healthfacilities within 48
hours.
The test involves only three manual steps:
The addition of sample treatment reagent to liquefy
and inactivate the sputum
Transfer of 2ml of liquefied sputum to the cartridge
Loading the cartridge into the device for the assay
30. Advantages of the test are :
It detects MTBand Rifampicin resistance from one specimen at the same time.
Resultsare available in approx. 2 hours.
It can also be used on the following processed samples- CSF,aspirates (gastric, lymph node)
and tissue (i.e. pleural biospy).
It is specificfor MTB complex
The limitations of this test are :
It cannot be used for monitoring treatment because it does not distinguish between live
and dead bacilli, its use is therefore limited to diagnosis
A small proportion of Rifampicin resistance detected may not correlate with physiological
resistance (leading to discordancebetween Xpert and DST results or clinical outcome)
The assay is semi-quantitative and definesa positive test as “very low”, “low”, “medium”, and
“high”. Thisgrading is not reported on the laboratory result.
There is no direct correlation between the Xpert semi-quantitative result and the smear grading
of scanty, +, ++ and +++. The rifampicin resultscan only be reported if MTB complex is
detected.
31. In 1969, Deland and Wagner developed a techniquefor semi-automateddetection of the metabolism of bacteria by
measuringthe 14CO2 liberated duringthe growth and decarboxylationof 14C-labeled substrateincorporated in the
growth medium. This radiometric techniquewas widelyused for blood culture using the BACTEC 460 instrument.
In 1980, this technique was introduced commercially for mycobacterialrecoveryfrom clinical specimens and
drug susceptibility testing.
One of the disadvantages of the BACTEC 460 TB System is the use of 14C-Labeled radioactive substrate.Because
of the strict regulations of handlingand waste disposal ofradioactive material, it became necessary to develop a
non-radiometric technique for mycobacterialculture and susceptibility testing.
Becton, Dickinson and Company (BD) developed a new system called Mycobacteria Growth Indicator Tube (MGIT™),
which is non-radiometric and offers the same rapid, sensitive and reliable methods of testing as the BACTEC 460 TB
System.
BBL MGIT™ System is the manual systemwhileBACTEC MGIT 960 (MGIT 960) is the fully automatic systemfor
detection of mycobacterial growth and drug susceptibilitytesting of M. tuberculosis
32. Principle of the BACTEC MGIT System
Manual MGIT medium.
The MGIT contains 7.0ml of modified Middlebrook 7H9 broth base.
In addition to Middlebrook 7H9 liquid media, the MGIT tube contains an
oxygen-quenched fluorochrome, tris 4, 7- diphenyl- 1, 10 - phenonthroline
ruthenium chloride pentahydrate, embedded in silicone at the bottom of the
tube.
During bacterial growth within the tube, the free oxygen is utilized and is replaced
with carbon dioxide. With depletion of free oxygen, the fluorochrome is no longer
inhibited, resulting in fluorescence within the MGIT tube when visualized under UV
light.
The intensity of fluorescence is directly proportional to the extent of oxygen
depletion and is indicative of the number of bacilli present.
MGIT tubes may be incubated at 37ºC and read using the manual
transillumination with a 365nm UV light.
35. MDR-TBIN PLHIV
The shorter or longer oral MDR-TB regimen can be used in PLHIV, including those who
are receiving ART. In PLHIV with pulmonary MDR/RR-TB, additive toxicities or drug-drug
interactions between anti-TB and ART medicines potentially overlap e.g. Mfx and Cfz or
Efavirenz and Bdq, ritonavir may potentially increase the risk of Bdq related adverse events
and hence combined use should be avoided or used with caution
37. MDR -TB in pre-
existing liver
disease
In general,most second-line drugs
can be safely used in the presence of
mild hepatic impairment, as They are
relatively less hepatotoxic than first-
line drugs.
patients with pre-existing liver
disease with persistently abnormal
liver function test, a shorter oral
MDR/RR-TB regimen will be avoided
due to presence of H(h), Eto and Z.
39. PREVENTIVETREATMENT OFCONTACTSOF DR-TB
MDR-TBisa seriousformof TB and islesseasyto treat than other typesof TB disease.
HHC of patients with MDR/RR-TBor H mono/poly DR-TBare at higher risk of TBI than
contacts exposed to drug-sensitive TB, however the risk of progression to TB disease does
not differ among contacts in both groups.
Recent evidence fromsystematic review & meta-analysis, andcost-effectiveness of
treatment of latent tuberculosis to reduce progressionto multidrug-resistant tuberculosis
revealed.
A reduced risk of TBincidence with treatment for MDR-LTBI, suggesting
effectiveness in prevention of progressionto MDR-TB, and confirmed cost-
effectiveness;
Estimated MDR-TBincidence reduction was 90% (9%-99%) using data from5
comparison studies;
High treatment discontinuationrates due to adverse effects in persons taking
pyrazinamide containing regimens; and
Cost-effectiveness was greatest using a fluoroquinolone/ethambutol combination
regimen.
40. WHOrecommendationsonTPTamongcontactsofDR-TB
patients
WHO recommends TPT among contacts exposed to MDR-
TB with FQ sensitive or H resistant with R sensitive DR-TB
patients following consideration of intensity of exposure;
confirming the source patient and her/his drug resistance
pattern confirmed bacteriologically and ascertaining TBI using
IGRA or TST.
Among contacts exposed to patients with known MDR-TB
with FQ sensitive, WHO suggeststhe use of levofloxacin for six
months (pediatric formulation for child contacts) if tolerated.
If H susceptibility is confirmed in RR-TB index patients, contacts
may be given 6H. Among contacts exposed to individuals with known
H-resistant TB with R sensitive, the use of rifampicin
for four months is proposed. Regardless of whether treatmentis given or not,
clinical followup should be done for two years and any emergent signs and
symptoms suggestive of TB
should be actively investigated and curative regimens started as needed.
41. ONGOINGSTUDIES
Randomizedcontrolledtrials onMDR-TB preventive treatment are urgently needed to
improve the evidence base results from following three RCTs of TPT among HHC ofMDR-TB
patients are expected to become available in the next few years:
TB CHAMP.Testingsix months of levofloxacin (Lfx) vs placebo in infants and
young children less than five years of age exposed to MDR-TB (South Africa;
ongoing recruitment and intending to publish by end 2021).
V-QUIN. Testing 24weeks of Lfx vs placebo in all ages with evidence of
infection (Viet Nam; recruitment completed; date of ending data
collection is March 2022).
PHOENIx. Testing26 weeks of delamanid vs isoniazid in all ages (11 countries;
estimated completion in mid-2025).
43. SALIENT
FEATURES
OF THE
INTEGRATED
ALGORITHM
● Once a DR-TB patient is identi ed, all HHCs are
counselled, screened and evaluated to rule out active TB.
● NAAT will be used upfront among contacts with symptoms
or abnormal chest X-ray to diagnose TB.
● If the result is MTB detected with no resistance, the
treatment for DS-TB is initiated;
● If the result is MTB detected with H and/or R resistance,
manage as per DR-TB guidelines;
● If the result is MTB not detected, in HHC <5 years, assess
for TPT and check for any contraindications.
● If the result is MTB not detected, in HHC >5 years of
age with TBI test positive or unavailable and chest X-ray
is normal or unavailable check for any contraindications;
● If contraindications to TPT drugs exists, defer TPT and if
no contraindication exists, offer TPT regimen as
appropriated based on DST pattern of the index patient;
and
● Follow-up for active TB as necessary, even for
patients who have completed preventive
treatmentirrespective of TPT offer.
45. TREATMENTOFMDR-TB
Goals of TB treatment
•Render the patient non-infectious, break the chain of
transmission and decrease pool of infection.
•Decrease TB deaths and related comorbidity by ensuring
relapse-free cure.
•Minimize & prevent development and amplification of drug
resistance.
46.
47. Shorter oral Bedaquiline-containing MDR/RR-TB
regimen
- Shorter oral Bedaquiline-containing MDR/RR-TB regimen is recommended for those MDR/ RR-TB
patients in whom resistance to the component drugs has been excluded or those who have not been
previously treated for more than one month with second-line drugs used in shorter oral Bedaquiline-
containing MDR/RR-TB regimen and have no other exclusion criteria.
-The regimen consists of an initial phase of 4 months that may be extended up to 6 months and a
continuation phase of 5 months, giving a total duration of 9–11 months. Bdq is used for a duration of 6
months.
(4-6) Bdq (6 m), Lfx, Cfz, Z, E, Hh, Eto. (5) Lfx, Cfz, Z, E,
Inclusion criteria ►► Rifampicin resistance detected/inferred►► MDR/RR-TB with H resistance
detected/inferred based on InhA mutation only or based on KatG mutation only (not both)
►► MDR/RR-TB with FQ resistance not detected
Exclusion criteria ►► MDR/RR-TB patients with H resistance detected with both KatG and InhA
mutation; and ►► MDR/RR-TB patients with FQ resistance detected.
48.
49. Duration:-
Longeroral M/XDR-TB regimen is of 18-20 months with no separate IP or CP. Although standardization in
the designof longerregimens is possible,in many cases,the modificationof the compositionand duration
of a regimento make it individualized could enhance regimen effectiveness orsafety(or both).
Longer oral M/XDR-TB regimen
Eligibility criteria:-
• Longeroral M/XDR-TB regimen is recommendedforMDR/RR-TB patients who are excluded from shorter
oral Bedaquiline-containing MDR/RR-TB regimenincluding for the XDRTB patients.
• In case of additional resistance or intolerance or non-availability of any drug in use or emergence of
exclusion criteria to shorter oral Bedaquiline-containing MDR/RR-TB regimenor any longer regimen,the
patient would be re-evaluated and initiated on longer oral M/XDR-TB regimenat N/DDR-TBC with any
modifications,if additional resistance to any second-line drugs especially Lfx, Mfx, Bdq*,Lzd, Cfz*, Dlm* and
Z (*whenever available)
18-20)Lfx Bdq (6 month or longer) Lzd Cfz Cs
54. OnceTPT is initiated, the individuals will be monitored by
the Doctor for clinical and laboratory parameters as below:-
● Screening with 4S symptoms (cough, fever,night sweats and weight loss)
● Any side effects
● If any of the sign/ symptoms of TB emerge,the personmay be referred to the DR-TB
centre forfurther evaluation foractive TB/DR-TB disease
Adherenceto the TPT course and treatment completionare important determinants of clinical
benefit, bothat individual and populationlevels.Irregular or inadequate treatment reduces the
protective efficacyof TPTregimen.Pooradherence or early cessationof TPT can potentially
increase the risk of the individual developing TB including drug-resistantTB