Tuberculosis%20infection%20means%20that%20Mycobacterium%20tuberculosis%20has%20infected%20a%20host%20but%20is%20not%20causing%20disease

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Definition

• Tuberculosis infection means that Mycobacterium
  tuberculosis has infected a host but is not
  causing disease
• Tuberculosis disease or tuberculosis means the
  disease caused by M. tuberculosis

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Basic facts on TB
Overall, one third of the world's population is
currently infected with the TB bacillus.
Each person with infectious TB will infect on
average between 10 and 15 pepole every year .
Someone in the world is newly infected with TB
every second. 5-10 of people who are infected
with TB (but who are not infected with HIV)
become sick or infectious at some time ring their
life.
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It is estimated that between 2002 and
2020, . Nearly one billion people will be newly
infected . 200 million people will get sick .35
million people will die from TB if control
is not further strengthened.
Basic facts on TB
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DOTS
Directly Observed Treatment Short-course
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????? ???? ????? ?????? DOTS

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????? ???? DOTS
1 - ????? ??? ????? ???? (???????? ?????) 2 -
????? ???? ??? ???? (?????) ?? ?????? ??????????
????? ??? 3 - ????? ?? ???? ?????? ????? ??? ???
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Directly Observed Therapy (DOT)

• Health care worker watches patient swallow each
• dose of medication
• Consider DOT for all patients
• DOT should be used with all intermittent regimens
• DOT can lead to reductions in relapse and
  acquired
• drug resistance

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Diagnosis of Tuberculosis

• Use of skin test of 5 U tuberculin PPD given
  intradermal
• gt5 mm induration is positive for infection for
  contacts of TB cases, HIV, Xray fibrosis (old
  disease), immune suppression
• gt10 mm induration is positive for persons in high
  prevalence countries, IDU, prisons and jails,
  medical conditions, children lt 4 y/o exposed to
  adults in high risk categories
• gt 15 mm induration with no risk factors for TB

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Diagnosis of Tuberculosis

• Requires positive PPD skin test and/or
• Chest X ray findings consistent with TB
• With confirmation by positive culture from
  specimen
• pulmonary disease with sputum collection (3
  single specimens) or gastric aspirates in child
  or bronchoscopy in rare instances
• specimens from urine, nodes, etc. if extra
  pulmonary site is suspected

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Evaluation for TB

• Medical history
• Physical examination
• Mantoux tuberculin skin test
• for latent infection, not for active TB (see
  below)
• Chest radiograph
• Bacteriologic or histologic exam
• microscopy
• culture
• DNA based detection

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?????? -II ???? ??? ???? ???? -III
???? ?????? ????? ???? ????????? .A
???????? MGIT .B ???
?????????? ? ?????? ??????? (PCR)
? ????? ?????) (ADA? ?? ????????? ???????
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??? ????? ???? ? ????? ???? FM ??? ??? ZN
????? ?????.
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??????? ?? ??? ?? ?????? ?? ????? ??? ?????
???????? ???? ???? ??? ?????? ???? ? ??????
???????? ????? ????? ?? ?? FM ????? ??? ??? ?????
??? ???? ?? ZN ????? ?????.
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Tuberculosis Transmission and Natural History
Self-Cure 90
Infection
Initial containment 95
Early Progression - 5 Fast TB
Late Progression - 5 Reactivation TB
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Role of interventions
INH
BCG

1. Sanitorium
2. Antibiotics

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Prioritizing TB Control

• Identify and treat active TB, to reduce number of
  contagious persons
• Identify contacts of cases, to test for recent
  infection and provide chemoprophylaxis
• Identify people with latent infection as
  potential candidates for chemoRx
• ? role of BCG vaccination

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Administering Tuberculin Skin Test

• Inject intradermally 0.1 ml of 5
• TU PPD tuberculin
• Produce wheal 6 mm to 10 mm
• in diameter
• Do not recap, bend, or break
• needles, or remove needles from syringes
• Follow universal precautions for infection control

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Needle too Shallow
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Needle too Deep
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Inserted Properly
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Reading the Tuberculin Skin Test

• Read reaction 48-72 hours
• after injection
• Measure only induration
• Record reaction in millimeters

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Classifying the Tuberculin Reaction

• gt 5 mm is classified as positive in
• HIV-positive persons
• Recent contacts of TB case
• Persons with fibrotic changes on chest radiograph
  consistent with old healed TB
• Patients with organ transplants and other
• immunosuppressed patients

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Classifying the Tuberculin Reaction (cont.)

• gt 10 mm is classified as positive in others
• e.g. medical students

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Future Trend in TB

• TB is still a major killer in the world
• The increase in HIV worldwide is increasing the
  number of TB cases
• Vaccines are not effective in disease prevention
• Drug resistance makes therapy more expensive and
  difficult

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Sputum collection
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Specimen Collection

• 3 sputum specimens for smear examination and
  culture
• Persons unable to cough up sputum
• induce sputum
• bronchoscopy
• gastric aspiration
• Follow infection control precautions during
  specimen collection

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RIF 5 mg / kg INH 5 mg / kg
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INH 50 300 300
Rif 75 300 Full Dose
PZA 250 1000 Full Dose
ETM 100 500 Full Dose
Str 125 500 Full Dose
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THE END..

• THANK
• YOU

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