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New aspect for detection and controlling of tuberculosis

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Title: New aspect for detection and controlling of tuberculosis


1
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??????? ? ???????
New aspect for detection and controlling of
tuberculosis
BY
?.?. ???? ???? ???
2
Historical Review
  • ??? ???? ?? ??????? ??????? ??? ??? ??????? ( ???
    ???? ????? ?????? ????? ??? ???? ??????)
  • ???? ???? ????? ?? ?????? ?????? ???? ??????????
    ? ???? ??? ??? ???? ( ???? ?????? ) ???? ????
    ?????? ???? ??????
  • ???? ?????? ????? ??? ?????? ???????? ??????
    (??????)
  • ?? ????? ?????? ??? ??????? ? ?? ???? ??????????
    ???????? ? ?????????
  • ??? ?????? ?????? ??? ????? ?????? ?? ?????
    ?????????? ??? ???? ????? ?? ????? ???????

3
????? ???????? ?????? ????? ??
???? ?? ???????
  • ??? ???? ?????? ?????? ????? ??????? ???????
    (2007(WHO -
  • ???? ????? ????? ??? ??? ????? ?? ????? ????? (7
    ????? ???? ?????)
  • ????? ???? ????? ??? ?? 10 ?????
  • ???? ??? ??????? ??????? ?? ??????? (15-40 ???)
  • ??? ?? ????? ?????? ????? ????? ????? ???? ?????
    10-15 ???? ??? ?? ?????
  • 5 ??? ?? ???? ???????? ??????? ?????? ??????? ?
    ??? ????? ???? ?????? ??????? ?????

4

???? ???? ??? ??? ???? ???? ?? ??? ???????
25 ??? ?????? ??? ???? ???? ??????
25 ????? ????? ???? ?????? ????? ?? ???
?????? ???????
50 ??? ?????? ????
5 ?????
5
98 ?? ????? ?????? ?????? ????? ?? ????? ???????
( ???? ??? ???? , ???????)
  • ????? ?? ???? 3 ????? ??? ?????
  • ??????? ????? ?? ??? ?????? ??? 3 ????? ??? ?????
    2020 ????? ???? 300 ????? ?? ????? ????? ? ????
    35 ????? ????? ? 90 ???? ????? ?????

??? ???????????
??? ???? ?????? 3 ?????? ??? ????? ????? ?????
5 ?????? ?? ??????
???? ???????? ?? ?????? ????? ??????
???? 50 ????? ??? ?????? ???????? ????????
???????
6
????? ???????? ????? ?? ??????? ?
  • ???? 50 ????? ??? ????? ( (cattle ????? ?????
    ???? ????? ???? 3????? ????? ??????
  • ??? ????? ????? 10-20
  • ????? ??????? ? ????? ????? ????? 10-25
  • 87??? ??? ??? ?????? ? ????? ?????? M . bovis
  • 20 ?? ????????? ??????? ???? ???????? ??
    ????????? ????????

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???? ?? ??? ????
  • ???? ??? ????? ??? ????? ?????? ??????? ?????
  • ?? ??? ????? (2006) 24 (24???? ??? ????? ???
    ???? ??? ?? ????? ?????? ?? ????? 16-17 ??? ????
    ??? ????? ????????? ????? ?????? ?????? ????????
    ?????? ??????? ????? ?????? ?? ??? ?????? ???????
    ????? ??? ?????? ?? ???????
  • ?? ??? 2006 4745 ???? ?? ??????? ?? 400, 10 ????
    ??? ???? ?????? ?????? ? ?????? ??? ???? ? ???
    ???? ?????

2.5 ?? ????? ????? ?? ????? 5 ?? ???????
????? ????? 63 ?? ????????? ??????????? ?? ????
?????
19
???? ????? ??? ??? ????
  • . ?????!!
  • ? ???? WHO ?? ??????? ???? ?????? ??? ??? ???
    ?????? ????? ????? ? ??????? ?????? ? ??? ???????
    ? ?????? ??????? ? ?????? ??????? ?????? ??? ????
    ??? ) (take away ? ????? ???????
  • ?? ?????? ???????
  • ????? ????? ??????? ???????? ????????? ?
    ?????????? ? ??? ????? ? ????? ?????? ? ?????
    ???? ? ?????? ? ?????? ? ??????
  • ??????? ????????? ????? ???? ???? ???? ??? ?????
    ?????
  • ??? ??????? ? ??????? ? ??????

20

????? ?????
  • ????? ??????? ???? ???? ??? ?????? ????? ??? ??
    ?????? ??? ???? ????? ????????? ?????? ? ???? ??
    ????
  • ??????? ????? ???? ? ????? ???? ??????? ?? ???

???? ?????? ?????? ???? ? ??? ???? ? ????? ????
?????? ? ???? ???? ????? ????? ?????
???? ???? ????? ????? ?? ??????? ??
?????? ?????? ? ???? ?????? ?????
21
??????????? ??????? ????? ???
  1. ???? ?????? ??????? ????? ????? ((DOTS
  2. ??????? ??? ???? ????? ????? ???????? ???????
    MDR, XDR)?????? ??????? ????????(
  3. ???????? ?? ????? ??????? ????? ? ????????? ?????
    ? ??????? ????? ?????? ????? ???????? ?? ???
    ?????

22

??? ????? ???? ?????? ?? ?????? ????? ???????
????????
424.000???? ????? 1000 ??? ???? ??????
  • ??? ?????? ?????? ?????? ?????? ??????? ???????
    ?? ??? ???? ?????????? ??????? ???????? ?????
    ???? ?? ?????? ??????? ?? ??? ?????? ?? ????
    ????? ?????? MDR ???????????? ,, ? ??????????
  • ??? ?????? ?? ???? ?????? ????? ???? ?? ??? ?????
    ? ?????? ?? ?????? ??????? ????????? ?? ?????? ?
    ?? ?????? ???? ??? ????? ?????? ?? ?????????
    ??????? ?? ?? ?????? ?????? XDR
  • ?? ??? 2007
  • ??? ????? ?? XDR ???? ??????? AIDS TB ????
    53?? 54 ???? ?? ???? ???? ?????? 25 ??? ?? ???
    ???????

?? 25 ??? ? 30.??? - ???? ?? 37 ???? ?? ?????

23
??????? ????????
????? ???
  • 2-??????? ????? ??????? ??????
  • ?????? ???????? ??? ???????? ???????
  • ? ?????? ????? ???????? ???? ???? ?? ??????
    ?????? ?? ????? ????? ?? ??? ??????? ???? ?????
    ???? ?? ??????? ??? ???? ???? ??? ???????
  • 1- ????? ????? ????? ??????
  • ????? ??????? ???? ????? ?? ???? ??? ??????
    (??????) ???? ??? ?? ?????? ????? ??? ??? ??????
    ??? ????? ???????? ?? ?????? ? ?????? ?? 4-6 ????
    . ? ??? ?? ???? ????????? ?????? ??? ???????
    ???????? DOTS

24
???????
  • ???? ???????
  • ?? ???? ????? ?????? ?? ??? ???????
  • ???? ?? ?? ??????? ??? ??????? ????? ????? ?? BCG
  • N.B
  • ???? BCG ???? ? ???? ??????? ?????? ???????
    ??????

25
Classic detection of tuberculosis
Tuberculin test

26
Tuberculin test and non specific reaction
  • Type ( PPD test )
  • Problem.
  • I - positive reactors with no visible lesions -
  • 1- Infected animals with no visible lesions
  • a- Infected in apparently normal LN ,
    organs and tissues .
  • b- Initial stages of infection that
    misleading detection.
  • c- Animal infected with human or avian
    tubercle bacilli.
  • 2- Non infected animals with false positive
    reactions.
  • a- Animal infected with Johns disease,
    skin TB or modified from of pathogenic
    Mycobacterium.
  • b- Animals sensitized with non
    pathogenic or saprophytic mycobacteria or MOTT .
  • c- Animals vaccinated with BCG .
  • e- Heterologous factors
  • - Parasetic infestation eg.
    Fasciola , Echinococcous or demodetic mange .
  • -Corynebacteria .
  • - Brucellosis.
  • - Actinobacillosis.
  • - Actinomycosis.
  • - Nocardiosis.

27
  • II Infected animals which yield false negative
    reactions -
  • Non clinical cases.
  • New infection in the pre allergic stage with no
    anatomical demonstrable lesions.
  • Animals with old and possible healed lesions.
  • Advanced generalized cases in chronic conditions
    .
  • Other desensitizing factors -
  • Injection of large dose of tuberculin .
  • Repeated tests in the same side.
  • Fibril condition.
  • Hypovitaminosis.
  • Pregnancy and parturition.
  • Seasonal variation related to changes in
    metabolism.

28
Postmortem diagnosis of Mycobacterium bovis
infection in cattle
  • Comparison between current abattoir and recent
    details necropsy for detection of gross lesions.
  • The principles interest of the inspectors is the
    susceptibility of meat for human consumption not
    the detection of all diseased cattle
  • Detected 95 .

29
Tissues to be examined for lesions in cattle
reacting to tuberculin test
Mandibular Ln- left and right parotid Ln-left and right medial retropharyngeal Ln-left and right lateral retropharyngeal (atlantal) Ln-left and right tonsils Head
Mediastinal Ln-anterior and posterior . tracheobronchial (bronchial) Ln-left, right, cranial and medial lungs Thorax
Liver Hepatic Ln spleen mesenteric Ln's along the entire length of the gastro- intestinal tract Kidneys Abdomen
Caudal cervical (prescapular) Ln-left and right subiliac (prefemoral) Ln-left and right internal iliac Ln-left and right medial iliac Ln-right and left lateral iliac (deep inguinal) Ln-right and left gluteal (ischiatic) Ln-left and right sacral Ln-left and right superficial inguinal (supramammary or scrotal) In-left and right udder or scrotal contents and seminal vesicles Carcase
Ln-lymph node. Ref. Comer et al., 1990.
30
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31
Solution structure of the major secreted M.bovis
protein MPB70.
32
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34
Bacilli cleared
NO INFECTION A (PM NEG.)
Exposure to Mycobacterium Bovis
Skin test negative
Bacilli Controlled
Innate Response
LATENT INFECTION B (PM POS/NEG.)
Skin Test Positive
Bacilli remain viable
Reactivation
Decreased Immune status
DISEASE C (PM POS.)
ACCUIRED RESPONSE
Bacilli not controlled
35
Figure (2) Diagram showing the most likely
outcomes resulting from exposure of cattle
M.bovis . When two events are possible , the red
arrow represents the pathway considered to be
most common . PM POS/NEG . Indicates positive or
negative findings at gross post mortem and
laboratory examinations .
36
Thanks You
37
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?????????? ??????? ?? ???????? ?
?????? ?.?.???? ???? ??? ???? ??? ???? ??????
??????? ?????????(????)
38
  • ???????? ????????? ????? ???? ?????? ??
  • ??? ?????? ????? ?????????? ???????(Caseous
    Lymphadenitis)
  • ??? ??????? ????? ?? ?????? (Thin Ewe Syndrome)
  • ??? ????? ????????? (Cheesy Gland)
  • ?? ??? ?????? ???? ? ???? ???? ????? ??????? ?
    ?????? ? ???? ????? ?????(Sporadic) ?? ?????? ?
    ??????? ? ?????? ? ??????? ? ???????? ?????? ?
    ?????? ? ?????? . ? ???? ??????? ??? ???? ??? ???
    ?????? ????? ?????????? ???????
  • ????? ????? ????? ??? ????? ??????? ???? ???????
    ??????????
  • 1-???? ?????? ???? ?????? ??????? ?????????
    ?????? ??? ???? ??????
  • ?????? ? ???????
  • 2-????? ????? ???? ??? ? ????? ?? ??? ??????? ?
    ?? ???? ?????
  • ??????? ???? ?????? .
  • 3-???? ?? ?????? ???????.

39
????? ??? ?????? ?? ????? ????? ??????? ? ?????
?? ????? ????? ?????? ? ????? ???????? ? ?????
??????? . ??????? ??????? ??????? ????
?????? Coryne Bacterium PseudoTuberculosis (
Coryne.ovis) . Nitrate - Negative Group
? ?? ??????? ? ??????
. Nitrate - Positive Group
? ?????? ??????? ?
????? ????? ???? ???? ???????
40
??????? ??????
1- ????? ??? ??????? ???? ????? ????
(1) ????? ???????? ???? ??? ??????? ??????
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41
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    ??? ????????? ??????? ????? ????? ??????

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?? ???????
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???????
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????????
42
  • ?????? ?????????
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    ????? .? ??? ???? ???? ???? ???? ??? ?????? ??
    ?????? ??????
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    ??? ????? ???? ?????? ?? ???? ?????? ?????
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    ??? ????? ?????????? .
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    ?????? ????? ?? ????? ????? ???? ????? ???? .
  • - ??? ?? ?????? ??? ????? ???? ???? ????? ?
    ?????? ?????? .

43
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50
  • ?????????
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    .
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    .
  • ????? ????? ?? ??? ??????? ? ?????? ????? ??
    ????? ?????? (?????) .

51
  • ????????
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  • ????? ?????? ??????? ??? ??????? , ???? ?????
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    ???????? ??????? , ?? ????? ? ???
  • ??????? ????????
  • ??? ?????? ?????
  • ?????? ?????????? (ELISA)

52
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??????? (?????? ??????? ???? ???? ????
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?? ?????? ??? ??? ???? . ? ??? ???? ?? ???????
???? ??? ?????? ??? ??? ?????? . 2. ????? ?? ????
???? ????? ?????? ? ????? ??????? ???? ???? ??
?????? .
3.??? ????? ?????? ??? ???? ?????? ?????
?????????? ?????? ??????? ????? ??? ??? ?????
?????? ?????? ???? ?? ????? ?? ????? ?????
?????????? . 4. ??? ??? ????? ??? ???? ????? ????
????? ?????? ??? ?? ??? ????? ????? ?? 24????
???? 3-4 ???? . 5. ?? ????? ?????? ????? ?????
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53
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54
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    ).
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55
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56
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