all about tuberculosis including its introduction, types, management, therapy, diagnosis, case study

1. Tuberculosis
Infection
A contagious infection that
usually affects lungs.

2. TABLE OF
CONTENTS
06
05
04
03
01
02
07
Types
Introduction
Etiology
Symptoms
Diagnosis
Pharmacotherapy
Case Study

3. Introduction
Tuberculosis (TB) is caused by a bacterium
called Mycobacterium tuberculosis. The bacteria
usually attack the lungs, but TB bacteria can attack
any part of the body such as the kidney, spine, and
brain. Not everyone infected with TB bacteria
becomes sick.

4. Types Of
Tuberculosi
s
Tuberculosis is mainly divide
into two categories hich are as
follows:
?

5. A. Pulmonary
Tuberculosis
The infection of an individual who has
not been previously infected or
immunized is called Primary
tuberculosis or Ghosn's complex or
childhood tuberculosis. Lesions
forming after infection is peripheral and
accompanied by hilar which may not
be detectable on chest radiography.
The infection that individual who
has been previously infected or
sensitized is called secondary or
post primary or reinfection or
chronic tuberculosis.
Primary Secondary
1 2

6. B. Extra Pulmonary
Tuberculosis
Seen frequently in HIV infected
patients.
Symptoms :
_Painless swelling of lymph nodes
most commonly at cervical and
Supraclavicular (Scrofula).
_Systemic systems are limited to HIV
infected patients.
_Results from Hematogenous spread
of Tubercle Bacilli.
_Spread is due to entry of infection into
pulmonary vein producing lesions in
different extra pulmonary sites.
2
Lymph node
TB
Miliary TB

7. Continue…
Gastrointestinal
Skeletal
Involvement of weight
bearing parts like spine, hip,
knee. Symptoms :- Pain in
hip joints n knees, swelling of
knees, trauma.
Involvement of any part
of GI Tract.
Symptoms :- Abdominal
pain, diarrhea, weight
loss
Pericardiatis
1- 8% of All Extra
pulmonary TB cases.
Spreads mainly in
mediastinal or hilar nodes
or from lungs.
Pleural TB
Involvement of pleura is
common in Primary TB and
results from penetration of
tubercle bacilli into pleural
space.
Upper Tract
Involvement of larynx,
pharynx and epiglottis.
Symptoms :- Dysphagia,
chronic productive
cough
Genitourinary
15% of all Extra pulmonary
cases. Any part of the
genitourinary tract get infected.
Symptoms :- Urinary
frequency, Dysuria, Hematuria.

8. Continue…
5% of All Extra pulmonary TB
Results from Hematogenous
speed of 10 & 20 TB.
uveitis, pan ophthalmitis, painful
Hypersensitivity related
phlyctenule conjunctivas.
2
Meningitis &
Tuberculoma
Less common Extra
Pulmonary TB

9. Latent Tuberculosis Active Tuberculosis
Active TB is contagious and
causes symptoms.
Symptoms include:
 Unexplained weight loss
 Loss of appetite
 Fever
 Chills
 Fatigue
 Night sweats
Active TB can be life-
threatening if not properly
treated.
 It doesn’t cause
symptoms and isn’t
contagious. Still, you’ll
have a positive result
from TB blood and skin
tests.
 Latent TB can turn into
active TB in 5 to 10
percent of people.
 This risk is higher for
those with a weakened
immune system due to
medication or an
underlying condition.

10. Etiology
TB spreads through the air when
a person with TB of the lungs or
throat coughs, sneezes, or talks.
You are more likely to get TB if
you have a weak immune system

11. Symptoms
• weakness or fatigue
• weight loss
• no appetite
• chills
• fever
• sweating at night
Cough for last 3
weeks may be
blood or sputum
Chest pain
Symptoms of TB disease depend on where in the body
the TB bacteria are growing. TB bacteria usually grow in
the lungs (pulmonary TB).
Common symptoms
Main symptoms

12. Chest Pain Weight loss
Sweating
Cough
Chills Chest Pain
Fever Loss of apetite Fatigue

13. Diagnostic Test Of
Tuberculosis

14. 1. Medical History
Consider demographic factors (e.g., country of
origin, age, ethnic or racial group,
occupation) that may increase the
patient’s risk for exposure to TB or to drug-
resistant TB.
Clinicians should determine whether the
patient has medical conditions, especially
HIV infection, that increase the risk of
latent TB infection progressing to TB
disease.

15. 2. Physical
Examination
A physical exam can provide valuable information about the
patient’s overall condition and other factors that may affect how
TB is treated, such as HIV infection or other illnesses.

16. 3. Test For Infection
The Mantoux tuberculin skin
test (TST) or the TB blood
test can be used to test
for M.
tuberculosis infection.
The Mantoux tuberculin skin test is
performed by injecting a small amount
of fluid called tuberculin into the skin in
the lower part of the arm. The test is
read within 48 to 72 hours by a trained
health care worker, who looks for a
reaction (induration) on the arm.
The TB blood test
measures the patient’s
immune system reaction
to M. tuberculosis.

17. 4. Chest Radiography
 A posterior-anterior chest radiograph is used to detect chest
abnormalities.
 Lesions may appear anywhere in the lungs and may differ in size,
shape, density, and cavitation.
 These abnormalities may suggest TB, but cannot be used to
definitively diagnose TB.
 A chest radiograph may be used to rule out the possibility of
pulmonary TB in a person who has had a positive reaction to a
TST or TB blood test and no symptoms of disease.

18. • The presence of acid-fast-bacilli (AFB) on a sputum smear or other specimen often indicates TB disease.
• A culture is done on all initial samples to confirm the diagnosis. (However, a positive culture is not always
necessary to begin or continue treatment for TB.)
• A positive culture for M. tuberculosis confirms the diagnosis of TB disease.
• Culture examinations should be completed on all specimens, regardless of AFB smear results.
• Laboratories should report positive results on smears and cultures within 24 hours by telephone or fax to the
primary health care provider and to the state or local TB control program, as required by law.
Diagnostic
Microbiology

19. Tuberclosis
Treatment
Effective treatment requires multiple antibiotics for
prolonged periods of time, up to aslong as12
months and even longer for resistant strains.
There are now many resistant strains of TB,
including Multi drug- resistant
tuberculosis (MDR-TB)and Extensively
drug-resistant tuberculosis(XDR-TB).
The treatment of tuberculosis which is resistant
to multiple drugs is more difficult, and
regimens have to be individualized according
to drug sensitivity.
This therapy is completely combinational and not
given alone.

20. CLASSIFICATIONOFTB
DRUGS TB DRUGS
FIRSTLINE SECOND LINE
Isoniazid
Rifampin
Ethambutol
Pyrazinamide
Thiacetazone
Para amino salicylicacid
Ethionamide
Cycloserine
*THIRD LINE DRUGS - FEW INPHASE III
NEWERDRUGS
Ciprofloxacin
Ofloxacin
Clarithromycin
Azithromycin
Amikacin
BEDAQUILINE
LINEZOLID

21. Mechanism of Action

22. DOT Treatment
‣ DOT is a component of case management that helps ensure patients adhere to
therapy. It is the method whereby a trained health-care worker or another
trained designated person watches a patient swallow each dose of anti-TB drugs
and documents it.
‣ DOT is the preferred core management strategy recommended by CDC for
treatment of TBdisease and, if resources allow, for latent tuberculosis
infection (LTBI)treatment.
‣ DOT can reduce the development of drug resistance, treatment failure, or relapse
after the end of treatment. Good case management, which includes establishing a
relationship with the patient and addressing barriers to adherence, facilitates
successful DOT.

23. Treatment of Latent TB
DRUG
INTERVAL AND
DURATION
COMMENTS
Isoniazid
Daily for 6
months
Not indicated for HIV infected
persons, those with fibrotic
lesions on chest radiographs,
or children
Twice weekly for
6 months
Directly observed therapy
must be used with twice-
weekly dosing
Rifampin
Daily for 4
months
for persons who are contacts of
patients with isoniazid-resistant,
rifampin-susceptible TBwho
cannot toleratePyrazinmide

24. ISONAIZID
▸ Most active drug which is structurally similar to pyridoxine.
▸ Bactericidal for fast growingbacteria
▸ Able to penetrate into phagocytic cells. Thus acting as both
intracellular and extracellular.
▸ Lessactive against atypicalMycobacterium.

25. Mechanism of
Action
▸ Isoniazid is a prodrug activatedby the
mycobacterial enzymekatG.
▸ The activated compoundreacts with
nicotinamide adenine
dinucleotide(NAD) to form an INH-
NAD complex.
▸ The INH-NAD complex inhibits one of
the final steps of mycelia acid synthesis
via theenzyme that is abbreviated InhA.
▸ The net results are accumulation of
long-chain fatty acids, decreased
production ofmycelia acid, and cellular
death.

26. RIFAMPIN
▸ Semi synthetic derivative of rifamycin, antibioticproduced by
Streptomyces mediterranei.
▸ Active against gram + & —
,some enteric mycobacterium and
chlamydia.
▸ There is no cross resistance to other class of anti microbial but
there is a cross resistance with other rifamycin derivatives

27. Mechanism of
Action
▸ Rifampin inhibits bacterial
RNA synthesis by binding
prokaryotic RNA
polymerase.
▸ It prevents Initiation of RNA
synthesis.
▸ It is bactericidal for
extracellular and
intracellular
bacteria.
▸ Not commonly used as SOLO
agent for treatmentof
established infections.

28. ETHAMBUTOL
▸ It is Synthetic drug, soluble in water and heat stable
compound.
▸ It disrupts the formation of the tuberculous cell wall by
blocking arabinosyltransferases.
▸ These enzymes attach the arabinose residueto
arabinogalactan to myceliaacid.
▸ It is bacteriostatic ; suppresses the growth of TBbut does not killTB.

29. PYRAZINAMIDE
▸ It is inactive at Neutral pH and gets active at pH 5.5.
▸ Drug act against intracellular organism.
▸ It is prodrug. It must first be converted to pyrazinoic acid. by
mycobacterial enzyme calledPyrazinamidase.
▸ Pyrazinamide is active only acidic environment.
▸ Never used assingle drug; resistance developsvery
quickly when it is used alone.

30. Mechanism of
Action
Pyrazinoic acid probably exerts
its antituberculosis
activity via inhibition of
an enzyme called Fatty
acid synthase I that is
involved in the cell wall
synthesis.

31. REPORTED BY:
Roman Kozlov, MD, DSc, Professor, Director of Institute of Antimicrobial Chemotherapy,
Smolensk State Medical Academy, Smolensk, Russian Federation

32. Patient
Background
Patient A is a 30-year-old male
who was admitted to the hospital
from home after 1 week of cough,
profuse nocturnal sweating, loss of
appetite and hyposomnia. He was
seen by an emergency room
physician who noted signs of
depression. The patient has a
history of intravenous drug abuse
and hepatitis B.

37. Diagnosis
Infiltrative TB of left lung with cavitation
without MTB shedding.

38. Patient A was originally administered isoniazid, rifampin, pyrazinamide, and ethambutol
for 7 days per week for 8 weeks, followed by isoniazid and rifampin 7 days per week for
24 weeks. After two months he returned to the hospital, concerned that he had been
“coughing up blood” over the previous 3 days. In addition to hemoptysis, he revealed
that, since his previous visit, he had continued to feel malaise, was continuing to lose
weight, and had been experiencing night sweats.
The emergency room physician immediately transferred the patient for isolation in a local
hospital. A repeat chest radiograph revealed progressive bilateral fibronodular disease
with a “miliary” pattern. The patient was given a 20-month regimen of levofloxacin,
kanamycin, cycloserine, pyrazinamide and prothionamide. Following completion of
therapy, closure of the destruction cavity was found with local pneumofibrosis.

39. ● With 1.3 million deaths annually, tuberculosis
remains one of the leading causes of mortality
worldwide. The emergence of multidrug- and
extensive drug resistance (MDR-TB and XDR-
TB, respectively) is a major public health
problem that threatens progress made in TB
care and control. Drug resistance arises due to
improper use of antibiotics in drug-susceptible
TB patients, which includes administration of
inappropriate treatment regimens and failure
to ensure that patients complete the whole
treatment course.
● Essentially, drug resistance arises in geographic
locales with weak TB control programs. A
patient who develops active disease with a
MDR-TB strain can transmit this form of TB to
other individuals.1

40. References
● Basic TB Facts | TB | CDC
● https://www.cdc.gov › topic › basics
● https://www.cdc.gov/tb/topic/basics/signsandsymptoms.htm
● https://medlineplus.gov/tuberculosis.html
● Roman Kozlov, MD, DSc, Professor, Director of Institute of
Antimicrobial Chemotherapy, Smolensk State Medical Academy,
Smolensk, Russian Federation

41. THANK YOU
Presented By:
Noor Fatima
Nosheen shabbir
Rafi
Haseeb
Munazza