Dr. Satti M. SalehChief of Infectious Diseases Department MGH

Director of IC Unit Meeqat General hospital CBAHI IC TEAM Member Medical

Director Meeqat General Hospital

HISTORY •* Mycobacterium tuberculosis

• * MoTT• * 24/3/1882( Robert Koch )

• * 1993( WHO – International Emergency)• * 2000 ( Global partenership (STOP

TB))• * DOT strategy

• * DOTS strategy • * 2006 ( THE STOP TB STRATEGY)

CLINICAL SYNDROMS

Primary TB ( 1st Exposure)

* Laten TB * Reactivation TB

* Pulmonary TB * Extra pulmonary TB

DIAGNOSIS:

AFB stain * Culture

LJmediaBactec

* Molecular Method PCR

Species determinationDrug resistant mutation

Typing * Others

BASIC CONTROLDetection of cases

* Treatment (DOT) * INH Prophylaxis for

high risk * Contact investigation

* Isolation

Standardized short-course anti-TB treatment (SCC) given under

direct and supportive observation (DOT)  .

1 -INH 5mg /kg2 -RMP 10mg/kg

3 -PZA 20-25mg/kg4 -ETM 15-25mg/kg

4 Drugs for 1st 2 months1st 2 Drugs for 2nd 4

months

IsolationAIRBORNE

Negative pressureHEPA filtersHEPA mask

Special mask for patient Pulmonary TB S+A Till

sputum Negative

DRUG RESISTANT TB

Mono resistant (1 drug) * Poly Resistant ( ~ 1 not

MDR) * MDR (INH + RIF)

* Extensively resistant (XDR – all 1st line)

Other drugs1 -Amikacine

2 -Kanamycine3 -Thiacetazone

4-Quinilone5 -cycloserine6-clofazemine

TREATMENT OF LATENT INFECTION

* Tuberculin test * PPD +ve

* PPD -ve (2 step testing)

( * Avoid misclassification)

INDICATION HIV ≥ 5mm

* Immunosuppressive drugs ≥ 5mm * Close contact of TB patient ≥ 5mm

Fibrotic lesion on CXR ≥ 5mm 2years ~10mm> Recently infected

person * High risk medical conditions ~10mm

* Low risk ~ 15mm

DOTS STRATEGY

- Detect smear +ve case & reporting

- Observation of therapy( DOTs ) - Treatment monitoring ( recording,

reporting assessment) - - Short course (Drug

Supply) - Government & non – government

commitment

STOP TB STRATEGY (2006 – 2015)

* DOTs * TB + HIV

* Health System support * Engage all health care

provider * Empower people with

TB & community* Enable & promote

research

Standardized recording and reporting

Helps to keep track of each individual patient and to monitor overall

programme performance

Sustained political and financial commitment.

TB can be cured and the epidemic reversed if adequate resources and

administrative support for TB control are provided