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Puteri ShamillahWan Hidayu
Farhana AzmiraShazeenah
Nadeeja
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May be associated with night sweats
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TB is major cause of illness & death
worldwide
Highest in ASIA & AFRICA
In 2011, almost 1.4 million people died fromTB
(WHO, 2012)
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Physical examination
Unusual breath sounds
Swollen lymph nodes Clubbing of fingers/toes
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L BOR TORY ND PHYSIC L
TESTING1) PPD (Purified protein derivative)
2) Thoracentesis
3) Sputum Examination
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4) Chest Radiography
cavity
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4) Chest Radiography
Acute miliary tuberculosis
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5) Bronchoscopy
6)Tuberculosis antibody testing
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Isoniazid (INH, H)
Ethambutol (RIF, R)
Pyrazinamide(PZA,Z)
Rifampicin (EMB,E)
The First line Supplementary Drugs Streptomycin (SM, S)
Second line Essential Drugs
Category Action
Inhibit cell wall
synthesis
Inhibit Protein
synthesis
Inhibit DNA
gyrase
Aminoglycosides Amikacin
Thioamide Ethionamide
Polypeptide capreomycin
Fluoroquinolones Ofloxacin,
ciprofloxacin
PAS
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Drugs which interfere with mycolic acid synthesis Drugs which inhibit nucleic acid synthesis
Drugs inhibiting protein synthesis
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Drugs Duration Interval Minimum dosesIsoniazid 9 months Daily 270
Twice weekly* 76Isoniazid 6 months Daily 180
Twice weekly* 52Isoniazid and
Rifapentine3 months Once weekly* 12
Rifampin 4 months Daily 120*used directly observed therapy (DOT)
(http://www.cdc.gov/tb/topic/treatment/ltbi.htm)
Table 1: The drugs and duration of the doses used to treat latent tuberculosis
http://www.cdc.gov/tb/topic/treatment/ltbi.htmhttp://www.cdc.gov/tb/topic/treatment/ltbi.htm -
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Highest ++++ High +++ Intermediate ++ Low +
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First Line DrugsHigh efficacy, low toxicity.
Always used in combination.
Bactericidal for rapid multipliers
Bacteriostatic for dormant bacteria
Effective against intracellular & extracellular M.
tuberculosisCombination with other drugs can combat
bacterial drug resistance
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Mycolate depleted cell walls structurally weak
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Used specifically as a TB treatment
Used during first two months of antibiotic therapy
to enhance the efficiency of the antibiotic therapy
Always used with isoniazid and rifampicin Bacteriostatic & bactericidal effect
Well absorbed from GI tract and can penetrate into
cerebrospinal fluid
Partially metabolised in liver
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Converted into pyrazinoic acid by bacterial pyrazinamidase
Acid accumulates inside the bacteria (acidic pH)
Inhibits the fatty acid synthesis in bacteria
Disturbs bacteria cell membrane &energy production
Approximately 70% of an oral dose is excreted in the urine
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Used for drug resistance
Affects for growing bacteria
Disturbs for the formation of bacteria cell
wall Well absorbed from GI tract
Excreted in urine and faeces
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Inhibit mycobacterial Arabinosyl transferases
Inhibit polymerizasion of arabinoglucans
Inhibit cell wall formation
Inhibit bacterial growth
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Resistance Results from an alteration in the polymerase enzyme (mutation in the
rpoB gene).
Semi-synthetic derivative of one of the rifamycins, a group of complex
macrocyclic antibiotics.
It is also considered the most important and potent antituberculosis
agent
Like isoniazid it is bactericidal and highly effective.
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Category Explanation
Absorption Well absorbed from the GI tract
Distribution -80% bound to plasma protein.
-half life: 2-5 hour
-Widely distributed throughout the body including
the CNS.
Metabolism In the liver
Excretion About 1/3 of the drug is excreted in urine, and
2/3 in the intestine. Adjust dose with decreased liver function.
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Antiarrhythmic ( i.e quinidine)Anticoagulants (i.e warfarin)
Oral hypoglycemic
Antiepileptics
Antifungals (i.e ketoconazole)
Antivirals
Oral contraceptive- alternative methodnecessary
Thyroxine
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Aminoglycoside antibiotic
Source: Streptomyces griseus
Bactericidal against the extracellular tuberculosis bacilli.
Overall only suppressive
Resistance:
Combination therapy will delay or prevent resistance.
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Category Explanation
Absorption Well absorbed by Intramuscular and intravenous.
Distribution -extracellular fluid
-34% bound to plasma protein.-half life: 4 -10 hour (Infant), 2-4 (adults)
-cross placenta- enter milk
Metabolism Does not well metabolise.
Excretion -90% in urine
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Drugs Significant side effects
Isoniazid Hepatotoxicity, peripheral neuropathy
Rifampin Gastrointestinal upset, hepatitis
Pyrazinamide hepatotoxicity
Streptomycin Ototoxity, Renal toxicity
Ethambutol Retrobulbar optic neuritis
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1. Skin tests (Tuberculin) detect whether body
had been exposed to TB
Used in high risk populations or in people who
may have been exposed to TB such as health care
workers
Vital for prevention of mycobacterium tuberculosis
2
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2. BCG (Bacillus Calmete Guerin) vaccination Live attenuated vaccine- derived from the bovine strain of tuberculosis
bacteria (mycobacterium bovis)
inducing an artificial primary infection leads to stimulation of acquiredresistance to possible successive infections with virulent bacilli
Recommended for:
a) Babies
b) Older children and adults (
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3. Ventilation of the room to reduce concentration of
aerosolized droplet nuclei
4. Prevent spread from those infected with pulmonary
tuberculosis -Isolation from crowded areas
5. Usage of protective measures-masks, gloves6. Implementation of education programs to educate
people about transmission and methods of
prevention
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5. Practice of several measure to eliminate
the conditions that can increase the risk of
infection
Wearing mask
Avoid spending long time in stuffy area with
infected patients
6. Implementation of education programs
Educate people about the transmission andmethods of prevention
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REFERENCES
Carroll, N. M., Uys, P., Hesseling, A., Lawrence, K., Pheiffer, C.,Salker, F., .Helden, P. D. (2008). Prediction of delayed treatmentresponse in pulmonary tuberculosis: Use of time to positivity valuesof Bactec cultures. Tuberculosis, 88(6), 624-630.
Parsyan, A. E., Saukkonen, J., Barry, M. A., Sharnprapai, S., &Horsburgh Jr, C. R. (2007). Predictors of failure to completetreatment for latent tuberculosis infection. Journal of Infection, 54(3),262-266.
Robertson, B. D., Altmann, D., Barry, C., Bishai, B., Cole, S.,Thomas, D., Young, D. (2012). Detection and treatment ofsubclinical tuberculosis. Tuberculosis, 92(6), 447-452.