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Transcript of Tuberculosis
o Nobel Prize in physiology or medicine in 1905 • Bacterium : Mycobacterium tuberculosis (M.tb)
o Highly aerobic
o Division Camille Balangue, Faith Cayobit, Gonzalo Escarate, Victoria Velinsky
o It is caused by bacterium Mycobacterium tuberculosis
o Bacteria is spread through the air
o It mostly attacks the lungs, but can also attack any part of the body
o Other common sites of infection are the kidney, spine, and brain
o Can lead to death if not carefully treated. • 2 Forms of Infection: Latent and Disease
• Latent Tuberculosis Infection (LTBI)
o Infected with the bacteria but asymptomatic
o Not considered infectious and cannot spread TB to others
o 5-10% of those with latent TB will develop TB disease
- People with compromised immune systems (i.e., HIV-positive) have a higher risk of developing TB disease
o Must be treated for latent TB to prevent TB disease from developing Tuberculosis What Mechanism of Infection Forms/Types of Disease How • TB Disease
o Bacteria overcome defense system and begin to multiply
o Symptoms: unexplained weight loss, loss of appetite, night sweats, fever, fatigue, chills
o Symptoms of TB infection of lungs: coughing for 3 weeks or longer, hemoptysis (coughing up blood), chest pain
o Infectious and can spread the disease to others Diagnosis • 2 kinds of diagnostic tests: tuberculin skin tests and TB blood tests
• Only confirm infected with M. tuberculosis, not latent TB or TB disease
o A chest x-ray and sputum sample to determine disease TB Skin Test (Mantoux Tuberculin Skin Test • Small portion of tuberculin fluid injected into the lower part of the arm
• Person must return within 48 to 72 hours to have a trained healthcare professional look for a reaction
o If a raised, hard, swelling area is present, they will measure it with a ruler
• Positive: Infected with TB bacteria
• Negative: Unreactive to the test. TB Blood Test (Interferon-Gamma Release Assays/IGRAs) • 2 FDA-approved IGRAs
o QuantiFERON ®-TB Gold In-Tube test (QFT-GIT)
o T-SPOT ® TB test
o Positive IGRA: Infected with TB bacteria
o Negative IGRA: Blood did not react to TB test Other Diagnostic Tests • Chest radiograph
o Lesions in the lungs varying in size, shape, density, and cavitation may suggest TB disease
• Sputum Smear
o The presence of acid-fast bacilli (AFB) indicates TB disease, but does not confirm TB diagnosis since there are other acid-fast bacteria besides M. tuberculosis
o A culture is done on all initial samples to confirm diagnosis Control & Prevention • There are several effective measures that can prevent TB
o Avoid spending long periods of time in stuffy, enclosed rooms with people infected with TB disease.
o Cover your mouth to avoid spreading air particles.
o Wear a face mask if you work in a facility that cares for people with TB.
• BCG (bacilli Calmette-Guerin) Vaccine
o Usually given to infants in places where tuberculosis is more common.
o Effective in preventing TB in infants and small children.
o Not recommended for general use in the U.S. because TB risk is low
o Not very effective in adults, causes a false-positive TB skin test result
o Researchers are working on developing a more effective vaccine Tuberculosis Today Treatment Treatment for Latent TB Infection (LTBI)
• 3 Drugs
o Isoniazid (INH)
o Rifampin (RIF)
o Rifapentine (RPT)
• 4 Regimens
o Chosen based on risk factors (i.e., HIV-infected, recent immigrants, organ transplant recipients) Treatment for TB Disease
• 10 Drugs
o First-line anti-TB agents that form the core of treatment regimens:
• Regimens Current Research • Trends
o How to control/treat its co-morbidity with the HIV epidemic
o Control of multi-drug resistant (MDR) & extensively drug resistant (XDR) strains
o Social, cultural, and geographic implications • Tuberculosis Epidemiologic Studies Consortium (TBESC)
o Strengthen, focus, and coordinate TB research
- Prospective Evaluation of immunogenetic and immunologic markers for susceptibility to M. tuberculosis infection and progression from M. tuberculosis infection to active TB
• Tuberculosis Trials Consortium (TBTC)
o To conduct programmatically relevant research concerning diagnosis, clinical management, and prevention of TB
- Randomized, placebo-controlled, double-blind Phase I/II clinical trial assessing the safety and microbiological activity of Linezolid added to Optimized Background Therapy (OBT) for MDR TB or XDR TB.
• Behavioral and Social Science Research
o How behaviors, social, cultural and environmental influences affect TB-related care seeking, diagnosis, treatment success, and prevention
- Enhanced Surveillance to Identify Missed Opportunities for Prevention of Tuberculosis in the Foreign-Born Current News • "Experimental Tuberculosis Vaccine Fails to Protect Infants"
• "Tuberculosis Hiding in Bone Marrow Helps Deadly Bacteria Survive"
• Several localized outbreak cases, generally in schools
• World TB Day March 24 Where Epidemiology • Worldwide disease
o One-third of the global population has some form of TB!
• Asia and Africa account for nearly 80% of cases worldwide.
• Still a concern in U.S. and other high-income nations
o 10,500 U.S. cases (2011)
o 61% of cases among people born outside the U.S. How Many People Infected Each Year? • 8.7 million new TB cases worldwide (2011)
• Africa has the highest number of new TB cases per capita at 260/100,000 people.
o Compare this with 3.4/100,000 Americans What May Promote High Levels of Infection • AIDS (The major risk factor for active TB)
• Crowded, unsanitary conditions Why Not Widespread in U.S. • Better access to healthcare and antibiotics
• Better standard of living even for people on low income Cell Wall Lipid content due to mycolic acid
Gram staining, positive
Acid-fast, M. tb turns red