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Copy of Biology Disease Tuberculosis

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Aditya Sripathi

on 22 January 2013

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Transcript of Copy of Biology Disease Tuberculosis

Tuberculosis Patient Profile Name: Christopher Tucker
Ethnic Origin: African-American
Age: 40 years old
Other Diseases: None
Weight: 170 lbs (down from 190 lbs)
Allergies: None Experimentally proved to be dangerous in people having consumed more than 40g of alcohol a day or have alcohol disorders
Risk of infection related to specific social mixing patterns associated with alcohol use
Influence on the immune system Patient History: Vulnerable to TB ggg - Frequent Smoking
- Occasional Drinking
- Close Contact with multiple people (Actor)
- Unhealthy Diet How does smoking help Tuberculosis? "Smoking lowers lung immunity, as well as the overall body immunity. Therefore, smokers are more prone to developing TB. That goes for not just active smokers, but passive smokers as well,” Dr Ashok Mahashur, consultant chest physician, Hinduja Hospital, said. Mr. Tucker had symptoms mentioned above
Sputum sample immediately sent to lab as first diagnostic measure *sputum = phlegm Diagnostics: 2 Since, Mr. Tucker was suffering from swollen lymph nodes, the following potential diseases had to be discarded.
1. Lung Cancer
2. COPD - Chronic Obstructive Pulmonary Disease
3. Infection with a fungus, such as inhistoplasmosis
4. HIV
5. Pneumonia - as it can caused by fungi, bacteria and visuses Physical Examination Examination
1. Swollen Nymph Nodes
2. Unusual Breath Sounds (Crackling) *Stethoscope * Lymph nodes - A lymph node is an oval-shaped organ of the immune system, distributed widely throughout the body including the armpit and stomach and linked by lymphatic vessels. Swelling of Lymph Nodes:
Occurs as a result of Bacterial Infection
Present in order to localize infection
Prevents spread of infection Thus, the potential disease our patient is suffering from would be are:
1. Tuberculosis
2. Empyema
3. Infection with another Mycobacterium, such as Mycobacterium kansasii or Mycobacterium avium-intracellularecomplex. Since it was caused by a bacteria which we identified by the swollen lymph nodes, we took blood samples and made him undergo a CXR. Diagnostic Measures 1. Mantoux Test (skin test)
2. Blood Sample Examination
3. Chest Radiograph
4. Sputum Culture 1. Mantoux Test - Involves injection of bacteria into patient intradermally
2. Blood Sample Examination - Useful if doubt of having TB is high
Provides accurate results
3. CXR - Shows different coloration depending on the density of material
4. Sputum Culture - Confirms TB diagnosis
Can take 1-8 weeks for results Diagnostic Tests: 1 1. The CXR was immediately received.
The negative showed presence of large amounts of mucus in the lungs
Mucus, having a low density, does not show a strong white coloration
Large amounts would be visible (murk, cloudy)
Following measures are taken:
The Mantoux test is carried out.
Involves the injection of bacteria intradermally.
If exposed to the bacteria, he will experience an immune development against the bacteria leading to an induration on the skin.
Results are always not accurate
Blood Sample was also sent for further verification Mr. Tucker returned, having no induration on his skin. However the blood samples came out positive showing the presence of Mycobacterium tuberculosis. Results of Diagnostic Test 2: Tuberculosis Cause: Various strains of Mycobacterium, mainly Mycobacterium Tuberculosis
Two main types depending on the activity of bacteria: Active Tuberculosis and Latent Tuberculosis
Vaccine: BCG - Bacillus of Calmette and Guerin, named after the two frenchmen who developed this strain for vaccination. This a form of living weakened germs vaccine. Active and Latent Tuberculosis Tuberculosis Active Latent Pulmonary Extrapulmonary Miliary 4 month treatment with rifampin or 9 month treatment with isoniazid Can be either normal, MDR or XDR form of Tuberculosis Depending upon which form, different types of drugs are prescribed to prevent the bacteria to develop further resistance Killed Germs Living Weakened Germs Living poisonous germs Toxoids Drugs used against Active TB Final Diagnosis Sputum:= positive for active pulmonary tuberculosis
Cannot be prescribed regular drugs to cure until examination
Objective: to identify if it is MDR-TB or XDR-TB, it took 8 weeks. Diagnosis Results Mr. Tucker is affected with XDR-TB (Extremely Drug Resistant Tuberculosis)
Tuberculosis is abbreviated as TB which is Tubercle Bacillus.
Diagnosis Report obtained: 3 weeks Introduction to Treatment XDR-TB has a very high mortality rate.
If known early, it can be successfully treated.
Linezolid - 600mg dose for first two months and depending on reaction 300mg/600mg dose for the next 18 months. Side Effects of Linezolid 1. Bone Marrow Surpression
2. Peripheral and Optic Neuropathy
3. Diarrhea
4. Pancreatitis
5. Vomitting
6. Thrombocytopenia - low blood platlets count
7. Bell's Palsey
8. Kidney Toxicity Antibiotic: Linezolid Synthetic antibiotic
Used for the treatment of serious infections caused by Gram+ bacteria resistant to several other antibiotics
Chemical formula - C16H20FN3O4 Known as reserve antibiotic - should be used sparingly so that it will remain effective as a drug of last resort against potentially intractable infections. How Linezolid works... Belongs to the oxazolidinone class of antibiotics.
It works by attaching to bacterial ribosomes (ribosomes are parts of cells that make protein). Post-treatment Mr. Tucker was hospitalized for a certain period of time
Prevent spread of infection
Co-workers were advised to consult doctor for diagnosis of TB
No side-effects - some people develop resistance against medication thus preventing any medical side-effects. Lifestyle Changes for Mr. Tucker Temporary Changes:
- Stay Home until no longer infectious
- Avoid coming in contact with others
Mandatory Changes:
- Take all medications on time
- Wear mask to cover mouth and nose
- Use tissue when sneezing or coughing
- Avoid unsanitary locations
- Maintain adequate ventilation inside home
- Do 30 mins of light physical exercise/day Patient's Symptoms How do you find out which strain it is ? Intern: Dr. Adz
Dr. Meet
Patient: Mr. Tucker Diagnostic Tests: 2 Patient: Chris Tucker (Actor) Interns: Dr. Patel
Dr. Adz Decrease immune response
Damage the function of the cilia in the airways
Can occur to both active and passive smokers Bibliography First Line Drugs Mainly used in the case of drug sensitive bacteria
Examples include Ethambutol, Isoniazid, Rifampin etc
Consumed orally Injectable second line drugs Injected into the body for faster response
Includes drugs such as Kanamycin and Amikacin Fluoroquinolones Fluoroquinolones are novel anti-TB drugs to be used when a patient is infected with a MDR-TB strain
Used when patient is suffering from MDR-TB
Includes drugs like Ofloxacin, Ciprofloxacin, Sparfloxacin and Levofloxacin
Used along with anti-TB drugs XDR-TB Drugs These drugs should be sparingly used
Not many drugs present
XDR-TB strain effective against the following - two of the strongest first line drugs = Isoniazid and Rafampin
- any fluoroquinolone
- atleast one of the three injectable drugs XDR-TB Drugs Ethambutol
PAS
Streptomycin
Cycloserine
Thioamides I work like this! Binds to the 50S subunit of the bacterial Ribosome
Responsible for making proteins Step 1: Step 2: Prevents it from making proteins required for its growth and also for it to multiply Finally, stops bacteria from growing
Known as bacteriostatic Step 3: Step 4: At the same time, Linezolid also kills the bacteria. Step 1: Isolate the bacteria from the patient from his blood or sputum Bacteria isolated from patient Step 2: Use this isolate and subject it to different anti-TB agents such as Rifampin and Isoniazid etc. Step 3: If growth takes place, then the drug cannot be used Step 4: If growth does not take place, rather the count of bacteria diminishes, then the drug is effective and can be used Known as reserve antibiotic Linezolid What does that mean??? Reserve Antibiotic should be used sparingly so that it will remain effective as a drug of last resort against potentially intractable infections
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