tuberculosis ppt


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1 : Tuberculosis Dr. Waseem Chisti Fellow Emergency medicine
2 : The Ronald Reagan Institute of Emergency Medicine Dedicated to saving lives by improving Emergency Care in the United States and around the world. Global Emergency Tuberculosis kills 5,000 people a day ! 2.3 million die each year !
3 : The Ronald Reagan Institute of Emergency Medicine Dedicated to saving lives by improving Emergency Care in the United States and around the world. Distribution statistics 1/3 of world’s population is infected with TB 8 Million people develop active TB every year TB kills more young women than any other disease More than 100,000 children will die from TB this year Hundreds of thousands of children will become TB orphans
4 : The Ronald Reagan Institute of Emergency Medicine Dedicated to saving lives by improving Emergency Care in the United States and around the world. TB is an infectious disease that affects mainly the lungs (pulmonary TB or PTB) but can also attack any part of the body (extra-pulmonary TB or EPTB) A person with PTB is infectious to others!
5 : The Ronald Reagan Institute of Emergency Medicine Dedicated to saving lives by improving Emergency Care in the United States and around the world. TB is an ancient infectious disease caused by Mycobacterium tuberculosis. It has been known since 1000 B.C., so it not a new disease. Since TB is a disease of respiratory transmission, optimal conditions for transmission include: overcrowding poor personal hygiene poor public hygiene
6 : The Ronald Reagan Institute of Emergency Medicine Dedicated to saving lives by improving Emergency Care in the United States and around the world. With the increased incidence of AIDS, TB has become more a problem in the U.S., and the world. It is currently estimated that 1/2 of the world's population (3.1 billion) is infected with Mycobacterium tuberculosis. Mycobacterium avium complex is associated with AIDS related TB.
7 : The Ronald Reagan Institute of Emergency Medicine Dedicated to saving lives by improving Emergency Care in the United States and around the world. Transmission Pulmonary tuberculosis is a disease of respiratory transmission, Patients with the active disease (bacilli) expel them into the air by: coughing, sneezing, shouting, or any other way that will expel bacilli into the air
8 : The Ronald Reagan Institute of Emergency Medicine Dedicated to saving lives by improving Emergency Care in the United States and around the world. Once inhaled by a tuberculin free person, the bacilli multiply 4 -6 weeks and spreads throughout the body. The bacilli implant in areas of high partial pressure of oxygen: lung renal cortex reticuloendothelial system
9 : The Ronald Reagan Institute of Emergency Medicine Dedicated to saving lives by improving Emergency Care in the United States and around the world.
10 : The Ronald Reagan Institute of Emergency Medicine Dedicated to saving lives by improving Emergency Care in the United States and around the world. TRANSMISSION Lungs Inhalation of droplet nuclei Coughing: 3000 droplet nuclei/cough Talking: 5 minutes Sneezing: BEST
11 : The Ronald Reagan Institute of Emergency Medicine Dedicated to saving lives by improving Emergency Care in the United States and around the world. Contd.. Person to person via Airborne transmission in Confined environment
12 : The Ronald Reagan Institute of Emergency Medicine Dedicated to saving lives by improving Emergency Care in the United States and around the world. Risk of infection Exposure to TB bacilli Duration of exposure to a person with PTB Intensity of exposure Untreated AFB smear positive PTB cases are the most infectious
13 : The Ronald Reagan Institute of Emergency Medicine Dedicated to saving lives by improving Emergency Care in the United States and around the world. Risk factors for disease Development of disease depends on individual susceptibility • HIV increases the risk of getting TB disease 10% Life time risk of TB in HIV negative 10% Annual risk of TB in HIV positive
14 : The Ronald Reagan Institute of Emergency Medicine Dedicated to saving lives by improving Emergency Care in the United States and around the world. TB presentation TB can present as an active infection with the symptoms of Fever ( evening), sweating Cough (productive) Weight loss Haemoptysis
15 : The Ronald Reagan Institute of Emergency Medicine Dedicated to saving lives by improving Emergency Care in the United States and around the world. Contd.. It can be also present as a latent infection with no clinical features in persons with normal immunity, Once the immunity is hampered it gets active as manifest as active tuberculoses. 10% latent infections turns to active TB in non immunocompromised in life time. 10% of turns to active TB in HIV patients each year.
16 : The Ronald Reagan Institute of Emergency Medicine Dedicated to saving lives by improving Emergency Care in the United States and around the world. cervical
17 : The Ronald Reagan Institute of Emergency Medicine Dedicated to saving lives by improving Emergency Care in the United States and around the world. Supra clavicular
18 : The Ronald Reagan Institute of Emergency Medicine Dedicated to saving lives by improving Emergency Care in the United States and around the world. Potts spine
19 : The Ronald Reagan Institute of Emergency Medicine Dedicated to saving lives by improving Emergency Care in the United States and around the world. Supra renal tuberculosis
20 : The Ronald Reagan Institute of Emergency Medicine Dedicated to saving lives by improving Emergency Care in the United States and around the world. Axillary tuberculosis
21 : The Ronald Reagan Institute of Emergency Medicine Dedicated to saving lives by improving Emergency Care in the United States and around the world. Diagnosis Clinical history Signs of fever, pleural rub,crackles Investigations: X ray chest intradermal PPD Mauntax ZN staning PCR DNA probing
22 : The Ronald Reagan Institute of Emergency Medicine Dedicated to saving lives by improving Emergency Care in the United States and around the world. Classification of Drugs 3 Groups depending upon the degree of effectiveness and potential side effects First Line: (Primary agents) are the most effective and have lowest toxicity. Isoniazid Rifampin Second Line: Less effective and more toxic effects include (in no particular order): p-amino salicylic acid, Streptomycin, Ethambutol Third Line are least effective and most toxic. Amikacin, Kanamycin, Capreomycin, Viomycin, Kanamycin, Cycloserine
23 : The Ronald Reagan Institute of Emergency Medicine Dedicated to saving lives by improving Emergency Care in the United States and around the world. CDC recommended regimes Daily 4 drugs INH. RIF, PZA, EMB for 8 weeks followed by INH/RIF or INH/Rifapentene for 18 weeks. Daily 4 drug therapy for 2 weeks followed by 2 times per week for 6 weeks with INH/RIF for 18 weeks Three times weekly 4 drugs for 8 weeks, RIF/INH for 18 weeks. More prolonged therapy in immunocompromised. Treatment to be given by DOTS.
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