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Tuberculosis

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Arun Kumar Sanapala
Arun Kumar Sanapala

Tuberculosis is caused by Mycobacterium tuberculosis and commonly affects the lungs and central nervous system. It is transmitted through inhalation of airborne particles. The bacteria spread via the lymphatic system and blood after initial infection of the lungs. Symptoms include weight loss, fatigue, cough, fever and night sweats. Diagnosis involves the Mantoux skin test. Treatment requires a combination of antibiotics like isoniazid, rifampin and pyrazinamide over several months to kill active and dormant bacteria. Patients are counseled on medication side effects, lifestyle changes and preventing transmission.

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Communicable Diseases Dr.S.Arun Kumar, M.Pharm., Ph.D Associate Professor, SDIP
Tuberculosis Tuberculosis is an infection caused by Mycobacterium tuberculosis that commonly affects lungs (Pulmonary tuberculosis) and also the central nervous system (meningitis), lymphatic system, circulatory system, genitourinary system, bones and joints. Etiology: ? Inhalation of airborne particles (droplet nuclei)
Pathogenesis i. Latent infection occurs when the tubercle bacilli are inhaled into the body. ii. After inhalation droplet nuclei containing M.tuberculosis settle into the bronchioles and alveoli of the lungs. iii. After 14 to 21 days of infection, tubercle bacilli spread via the lymphatic system and blood system to other organs. iv. The organism replicate for 2 to 12 weeks till they reach a specific number. v. T cells secrete interferon-Y, interlukin-2, interlukin-10 and other cytokines and macrophages to engulf and kill the tubercle bacilli and prevent further spread. vi. At this point patient develops cell mediated immunity which can be detected by a reaction to tuberculin test.
Clinical Manifestations ? Weight loss ? Fatigue ? Productive cough ? Fever ? Night sweats ? Frank Hemoptysis
Lab Investigations ? Mantoux Test: is the preferred TB skin test. ? It uses tuberculin purified protein derivative. ? The standard 5 tuberculin unit ppd dose is placed intracutaneously on volar aspect of forearm with a 26-27 gauge needle. ? The injection should produce a small raised blanched wheal. ? The area of in duration (bump) is the end point.
Management ? Non-Pharmacological ? Pharmacological Treatment ? Drugs used for treating Tuberculosis: ? First Line drugs ? Isoniazid ? Rifampicin ? Ethambutol ? Pyrazinamide ? Streptomycin
Drugs Used for Treating Tuberculosis
? The current treatment for the complete elimination of active and dormant bacilli involves two phases: ? Initial phase: Three or more drugs (INH, rifampicin, pyrazinamide and ethambutol or streptomycin) are used for two months and allow a rapid killing of actively dividing bacteria, resulting in the negativization of sputum. ? Continuation phase: Fewer drugs (INH and rifampicin) are used for 4 to 7 months, aimed at killing any remaining or dormant bacilli and preventing recurrence.
Counseling Points for TB Patients ? It mainly spreads from one person to another through inhalation of air suspended droplets contaminated with tuberculosis pathogens. ? TB is a serious illness and need combination of medications to treat the disease. ? Typical symptoms of TB are persistent cough for more than 2-3 weeks, fever for more than 7 days, shortness of breath, decrease in appetite, sudden or unexpected weight loss, fatigue, sweating at night and productive cough with sputum.
About Medication ?First Line Medication ? Rifampicin: Body fluids (tears, urine, and saliva) may turn orange colored. ? INH: Ask patients to minimize alcohol consumption-hepatitis ? Pyrazinamide: Patient must be asked to seek medical attention if signs of liver disorder. ? Ethambutol: Patient must also be told to get routine vision test done as ethambutol can cause blindness.
Lifestyle modifications ? Patient should be asked to cover the nose and mouth while sneezing or coughing ? Stay in well ventilated room ? Avoid close contact with children and elderly who have weak immune system. ? Advise to dispose patient’s sputum by burning or burying.

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Tuberculosis

  • 1. Communicable Diseases Dr.S.Arun Kumar, M.Pharm., Ph.D Associate Professor, SDIP
  • 2. Tuberculosis Tuberculosis is an infection caused by Mycobacterium tuberculosis that commonly affects lungs (Pulmonary tuberculosis) and also the central nervous system (meningitis), lymphatic system, circulatory system, genitourinary system, bones and joints. Etiology: ? Inhalation of airborne particles (droplet nuclei)
  • 3. Pathogenesis i. Latent infection occurs when the tubercle bacilli are inhaled into the body. ii. After inhalation droplet nuclei containing M.tuberculosis settle into the bronchioles and alveoli of the lungs. iii. After 14 to 21 days of infection, tubercle bacilli spread via the lymphatic system and blood system to other organs. iv. The organism replicate for 2 to 12 weeks till they reach a specific number. v. T cells secrete interferon-Y, interlukin-2, interlukin-10 and other cytokines and macrophages to engulf and kill the tubercle bacilli and prevent further spread. vi. At this point patient develops cell mediated immunity which can be detected by a reaction to tuberculin test.
  • 4. Clinical Manifestations ? Weight loss ? Fatigue ? Productive cough ? Fever ? Night sweats ? Frank Hemoptysis
  • 5. Lab Investigations ? Mantoux Test: is the preferred TB skin test. ? It uses tuberculin purified protein derivative. ? The standard 5 tuberculin unit ppd dose is placed intracutaneously on volar aspect of forearm with a 26-27 gauge needle. ? The injection should produce a small raised blanched wheal. ? The area of in duration (bump) is the end point.
  • 6. Management ? Non-Pharmacological ? Pharmacological Treatment ? Drugs used for treating Tuberculosis: ? First Line drugs ? Isoniazid ? Rifampicin ? Ethambutol ? Pyrazinamide ? Streptomycin
  • 7. Drugs Used for Treating Tuberculosis
  • 8. ? The current treatment for the complete elimination of active and dormant bacilli involves two phases: ? Initial phase: Three or more drugs (INH, rifampicin, pyrazinamide and ethambutol or streptomycin) are used for two months and allow a rapid killing of actively dividing bacteria, resulting in the negativization of sputum. ? Continuation phase: Fewer drugs (INH and rifampicin) are used for 4 to 7 months, aimed at killing any remaining or dormant bacilli and preventing recurrence.
  • 9. Counseling Points for TB Patients ? It mainly spreads from one person to another through inhalation of air suspended droplets contaminated with tuberculosis pathogens. ? TB is a serious illness and need combination of medications to treat the disease. ? Typical symptoms of TB are persistent cough for more than 2-3 weeks, fever for more than 7 days, shortness of breath, decrease in appetite, sudden or unexpected weight loss, fatigue, sweating at night and productive cough with sputum.
  • 10. About Medication ?First Line Medication ? Rifampicin: Body fluids (tears, urine, and saliva) may turn orange colored. ? INH: Ask patients to minimize alcohol consumption-hepatitis ? Pyrazinamide: Patient must be asked to seek medical attention if signs of liver disorder. ? Ethambutol: Patient must also be told to get routine vision test done as ethambutol can cause blindness.
  • 11. Lifestyle modifications ? Patient should be asked to cover the nose and mouth while sneezing or coughing ? Stay in well ventilated room ? Avoid close contact with children and elderly who have weak immune system. ? Advise to dispose patient’s sputum by burning or burying.
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