Management ofTuberculosisTuberculosis is a typed of infectious diseases would affectour lungs. This is consisting many different systemic infectious disease.Mycobacterium tuberculosis, it’s bacteria is a rod-shaped bacterium.
Thisbacteria can cause people to get tuberculosis. Tuberculosis is second killer’s diseases inworld. Research from World Health Organization, this disease had been killed1.5 million people in 2014, than at 2015 about of 1.8 million people diedbecause of Tuberculosis. Tuberculosis is common disease that can be seen in manydeveloping countries.
In many European countries, TB was caused about 25% ofadult people to die. Robert Koch discovered this disease’s causes,” Mycobacteriumtuberculosis” in 1982. Pulmonary tuberculosis is the most common one from thedisease. It is the form of tuberculosis that can be contagious.Extra-pulmonary tuberculosis is different from othertuberculosis it can affect organs other than lungs. Exampe, pleura, lymphnodes, spine ,nervous system, abdomen and etc.
Mycobacterium tuberculosisMycobacterium tuberculosis was discovered and described byRobert Koch, a physician in German by 24 March 1882.Morphology-slightly curved to straight bacillus-obligate aerobic, acid fast, non-motile, non-spore formingbacilli.- Contains mycolic acid in their cell wall.-grows slowly between 18-24 hours.
How doestuberculosis develop?There are two steps of develop of tuberculosis. First stageis when an individual is exposed to the microorganism from the active carrier’sTB. The second stage is the infected individual develops the disease. Symptoms oftuberculosisMany of Tb’s carriers do not experiences any symptoms, thiscondition we called it as latent Tb. Actually Tb can stay in our body foryears, and it will develop into active Tb.
Active Tb can trigger many symptoms and most of the symptomsis related to respiratory system. Example, coughing up the blood or phlegm. Forthe Tb’s patients will experience a cough for over three weeks and pain whencoughing or during normal breathing.Others symptoms from related with respiratory systems.
-unexplained fatigue-fever-night -appetite loss-weight lossTb can affect many organ such as lungs, kidney, spine andbrain. Symptoms is vary depend on which organ is infected. For example,tuberculosis of kidneys cause the patient urinates blood.
TB affects the brainand causes meningitis.Risk factors fortuberculosisThere is more than 95% of all diagnosed Tb cases fromdeveloping countries , according research from WHO.Risk factor1. Peoplewho like to take tobacco or drug and alcohol abusers2. Peoplewho have HIV or AIDS3. Diabetespatients4. End-stagekidney disease.
5. Malnourishment6. Medicationsthat suppress the immune systems example, cancer, rheumatoid arthritis, Crohn’sdisease, psoriasis.7. Peoplewho travel to high rate TB countries such as sub—Saharan Africa, India, Mexicoand other Latin American countries.Causes of tuberculosis Bacteria “Mycobacterium tuberculosis” cause tuberculosis.
Some of the bacteria are resistant to the medication. TB bacteria can inhalethem and get tuberculosis. They can transmitted via sneezing, coughing,speaking , and singing. They also can be transmitted by manipulating of lesions orprocessing of tissue or secretions in hospital or laboratory. Droplet nuclei istoo small which is between 1 to 5 nanometer that can present in indoor for longtime of period. Once released from the host , they will dispread throughout theroom.For larger particle they contain of numerous of bacilli,these particle are not serve aseffective vehicle, they do not emitted to alveoli.
They will deposit on the mucosa, or skin do not invade to the tissues.Some people have strong immune system may not experience TBsymptoms but they will be carriers. After some time, inactive TB will turn inactive TB then only show their systems.Complications TB can befatal, mostly it affects the lungs, and also spreads to other places throughblood, causing complications.
For examples:-Meningitis: swelling of the membranes that cover the brain-spinal pain-joint damage-heart disordersManagement fortuberculosisTreatment of TB commonly involved of antibiotic for 6 to 9months.Pulmonary TBTreatment of pulmonary TB consists of few typed ofantibiotics.The treatment will be:-two antibiotics which is isoniazid and rifampicin for sixemonths.-two antibiotics pyrazinameide and ethambutol for the firsttwo weeks of the six months treatment period.
The patient must continue to take the medicine as what doctorprescribed and to complete all the antibiotics. Taking the antibiotics for 6months is ensured that the TB bacteria is completely killed by the antibiotics.The aims of the TB treatment is 1. Tocure the TB patients2. Todecrease the rate of transmission of TB to others3. Toprevent the TB’s bacteria acquired drug resistance.
4. Preventex-patient of TB relapse 5. Preventpeople death from TB or its complications.
The essential TBdrugsThe TB drug are carried vary properties, they may bebactericidal, bacteriostric or having the ability to prevent TB. They areclassified based on their ability to against the various populations of thebacilli that can be found in tuberculosis. The various populations of bacillican be metabolically active bacilli, intermediately active bacilli,semi-dormant bacilli, these 3 bacilli can undergo occasional spurt ofmetabolism and dormant bacilli.
Some of TB drugs can function well in an acidenvironment and others is better in alkaline environment. Bacilli can occur inboth extracellular and intracellular spaces, for extracellular space is neutraland alkaline condition but for intracellular is acidic condition. Drug Property of drug Target of Bacilli pH properties Site of Action Isoniazid -this drug killed the bacterial after 24 hours. -there is more than 90% of bacterial in first few days of treatment.
-Targeted rapid intermediate growing bacilli. -Can function at alkaline and acid media. -Intracellular and extracellular spaces. Rifampicin -killed the bacteria within one hour -high potency.
– this is more effective sterilizing agent. -Targeted all population including dormant bacilli. -Alkaline and acid media.
-Both extracellular and intracellular space. Pyrazinamide -it is a bactericidal with low potency. -achieves its sterilizing action around 2 to 3 months. -Only target solely growing bacteria -Acid medium -Intracellular bacilli only. Ethambutol -bacteriostatic. -low potency -it can minimizes the emergence of the drug resistance.
-including all the bacterial population. -alkaline and acid media. – both intracellular and extracellular. Streptomycin -this is bactericidal with low potency -rapidly growing bacilli. -Only exist in alkaline medium -Extracellular bacilli. Extra pulmonary TBFor extra pulmonary, theperiods for treatment recommended is 6 months, if the patients have severecomplicated disease then the time for treatment will be extended which more than6 months. The intensive months is two months and the continuation phase will beextended which changed to 6 months. Adjunctive treatmentPyridoxine (vitamin B6)Pyridoxine is most recommendedto TB’s patient, it can prevent peripheral neuropathy.
Dose of pyridoxine is25mg daily. If the patient get peripheral neuropathy during receiving treatmentof TB, the dose can increase to 50-75mg until the symptoms reduced, then reduceto 25mg daily.Steroids The used of corticosteriods issuitable for extra-pulmonary tuberculosis, especially for the TB meningitis andpericarditis. Standard treatment protocolsStandard treatment protocolsis a treatment with fixed dose combination medicines used in TB treatment.This treatment are dividedinto 3 regimenRegimen 1: for new andpreviously treated adults and children which more than 8 years old and morethan 30 kgRegimen 3A: for children small than 8 years old andless than 30 kg with uncomplicated TB diseaseRegimen 3B: for children small than 8 years old andless than 30 kg with uncomplicated TB disease.
Daily dosagesof the individual drugs for adults and children which small than 8 years oldand less than 30 kg Essential TB drug Dose mg/kg Dose range Rifampicin 10 8-12 Isoniazid 5 4-6 Streptomycin 15 12-18 Ethambutol 15 15-20 Streptomycin 15 12-18 Fixed dosecombination tablets available for adults and children more than 8 years old and30 kg Intensive phase Continuation phase RHZE( 150,75,400,275mg) RH( 150,75mg) RH( 300,150mg) Latent TBLatent TB carrier is a person that carry TB bacteria ,but without any symptoms show.For people who have latent TB which are 65 years oldor under 65, then treatment will be recommended. In fact, the antibiotics usedto treat TB can cause liver damage in gediatric patients.Latent TB may not to be treated if it is thought to bedrug resistant.
In this situation, the carrier latent TB may be go formonitoring to check the infection.In some time, testing and treatment of latent TB isrequired when people who request to do the treatment, and these treatment willbe weaken their immune system, such as long term corticosteroids, chemotherapyor biological inhibitors such as TNF inhibitor. Treatment of latent TB-taking combination of rifampicin and isoniazid for 3months-isoniazid on its own for six months. Management ofthe common side effects of TB medicines.The patient who accepted the treatment of TB maybeeffect some side effect. Symptoms is including:1. Burning, numbnessand tingling sensation in feet2.
Joint pains3. Anorexia4. Nausea5. Abdominal6.
Skin rash with orwithout itching.7. Changes in thecolour of urine8. Yellow colour eyes9. ConfusionCommonside effect of TB drugs Side effect ( minor) Drugs Anorexia, nausea, abdominal pains Rifampicin Burning sensation in feet Isoniazid Joint pains Pyrazinamide Orange/ red coloured urine Rifampicin Side effects (major) Drugs Skin itching or rash Streptomycin, Rifampicin, Isonazid Dizziness Streptomycin Deafness Streptomycin Vomiting, confusion Isoniazid, Rifampicin, Pyrazinamide Generalised purpura, shock and purpura Rifampicin Visual impairment/ loss Ethambutol Own strategies for management of tuberculosis.
Mycobacterium tuberculosis canbe transmitted through airborne, and technique that reduce the number number ofdroplet nuclei in the room air is veryeffective in preventing the airborne transmission transmissions oftuberculosis. Ventilation with fresh air is very important, so we need tomaintain the good ventilation all the time.The number of the airbornevehicle can be reduced by ultraviolet irradiation of air in the upper part ofroom. Effective anti-tuberculosis chemotherapy reduces the number of thebacilli released into air by reducing the number of the organism in the sputumand the frequency of coughing. With covering the mouth and the nose with tissuewhile sneezing and coughing or can use mask also. With reduce the number of thedroplet nuclei put in air, then directly reduce the rate of the transmission.
For the TB patients, theyshould:1. Spend more at outdoor.2. Possiblysleep alone or separate with people3. Preventused public transport4. Preventgo the place that gathered a lot of people.BCG vaccineBCG vaccine is known asbacilli Calmette- Guerin is a vaccine for tuberculosis disease.
Many foreigncountries ,the new born baby will be inject BCG vaccine to preventtuberculosis, tuberculosis meningitis and also military disease.However BCG vaccine is notrecommend in US because it is not effective to adult and they considered it islow risk of infection mycobacterium tuberculosis. This is because that variableeffectiveness of the vaccine against adult pulmonary TB, and the vaccine’spotential interference with the tuberculin skin test reactivity. The BCGvaccine should be considered only fo very few select persons who meet criteriaand the consultation with a TB expert.
BCG vaccine should onlyconsidered for children who have a negative tubulin skin test and whocontinually exposed and adult who cannot separate from it, and who have TBcaused by strained resistant to isoniazid and rifampin.BCG vaccine also should giveto health care workers on an individual basis in setting in which the aroundthe high percentage of TB patient which mycobacterium tuberculosis strainsresistant to both isoniazid and rifampin and comprehensive TB infection control precaution had been implement,but have not been successful.BCG should apply to:-people who areimmunosuppressed or who are likely ti become immunocomprised.
-BCG vaccine should not giveto pregnant.Detect the disease will bebetter and it can be cured in high percentage. TB skin test and the TB bloodtests.If positive test for these twotests shown that the person had been infected by TB disease.
