Management of TuberculosisWhat istuberculosis? Tuberculosis is a typed of infectious diseases that affected ourlungs.
This is a multisystemic infectious disease which is caused byMycobacterium tuberculosis, a rod-shaped bacterium. Tuberculosis is second killer of diseases inworld. Research from World Health Organization (WHO), this disease had beenkilled 1.5 million people in 2014,then at 2015 about of 1.8 million people diedbecause of this disease. Tuberculosisis the most common disease in developing countries. For many Europeancountries, TB caused about 25% of adult people died.
Robert Koch discoveredthis disease’s causes,” Mycobacterium tuberculosis” in 1982. Pulmonarytuberculosis is the most common one from the disease. It is the form oftuberculosis that can be contagious.Extra-pulmonarytuberculosis is a tuberculosis that affected organs other than lungs, such aspleura, lymph nodes, spine ,nervous system, abdomen and etc.Mycobacterium tuberculosisMycobacteriumtuberculosis was identified and described by Robert Koch, a physician in Germanby 24 March 1882.Morphology-slightlycurved to straight bacillus-obligateaerobic, acid fast, non-motile, non-spore forming bacilli.- Containsmycolic acid in their cell wall.
-growsslowly between 18-24 hours.How does tuberculosis develop?There aretwo steps of develop of tuberculosis. First stage is when an individual isexposed to the microorganism from the active carrier’s TB.
The second stage isthe infected individual develops the disease. Symptoms of tuberculosisMany of Tb’scarriers do not experiences any symptoms, this condition we called it as latentTb. Actually Tb can stay in our body for years, and it will develop into activeTb.Active Tbcan trigger many symptoms and most of the symptoms is related to respiratorysystem. Example, coughing up the blood or phlegm. For the Tb’s patients willexperience a cough for over three weeks and pain when coughing or during normalbreathing.Otherssymptoms from related with respiratory systems.
-unexplainedfatigue-fever-night -appetiteloss-weight lossTb canaffect many organ such as lungs, kidney, spine and brain. Symptoms is varydepend on which organ is infected. For example, tuberculosis of kidneys causethe patient urinates blood. TB affects the brain and causes meningitis.Risk factors for tuberculosisThere ismore than 95% of all diagnosed Tb cases from developing countries , accordingresearch 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 oftuberculosis Bacteria”Mycobacterium tuberculosis” cause tuberculosis. Some of the bacteria areresistant to the medication.
TB bacteria can inhale them and get tuberculosis.They can transmitted via sneezing, coughing, speaking , and singing. They alsocan be transmitted by manipulating of lesions or processing of tissue orsecretions in hospital or laboratory. Droplet nuclei is too small which isbetween 1 to 5 nanometer that can present in indoor for long time of period.Once released from the host , they will dispread throughout the room.For largerparticle they contain of numerous of bacilli, these particle are not serve as effective vehicle, they do not emittedto alveoli. They will deposit on the mucosa, or skin do not invade to the tissues.Some peoplehave strong immune system may not experience TB symptoms but they will becarriers.
After some time, inactive TB will turn in active TB then only show theirsystems.Complications TB can be fatal, mostly it affects thelungs, and also spreads to other places through blood, causing complications. Forexamples:-Meningitis:swelling of the membranes that cover the brain-spinal pain-jointdamage-heartdisordersManagement for tuberculosisTreatment ofTB commonly involved of antibiotic for 6 to 9 months.Pulmonary TBTreatment ofpulmonary TB consists of few typed of antibiotics.
Thetreatment will be:-twoantibiotics which is isoniazid and rifampicin for sixe months.-twoantibiotics pyrazinameide and ethambutol for the first two weeks of the sixmonths treatment period.The patientmust continue to take the medicine as what doctor prescribed and to completeall the antibiotics. Taking the antibiotics for 6 months is ensured that the TBbacteria 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 TB drugsThe TB drugare carried vary properties, they may be bactericidal, bacteriostric or havingthe ability to prevent TB. They are classified based on their ability toagainst the various populations of the bacilli that can be found intuberculosis. The various populations of bacilli can be metabolically activebacilli, intermediately active bacilli, semi-dormant bacilli, these 3 bacillican undergo occasional spurt of metabolism and dormant bacilli. Some of TBdrugs can function well in an acid environment and others is better in alkalineenvironment.
Bacilli can occur in both extracellular and intracellular spaces,for extracellular space is neutral and alkaline condition but for intracellularis acidic condition. Drug Drug Property Target 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, the periods for treatmentrecommended is 6 months, if the patients have severe complicated disease thenthe time for treatment will be extended which more than 6 months.
The intensivemonths is two months and the continuation phase will be extended which changedto 6 months. AdjunctivetreatmentPyridoxine (vitamin B6)Pyridoxine is most recommended to TB’s patient, it canprevent peripheral neuropathy. Dose of pyridoxine is 25mg daily.
If the patientget peripheral neuropathy during receiving treatment of TB, the dose canincrease to 50-75mg until the symptoms reduced, then reduce to 25mg daily.Steroids The used of corticosteriods is suitable forextra-pulmonary tuberculosis, especially for the TB meningitis andpericarditis. Standard treatmentprotocolsStandard treatment protocols is a treatment with fixeddose combination medicines used in TB treatment.This treatment are divided into 3 regimenRegimen 1: for new and previously treated adults andchildren which more than 8 years old and more than 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 for monitoringto 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