Management individual is exposed to the microorganism from

Management of Tuberculosis

What is
tuberculosis? Tuberculosis is a typed of infectious diseases that affected our
lungs. This is a multisystemic infectious disease which is caused by
Mycobacterium tuberculosis, a rod-shaped bacterium.  Tuberculosis is second killer of diseases in
world. Research from World Health Organization (WHO), this disease had been
killed 1.5 million people in 2014,then at 2015 about of 1.8 million people died
because of this disease.

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Tuberculosis
is the most common disease in developing countries. For many European
countries, TB caused about 25% of adult people died. Robert Koch discovered
this disease’s causes,” Mycobacterium tuberculosis” in 1982.

Pulmonary
tuberculosis is the most common one from the disease. It is the form of
tuberculosis that can be contagious.

Extra-pulmonary
tuberculosis is a tuberculosis that affected organs other than lungs, such as
pleura, lymph nodes, spine ,nervous system, abdomen and etc.

Mycobacterium tuberculosis

Mycobacterium
tuberculosis was identified and described by Robert Koch, a physician in German
by 24 March 1882.

Morphology

-slightly
curved to straight bacillus

-obligate
aerobic, acid fast, non-motile, non-spore forming bacilli.

– Contains
mycolic acid in their cell wall.

-grows
slowly between 18-24 hours.

How does tuberculosis develop?

There are
two steps of develop of tuberculosis. First stage is when an individual is
exposed to the microorganism from the active carrier’s TB. The second stage is
the infected individual develops the disease.

Symptoms of tuberculosis

Many of Tb’s
carriers do not experiences any symptoms, this condition we called it as latent
Tb. Actually Tb can stay in our body for years, and it will develop into active
Tb.

Active Tb
can trigger many symptoms and most of the symptoms is related to respiratory
system. Example, coughing up the blood or phlegm. For the Tb’s patients will
experience a cough for over three weeks and pain when coughing or during normal
breathing.

Others
symptoms from related with respiratory systems.

-unexplained
fatigue

-fever

-night

-appetite
loss

-weight loss

Tb can
affect many organ such as lungs, kidney, spine and brain. Symptoms is vary
depend on which organ is infected. For example, tuberculosis of kidneys cause
the patient urinates blood. TB affects the brain and causes meningitis.

Risk factors for tuberculosis

There is
more than 95% of all diagnosed Tb cases from developing countries , according
research from WHO.

Risk factor

1.     
People
who like to take tobacco or drug and alcohol abusers

2.     
People
who have HIV or AIDS

3.     
Diabetes
patients

4.     
End-stage
kidney disease.

5.     
Malnourishment

6.     
Medications
that suppress the immune systems example, cancer, rheumatoid arthritis, Crohn’s
disease, psoriasis.

7.     
People
who travel to high rate TB countries such as sub—Saharan Africa, India, Mexico
and other Latin American countries.

Causes of
tuberculosis

Bacteria
“Mycobacterium tuberculosis” cause tuberculosis. Some of the bacteria are
resistant to the medication. TB bacteria can inhale them and get tuberculosis.
They can transmitted via sneezing, coughing, speaking , and singing.

They also
can be transmitted by manipulating of lesions or processing of tissue or
secretions in hospital or laboratory. Droplet nuclei is too small which is
between 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 larger
particle they contain of numerous of bacilli, these particle are  not serve as effective 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 TB symptoms but they will be
carriers. After some time, inactive TB will turn in active TB then only show their
systems.

Complications

        TB can be fatal, mostly it affects the
lungs, and also spreads to other places through blood, causing complications.

For
examples:

-Meningitis:
swelling of the membranes that cover the brain

-spinal pain

-joint
damage

-heart
disorders

Management for tuberculosis

Treatment of
TB commonly involved of antibiotic for 6 to 9 months.

Pulmonary TB

Treatment of
pulmonary TB consists of few typed of antibiotics.

The
treatment will be:

-two
antibiotics which is isoniazid and rifampicin for sixe months.

-two
antibiotics pyrazinameide and ethambutol for the first two weeks of the six
months treatment period.

The patient
must continue to take the medicine as what doctor prescribed and to complete
all the antibiotics. Taking the antibiotics for 6 months is ensured that the TB
bacteria is completely killed by the antibiotics.

The aims of the TB treatment is

1.     
To
cure the TB patients

2.     
To
decrease the rate of transmission of TB to others

3.     
To
prevent the TB’s bacteria acquired drug resistance.

4.     
Prevent
ex-patient of TB relapse

5.     
Prevent
people death from TB or its complications.

The essential TB drugs

The TB drug
are carried vary properties, they may be bactericidal, bacteriostric or having
the ability to prevent TB. They are classified based on their ability to
against the various populations of the bacilli that can be found in
tuberculosis. The various populations of bacilli can be metabolically active
bacilli, intermediately active bacilli, semi-dormant bacilli, these 3 bacilli
can undergo occasional spurt of metabolism and dormant bacilli. Some of TB
drugs can function well in an acid environment and others is better in alkaline
environment. Bacilli can occur in both extracellular and intracellular spaces,
for extracellular space is neutral and alkaline condition but for intracellular
is 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 TB

For extra pulmonary, the periods for treatment
recommended is 6 months, if the patients have severe complicated disease then
the time for treatment will be extended which more than 6 months. The intensive
months is two months and the continuation phase will be extended which changed
to 6 months.

Adjunctive
treatment

Pyridoxine (vitamin B6)

Pyridoxine is most recommended to TB’s patient, it can
prevent peripheral neuropathy. Dose of pyridoxine is 25mg daily. If the patient
get peripheral neuropathy during receiving treatment of TB, the dose can
increase to 50-75mg until the symptoms reduced, then reduce to 25mg daily.

Steroids

The used of corticosteriods is suitable for
extra-pulmonary tuberculosis, especially for the TB meningitis and
pericarditis.

Standard treatment
protocols

Standard treatment protocols is a treatment with fixed
dose combination medicines used in TB treatment.

This treatment are divided into 3 regimen

Regimen 1: for new and previously treated adults and
children which more than 8 years old and more than 30 kg

Regimen 3A: for children small than 8 years old and
less than 30 kg with uncomplicated TB disease

Regimen 3B: for children small than 8 years old and
less than 30 kg with uncomplicated TB disease.

Daily dosages
of the individual drugs for adults and children which small than 8 years old
and 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 dose
combination tablets available for adults and children more than 8 years old and
30 kg

Intensive
phase

Continuation
phase

RHZE(
150,75,400,275mg)

RH(
150,75mg)
RH(
300,150mg)

 

Latent TB

Latent TB carrier is a person that carry TB bacteria ,
but without any symptoms show.

For people who have latent TB which are 65 years old
or under 65, then treatment will be recommended. In fact, the antibiotics used
to treat TB can cause liver damage in gediatric patients.

Latent TB may not to be treated if it is thought to be
drug resistant. In this situation, the carrier latent TB may be go for monitoring
to check the infection.

In some time, testing and treatment of latent TB is
required when people who request to do the treatment, and these treatment will
be weaken their immune system, such as long term corticosteroids, chemotherapy
or biological inhibitors such as TNF inhibitor.

Treatment of latent TB

-taking combination of rifampicin and isoniazid for 3
months

-isoniazid on its own for six months.

 

Management of
the common side effects of TB medicines.

The patient who accepted the treatment of TB maybe
effect some side effect. Symptoms is including:

1.      Burning, numbness
and tingling sensation in feet

2.      Joint pains

3.      Anorexia

4.      Nausea

5.      Abdominal

6.      Skin rash with or
without itching.

7.      Changes in the
colour of urine

8.      Yellow colour eyes

9.      Confusion

Common
side 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

 

 

 

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