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TUBERCULOSIS

TUBERCULOSIS. PROPHYLAXSIS TREATMENT. PROPHYLAXIS. General prophylaxis Chemo prophylaxis Immuno prophylaxis. GENERAL PROPHYLAXIS. Adequate nutrition Good housing Health education. immunoprophylaxis. BCG vaccine

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TUBERCULOSIS

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  1. TUBERCULOSIS • PROPHYLAXSIS • TREATMENT

  2. PROPHYLAXIS • General prophylaxis • Chemo prophylaxis • Immuno prophylaxis

  3. GENERAL PROPHYLAXIS • Adequate nutrition • Good housing • Health education

  4. immunoprophylaxis • BCG vaccine • AIM: to induce a benign artificial primary infection which stimulates an acquired resistance to possible subsequent infection with virulent tubercle bacili • Live attenuated vaccine developed by Calmette &Guerin

  5. contd…… • It is a strain of M.bovis attenuated by 239 serial subcultures in Glycerin-bile-potato medium over a period of 13 years • It gives DELAYED hypersensitivity & immunity • Following BCG vaccine tuberculin negative pt becomes a positive reactant

  6. contd… • Immunity lasts for 10-15 years • Protection obtained is variable from 0-80% • may be due to • Difference in prevalance&virulence of bacilli in various communtiies • type &potency of vaccine used • Presence of “ atypical mycobacteria” in the areas

  7. complications of vaccine • LOCAL : abscess, indolent ulcer,keloid,tuberculides,confluentlesions,lupoid lesions, lupus vulgaris. • REGIONAL : enlargement & suppuration of draining lymph nodes • GENERAL : fever, mediastinaladenitis,erythemanodosum , tendency to keloid formation ,rarely non fatal meningitis

  8. Pustule formation after adm of BCG vaccine

  9. IS BCG so effective? • it may not protect from risk of TB infection but gives protection to infants &children aginst the more serious types of diseases • Meningitis • Disseminated tuberculosis

  10. contd… • BCG vaccine is included under national immunisation schedule • Given immediately after birth or even at 6 weeks of birth • Route of adm: intradermal injection on deltoid • Dosage: 0.1 ml • O.05 in infant with tuberculin syringe omega microstst needle fitted with 26 gauge 1 cm long steel intrdermal needle

  11. Administration of BCG vaccine

  12. contraindications • Not to be given to infants &children with HIV • Babies born to mothers with AFB +ve sputum shouldnot be given BCG at birth ,but only after a course of preventive chemo therapy

  13. additionally • BCG induces non specific stimulation of immune system providing protection against • Leprosy • Leukemia • In malignancies also

  14. CHEMOPROPHYLAXIS • Adm of antitubercular drugs (isoniazid) to persons with latent TB • High risk of developing active TB • To uninfected exposed to high risk of infection • In infants of mothers with active TB • In children living with a case of active TB in house • ISONIAZID – 5 mg/kg daily for 6 -12 months ( risk decreses by 90%)

  15. THERAPY • Anti tubercular drugs-2 types • Bactericidal drugs • Bacteristatic drugs

  16. FIRST LINE DRUGS • BACTERICIDAL DRUGS • Sterilizing drugs(effectively kill bacteria in the lesions ) • Rifampicin(R) • Pyrazinamide(Z)

  17. Contd…. • Isoniazid(H) –effective only against replicating bacteria • Streptomycin(S)-only against extracellular bacteria

  18. BACTERISTATIC DRUG • Ethambutol(E)

  19. DOTS • Older practice was adm of drugs daily for 2 years which is now replaced by short course regimen of 6-8 months( DOTS ) • There are 3 categories of treatment • Category 1:new sputum positvecases,seriously ill sputum negative pt, seriously ill extra pulmonary cases

  20. Category2 :sputum smear positive relapse,sputum smear positive failure Sputum smear positive treatment after Default Category3:sputum smear negative not Seriously ill,extra pulmonary not seriously ill

  21. Schedule of treatment • Eg:schedule for a new smear positive case • Initial intensive phase • 2 months • HRZE • Given 3 times a week Continuation phase • HR • 3 times a week

  22. DRUG RESISTANCE • Occurs in tubercle bacilli with an approximate rate of once in 10* cell divisions • So multiple drug therapy is implemented • Drug resistance is 2 types • Primary(pretreatment, initial) • Patient is infected with a strian of tubercle bacilli which alredy resistant

  23. contd… • Acquired (secondary,post treatment) • When the infecting strain is initially sensitive becomes resistant usually as a result of • Improper or inadequate treatment • Due to combination lapses in prescribing practices • Drug delivery • Patient compliance • Acquired resistance is most common now –a-days

  24. MDR-TB • It is the serious consequence of unchecked drug resistance • Multi drug resistance means resistance to 2 or more drugs • In TB , it mainly refers to Rifampicin & Isoniazid • These bacilli are unlikely to respond to treatment

  25. treatment of MDR-TB • SECOND LINE DRUGS • Quinolones, • Aminoglycosides, • Macrolides, • Para amino salicylic acid • Thiacetazone, • Cycloserine • Capreomycin etc • Disadvantage is much less effective,more toxicand require prolonged usage

  26. DOTS • To avoid resistance DOTS (directly observed therapy under supervision) • was introduced by RNTCP • This strategy can prevent deterioration of the resistance problem by ensuring the patient’s compliance

  27. THANK YOU

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