AYAZ MUHAMMAD
SHUMAIL
GROUP 41
TOPIC 7
DRUGS RESISTANT
• Drug resistance in TB remains a man-made phenomenon. It emerges as a result
of spontaneous gene mutations in M. tuberculosis that render the bacteria resistant to
the most commonly used anti-TB drugs. Among the reasons for this, the non-compliance
with the treatment regimens is signaled as the first cause.
• few mechanisms are genetic, epigenetic, posttranslational, cellular, or pharmacokinetic
causing drug resistance [7]. Cancer cells can acquire genetic modifications that make
these cells insensitive to therapeutic agents
TYPES OF DRUG-RESISTANT TB
• Mono-resistance:
• resistance to one first-line anti-TB drug only
• Poly-resistance
• resistance to more than one first-line anti-TB drug, other than both isoniazid and
rifampicin
• Multidrug resistance (MDR)
• resistance to at least both isoniazid and rifampicin
CONT..,
• Extensive drug resistance (XDR):
• resistance to any fluoroquinolone, and at least one of three second-line injectable
drugs (capreomycin, kanamycin and amikacin), in addition to multidrug resistance
• Rifampicin resistance (RR):
• resistance to rifampicin detected using phenotypic or genotypic methods, with or
without resistance to other anti-TB drugs. It includes any resistance to rifampicin,
in the form of mono-resistance, poly-resistance, MDR or XDR
DETECTION AND DIAGNOSIS
• There are two kinds of tests used to detect TB bacteria in the body: the TB skin test
(TST) and TB blood tests. A positive TB skin test or TB blood test only tells that a
person has been infected with TB bacteria. It does not tell whether the person
has latent tb infection (LTBI) or has progressed to tb disease . Other tests, such as
a chest x-ray and a sample of sputum, are needed to see whether the person
has TB disease
WHO SHOULD BE TESTED
• Certain people should be tested for TB infection because they are at higher
risk for being infected with TB bacteria, including:
• People who have spent time with someone who has TB disease
• People from a country where TB disease is common (most countries in Latin
America, the Caribbean, Africa, Asia, Eastern Europe, and Russia
• People who live or work in high-risk settings (for example: correctional
facilities, long-term care facilities or nursing homes, and homeless shelters
CONTINUE
• Health-care workers who care for patients at increased risk for TB disease
• Infants, children and adolescents exposed to adults who are at increased risk for
latent tuberculosis infection or TB disease
• People with HIV infection
• People who became infected with TB bacteria in the last 2 years
• People who are sick with other diseases that weaken the immune system
• Elderly people
• People who were not treated correctly for TB in the past
TESTING FOR TB INFECTION
• There are two types of tests for TB infection: the TB skin test and the TB
blood test. A person’s health care provider should choose which TB test to
use. Factors in selecting which test to use include the reason for testing, test
availability, and cost. Generally, it is not recommended to test a person with
both a TB skin test and a TB blood test.
• The TB skin test is also called the Mantoux tuberculin skin test (TST). A TB skin
test requires two visits with a health care provider.
On the first visit the test is placed; on the second visit the health care provider
reads the test.
CONTINUE
• The TB skin test is performed by injecting a small amount of fluid (called
tuberculin) into the skin on the lower part of the arm.
• A person given the tuberculin skin test must return within 48 to 72 hours to
have a trained health care worker look for a reaction on the arm.
• The result depends on the size of the raised, hard area or swelling.
•
• Positive skin test: This means the person’s body was infected with TB
bacteria. Additional tests are needed to determine if the person has latent TB
infection or TB disease.
• Negative skin test: This means the person’s body did not react to the test,
and that latent TB infection or TB disease is not likely.
• There is no problem in repeating a TB skin test. If repeated, the additional test
should be placed in a different location on the body (e.g., other arm).
• The TB skin test is the preferred TB test for children under the age of five
TESTING DURING PREGNANCY
• There is a greater risk to a pregnant woman and her baby if TB disease is not
diagnosed and treated.
• TB skin testing is considered both valid and safe throughout pregnancy. TB
blood tests also are safe to use during pregnancy, but have not been
evaluated for diagnosing TB infection in pregnant women. Other tests are
needed to show if a person has TB disease.
DIAGNOSING LATENT TB INFECTION AND TB
DISEASE
• Diagnosis of Latent TB Infection
• diagnosis of latent TB infection is made if a person has a positive TB test
result and a medical evaluation does not indicate TB disease. The decision
about treatment for latent TB infection will be based on a person’s chances of
developing TB disease by considering their risk factors
•
TB
• TB disease should be suspected in persons who have any of the following
symptoms:
• Unexplained weight loss
• Loss of appetite
• Night sweats
• Fever
• Fatigue
• TB disease is in the lungs (pulmonary), symptoms may include:
• Coughing for longer than 3 weeks
• Hemoptysis (coughing up blood)
• Chest pain
CHEST RADIOGRAPH
• A posterior-anterior chest radiograph is used to detect chest abnormalities.
Lesions may appear anywhere in the lungs and may differ in size, shape,
density, and cavitation. These abnormalities may suggest TB, but cannot be
used to definitively diagnose TB. However, a chest radiograph may be used to
rule out the possibility of pulmonary TB in a person who has had a positive
reaction to a TST or TB blood test and no symptoms of disease.
DIAGNOSTIC MICROBIOLOGY
• The presence of acid-fast-bacilli (AFB) on a sputum smear or other specimen
often indicates TB disease. Acid-fast microscopy is easy and quick, but it does not
confirm a diagnosis of TB because some acid-fast-bacilli are not M. tuberculosis.
Therefore, a culture is done on all initial samples to confirm the diagnosis.
(However, a positive culture is not always necessary to begin or continue
treatment for TB.) A positive culture for M. tuberculosis confirms the diagnosis of
TB disease. Culture examinations should be completed on all specimens,
regardless of AFB smear results. Laboratories should report positive results on
smears and cultures within 24 hours by telephone or fax to the primary health
care provider and to the state or local TB control program, as required by law.
DRUG RESISTANCE
• For all patients, the initial M. tuberculosis isolate should be tested for drug
resistance. It is crucial to identify drug resistance as early as possible to
ensure effective treatment. Drug susceptibility patterns should be repeated
for patients who do not respond adequately to treatment or who have
positive culture results despite 3 months of therapy. Susceptibility results
from laboratories should be promptly reported to the primary health care
provider and to the state or local TB control program.
TREATMENT
• Pulmonary TB
• The usual treatment is:
• 2 antibiotics (isoniazid and rifampicin) for 6 months
• 2 additional antibiotics (pyrazinamide and ethambutol) for the first 2 months of the 6-
month treatment period
EXTRAPULMONARY TB
• Extrapulmonary TB – TB that occurs outside the lungs – can be treated using the same
combination of antibiotics as those used to treat pulmonary TB.
• If you have TB in areas like your brain or the sac surrounding your heart (pericardium),
you may initially be prescribed a corticosteroids such as predinsilone or for several
weeks to take at the same time as your antibiotics. This will help reduce any swelling in
the affected areas.
•
MULTIDRUG-RESISTANT TB
• Multidrug-resistant TB requires a much longer course of antibiotics; between 9 to 24 months depending on the strain.
Multidrug-resistant TB tends to have less favourable outcomes than standard TB.
• Latent TB
• some cases, testing and treatment for latent TB may be recommended for people who require treatment that will weaken their
immune system, such as long-term steroid medicine , chemotherapy biological inhibitors like TNF inhibitors. This is because
there's a risk of the infection becoming active.
• Treatment for latent TB generally involves:
• either taking a combination of rifampicin and isoniazid for 3 months
• or isoniazid on its own for 6 months
•
CHEMOTHERAPY SIDE EFFECTS
• MANAGING DRUG TOXICITY TO ANTI-TB THERAPY[43]
• Gastrointestinal intolerance. Nausea due to gastrointestinal intolerance is usually self-
limiting. ...
• Itching and skin rash. ...
• Drug hypersensitivity. ...
• Hepatotoxicity. ...
• Thrombocytopenia