Tuberculosis In ThailandBy Junior Sethasathien

What is tuberculosis(TB)?

•An infectious disease that mainly affects the lungs

•Cause by a bacteria

•Spread through microscopic droplets which are released into the air by coughing and sneezing

Causes

•Mainly caused by a non-motile bacillus called Mycobacterium Tuberculosis

•Humans are the only known reservoirs of M. tuberculosis

•Other TB causing mycobacteria includes: M. bovis, M.microti, M.africanum, M.canetti

Risk FactorsMost people who are infected with TB do not develop active TB. However, there are certain factors which increases the risk that the latent TB will develop into the active TB• HIV (50 670 TB patients with known HIV status)• Diabetes• Alcohol• Tobacco • Certain cancers• Chemotherapy• Immunosuppressant

Epidemiology

Epidemiology

SymptomsLatent TB• No symptoms• Not contagious

Active TB• Coughing (lasting 3 weeks or more or with blood)• Chest pain• Unintentional weight loss• Fatigue • Fever • Night sweats• Chills• Loss of appetite

Without treatment

Can spread to other parts of the body through the bloodstream (15-20% of the active cases)•Spinal pain (Pott disease)•Lymph nodes (swelling)•Joint damage•Tuberculous Meningitis•Liver and Kidney problems•Heart Disorders(cardiac tamponade)-rare

TestsTuberculin Skin Test• patient is injected with a small amount of

tuberculin and must return within 48-72 hours to check the results of the skin test (if positive, a raised, hard area, or swelling is found)

TB blood Test (IGRAs = interferon-gamma release assays)• Measures how the immune system to reacts to

the bacteria that causes TB

Treatment Less resistant Active TB

Latent: May only need 1 type of drug depending on the strain of TBActive: Several types of drugs at onceAt least 6-9 MonthsCommon drugs• Isoniazid• Rifampin• Ethambutol• Pyrazinamide

Combination of antibiotics and injectable medications • fluoroquinolones • Amikacin• Kanamycin• Capreomycin

At least 20-30 Months

Vaccine• Bacille Calmette-Guerin (BCG) vaccine

• Partially affective

• Provides some protection against severe form of paediatric TB

• Not completely protective against infants and Adult Pulmonary TB

• Use of BCG makes the Tuberculin skin test a false positive

Future Development• Several new anti-TB drugs are in the advanced

phases of clinical trials

• A new platform called the GeneXpert Omni is in development which would be used for testing TB and rifampicin-resistant TB

• 15 vaccines candidates are in clinical trials whom are focused on adolescents and adults

Bibliography • In search of a new paradigm for protective immunity to TB Cláudio Nunes-

Alves, Matthew G. Booty, Stephen M. Carpenter, Pushpa Jayaraman, Alissa C. Rothchild & Samuel M. Behar Nature Reviews Microbiology 12, 289–299 (2014)

• van Soolingen D, et al. (1997). "A novel pathogenic taxon of the Mycobacterium tuberculosis complex, Canetti: characterization of an exceptional isolate from Africa".International Journal of Systematic Bacteriology 47 (4): 1236–45Sdfsdf

• Teo, SS; Shingadia, DV (June 2006). "Does BCG have a role in tuberculosis control and prevention in the United Kingdom?". Archives of Disease in Childhood 91 (6): 529–31

• http://www.mayoclinic.org/diseases-conditions/tuberculosis/basics/definition/con-20021761

• http://www.cdc.gov/tb/topic/vaccines/• http://www.cdc.gov/tb/topic/testing/• http://apps.who.int/iris/bitstream/10665/44241/1/9789241598866_eng.pdf• http://www.who.int/tb/publications/global_report/

gtbr2015_executive_summary.pdf?ua=1