TUBERCULOSIS

INTRODUCTION:-Tuberculosis which is also referred to as TB in short is a highly infectious disease caused by bacteria named Mycobacterium tuberculosis. It is an air borne germ which is often carried by tiny droplets expelled with cough by an infected person. It can affect both adults as well as small children.

CAUSES:-The primary cause of TB, Mycobacterium tuberculosis, is a small aerobic non-motile bacillus. High lipid content of this pathogen accounts for many of its unique clinical characteristics. The M. tuberculosis complex includes four other TB-causing mycobacterium: M. bovis, M. africanum, M. Canetti and M. microti.Other known pathogenic mycobacterium include Mycobacterium leprae, Mycobacterium avium and M. kansasii. The last two are part of the nontuberculous mycobacteria (NTM) group but are responsible for some pulmonary diseases

SYMPTOMS:-Cough that lasts 3 weeks or longer, and can bring up blood, Chest pain, Fever Fatigue, Unintended weight loss, Loss of appetite, Chills and night sweats.

DIAGNOSIS:-A complete medical evaluation for tuberculosis (TB) must include a medical history, a physical examination, a chest X-ray and microbiological examination (of sputum or some other appropriate sample).It may also include a tuberculin skin test, other scans and X-rays, surgical biopsy. Two tests are available: the Mantoux and Heaf tests.

Mantoux skin test: The Mantoux test for TB involves intradermally injecting PPD (Purified Protein Derivative) tuberculin and measuring the size of induration 48-72 hours later..

Heaf test: A Heaf gun is used to inject multiple samples of testing serum under the skin at once. The needle points are dipped in tuberculin purified protein derivative (PPD) and pricked into the skin. A Heaf gun with disposable single-use heads is recommended. The gun injects purified protein derivative equivalent to 100,000 units per ml to the skin over the flexor surface of the left forearm in a circular pattern of six. The test is read between 2 and 7 days later. The equivalent Mantoux test positive levels done with 10 TU (0.1 ml 100 TU/ml, 1:1000) are 0–4 mm indurations (Heaf 0 to 1); 5–14 mm indurations’ (Heaf 2) ;Greater than 15 mm indurations (Heaf 3 to 5).

TREATMENT: - First-line anti-tuberculosis drug include, Ethambutol, isoniazid, pyrazinamide, rifampicin,Streptomycin. Apart from these there are six classes of second-line drugs (SLDs) used for the treatment of TB include amino glycosides: e.g., amikacin, kanamycin,

Polypeptides: e.g., capreomycin, viomycin, enviomycin;

Fluoroquinolones: e.g., ciprofloxacin, levofloxacin, moxifloxacin;

Thioamides: e.g. ethionamide, prothionamide

Cycloserine

P-amino salicylic acid. Other drugs that may be useful are rifabutin, macrolides: e.g, clarithromycin,

Linezolid; thioacetazone;

PREVENTION:-TB prevention and control takes two parallel approaches. In the first, people with TB and their contacts are identified and then treated. Identification of infections often involves testing high-risk groups for TB. In the second approach, Calmette–Guérin bacillus vaccine is recommended for infants and children who test negative to purified protein derivative, who are continually and intimately exposed to contagious adults or to adults with TB. However, in tropical areas where the levels of other species of mycobacterium are high, exposure to nontuberculous mycobacterium gives some protection against TB. Some of the different medications in the possible prevention of Tuberculosis include: BCG vaccine, TheraCys, TICE, BCG, ImmuCyst, Oncotice, Pacis etc.