A SEMINAR ON

Tuberculosis.

BySAI KUMAR.D.

Reg.No.06171R0037

Under the guidance of

Ms.M PRAVEENA KUMARI, M Pharm.

BHARAT INSTITUTE OF TECHNOLOGY

Tuberculosis

It is a bacterial infection. Caused by mycobacterium

tuberculosis (also called tubercle bacillus) Damages a person lungs and other parts of body Fatal if not treated properly

TRANSMISSION Spreads through the air when a

person with active TB • coughs• speaks • laughs • sneezes

Another person breathes in the bacteria and becomes infected

INSIDE THE BODY Once inhaled by a tuberculin free person,

the bacilli multiply 4-6 weeks and spreads through out the body. The bacilli implant in areas of high partial pressure of oxygen: Lung Renal cortex Reticuloendothelial system

SYMPTOMS Perpetual cough Fever Weight loss Pain while breathing Loss of appetite Fatigue Swollen glands chills

DIAGNOSISSkin test- mantoux test Purified protein derivative-PPD

Injected in forearm and examined

2-3 days later Red welt around site of injection indicates infection Other test:

The heaf testThe tine multiple puncture test

CLASSIFICATION OF DRUGS Depending upon the degree of effectiveness and

potential side effects First line drugs: (primary agents)

Are the most effective and lowest toxicity. Isoniazid, Rifampicin

Second line: Less effective and more toxic effects. Pyrazinamide, Ethambutol, Streptomycin

Third line: are least effective and most toxic. Amikacin,Thiacetazone, Viomycin, Cycloserine

BACTERICIDAL AND BACTERIOSTATIC DRUGS

bacteriostatic drugs inhibit the growth of bacteria by interfering with bacterial protein production, DNA replication, or other aspects of bacterial cellular metabolism.

bactericidal drugs inhibit the multiplication of bacilli and destroys the bacilli totally. Bactericidal drugs: Rifampicin, Streptomycin,

Pyrazinamide. Bacteriostatic drugs: Ethambutol, Thioactazone.

RIFAMPICICN (RMP):

RMP is a powerful bactericidal drug. It permeates all tissue membranes including the blood-brain and placental barriers. RMP is specially used when the bacilli resists the other drugs. It is effective against both intracellular and extra cellular bacilli. M.O.A: It acts by binding and inhibiting, DNA-

dependent RNA polymerase in bacilli. Toxic effects :

It includes hepatotoxicity, gastritis, influenza- like illness, thrombocytopenia and nephrotoxicity.

ISONIAZID:

It is a bacteriostatic acting against resting organisms but can

Kill dividing bacteria.

M.O.A: The mechanism of action is not clear but, there is

a evidence that it inhibits the synthesis of Mycolic acid, important constituents of the cell wall and peculiar to mycobacteria.

Adverse Effects: Fever, Hepatotoxicity, Haematological changes.

PYRAZINAMIDE: The drug is bactericidal and is particularly active against slow

multiplying intra cellular bacilli which are unaffected by other drugs.

The drug is given orally and the usual dose is 30mg/kg of body weight divided into 2 or 3 doses per day. It is also used in tuberculosis meningitis.

Pyraniazide is inactivate at neutral PH but tuberculostatic at acid PH. Toxic effects:

hepatotoxicity,

hyperuremia,

Ethambutol is bacteriostatic and is used in combination to prevent the emergence of resistance to other drugs. It is given orally. Ethambutol has replaced para amino salicylic acid (PAS) almost entirely in adults

THIACETAZONE: It is companion drug to isoniazid that is commonly used in India. The usual dose is 2 mg/kg body weight

Toxic effects:

gastrointestinal disturbances, bluring of vision, haemolytic anemia

ETHAMBUTOL:

TREATMENT CHEMOTHERAPY: Chemotherapy of tuberculosis is the new

advancement in this century. The objective of the treatment is elimination of both the fast and slowly multiplying bacilli from the patients body.

Two phase chemotherapy• The first is short, lasting 1-3 months.

During the intensive phase 3 or more drugs are combined to kill as many bacilli as possible

• The second is aimed at sterilizing the small number of persisting bacilli.

SHORT COURSE CHEMOTHERAPY: It is also called as “Directly observed

treatment” (DOTS).

In DOTS treatment a trained person watches the patient as he swallows the drug in his presence and confirming that the drug is taken in intensive phase.

During continuation phase the patient is issued a

medicine for one week in a multi-blister combipack in the purpose of successful chemotherapy by regular and adequate intake.

VACCINESBacilli calmette guerin(BCG): BCG is the current available oral vaccine available today for

protection against tuberculosis. It contains live weakened strains of mycobacterium bovis. It

was first used in 1921 against tuberculosis. Today it is estimated that more than 1 billion people have

received BCG and the safety of this vaccine has not been a issue until recently.BCG vaccine is given at any time from birth to 15 days of

life along with zero dose of oral polio vaccine as recommended by Govt. of India.

BCG vaccine is given on left arm. A wheel or swelling of 6mm is raised above the surface. No spirit is applied before the injection.

• BCG should be given as early as possible in life, before child comes in contact with tuberculosis.

• BCG can be given with other vaccines except measles and MMR.

• Immediately after BCG vaccine there is a small swelling at the injection site which persists up to 6-8 hrs.

• After that swelling disappears and looks like a mosquito bite. After that it forms a small nodule which breaks open and discharges fluid and forms ulcer.

• That heals by a scar the whole process takes up to 2-5 weeks. If scar not formed until 6 months Mantoux test is done if it shows negative BCG vaccine is repeated.

TUBERCULOSIS AND HIV

o World wide the number of people infected with both HIV and tuberculosis are rising.

The disease enters when the HIV kills the normal immune system of the patient and kills the patient which is frequently seen in HIV +ve people.

It is cured by proper TB control program and extending the life of HIV +ve people.

Good TB control program (DOTS) is the largest thing that can be done to control, cure and extend the life of HIV +ve people.

THE FUTURE Despite effective case finding and therepeutic

tools and declines in mortality rates in some countries tuberculosis, appears to continue as an important communicable disease problem world wide for several decades of life.

The high prevalence of infection rates in some countries, the emergence of drug – resistant strains, association of tuberculosis with HIV infection and above all, the perpetuation of the “Non-specific determinants” of the disease in the third world countries made a rapid conquest of the disease.

THANK YOU