Академический Документы
Профессиональный Документы
Культура Документы
ID: 10-4-169
Incubation Period
From infection to development of a primary lesion (the incubation period) or
significant TST reaction or positive IGRA is approximately 2 to 12 weeks. The risk
for developing active disease is the highest in the first two years after infection
and development of a positive TB skin test reaction.
Cycle of infection
Causative agent
The main cause of TB is Mycobacterium tuberculosis, a small, aerobic, nonmotile bacillus. The
high lipid content of this pathogen accounts for many of its unique clinical
characteristics. It divides every 16 to 20 hours, which is an extremely slow rate compared with other
bacteria, which usually divide in less than an hour. Mycobacteria have an outer membrane lipid
bilayer. If a Gram stain is performed, MTB either stains very weakly "Gram-positive" or does not retain
dye(acid fast) as a result of the high lipid and mycolic acid content of its cell wall. MTB can withstand
weak disinfectants ,anti microbials and survive in a dry state for weeks. In nature, the bacterium
can grow only within the cells of a host organism, but M. tuberculosis can be cultured in the
laboratory.
Reservoir
Humans are the only known reservoir for M. tuberculosis. Reservoirs are
pulmonary TB cases with positive sputum for acid fast bacilli.
Source of infection:
Sputum positive for tubercle bacilli who either received no treatment or not fully
treated ( can discharge the bacilli in their sputum for years)
Entry and Exit
Nose and Mouth
Mode of transmission
When people with active pulmonary TB cough, sneeze, speak, sing, or spit, they
expel infectious aerosol droplets 0.5 to 5.0 m in diameter. A single sneeze can
release up to 40,000 droplets. Each one of these droplets may transmit the
disease, since the infectious dose of tuberculosis is very low (the inhalation of
fewer than 10 bacteria may cause an infection)
Susceptibility
A number of factors make people more susceptible to TB infections. The most
important risk factor globally is HIV; 13% of all TB cases are infected by the
virus.This is a particular problem in sub-Saharan Africa, where rates of HIV are
high. Of people without HIV who are infected with tuberculosis, about 510%
develop active disease during their lifetimes; in contrast, 30% of those
coinfected with HIV develop the active disease.
Tuberculosis is closely linked to both overcrowding and malnutrition, making it
one of the principal diseases of poverty. Those at high risk thus include: people
who inject illicit drugs, inhabitants and employees of locales where vulnerable
people gather (e.g. prisons and homeless shelters), medically underprivileged
and resource-poor communities, high-risk ethnic minorities, children in close
contact with high-risk category patients, and health care providers serving these
patients.
Chronic lung disease is another significant risk factor. Silicosis increases the risk
about 30-fold. Those who smoke cigarettes have nearly twice the risk of TB than
nonsmokers.
Other disease states can also increase the risk of developing tuberculosis. These
include alcoholism and diabetes mellitus (threefold increase).
Control program of TB
I.
II.
B. Chemotherapy
Direct observation therapy with short course chemotherapy( DOTS)is
recommended for TB case control. According to WHO, The most costeffective way to stop the spread of TB in communities with a high
incidence is by curing it. The best curative method for TB is known as
DOTS. DOTS has five main components:
Advantages of DOTS
Rapid cure; eliminate rapid & slow multipliers
Low failure rate
Reduce emergence of drug resistant straint
Improved compliance
Second line
The second line drugs are considered as the reserved therapy for tuberculosis
treatment. These drugs are often used in special conditions. When situations like
resistance to first line therapy, extensively drug-resistant tuberculosis (XDR-TB)
or multidrug-resistant tuberculosis (MDR-TB) arise, the second-line drugs are
implemented for the treatment of tuberculosis. There are six classes of secondline drugs (SLDs) used for the treatment of TB. A drug may be classed as secondline instead of first-line for one of three possible reasons: it may be less effective
than the first-line drugs (e.g., p-aminosalicylic acid); or, it may have toxic sideeffects (e.g., cycloserine); or it may be unavailable in many developing countries
(e.g., fluoroquinolones):
Terizidone
C. Other measures
Isolation : isolate at home if condition permits, otherwise hospitalization
is required
Concurrent and terminal disinfections of the patients sputum
Rehabilitation : help the patient integrate himself into society within his
limited physical ability.
Reference.
www.vanderbilt.edu/HRS/wellness/OHC/ohctb.pdf
http://tb.med.cam.ac.uk/tuberculosis/
http://en.wikipedia.org/wiki/Tuberculosis_management
http://www.state.in.us/isdh/23325.htm
http://en.wikipedia.org/wiki/Tuberculosis
http://en.wikipedia.org/wiki/DOTS_(Directly_Observed_Treatment,_Short
-Course)