TUBERCULOSIS

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TUBERCULOSIS

• Known to occur 3000 years ago
• Chronic bacterial infection causing high disease
  morbidity and mortality world-wide
• Airborne disease that is transmitted only after
  prolonged exposure to someone with active disease
• TB usually infects the lungs but other organs can
  be involved

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Mycobacterium tuberculosis
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TRANSMISSION
Aerosols generated by coughing, sneezing and
talking dry to form droplet nuclei. Those (1-5um)
containing 1-3 bacilli are inhaled
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(No Transcript)
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TUBERCULOSIS-THE PROBLEM

• DISEASE STATUS - 2000
• 2 billion people infected world-wide
• 10 million world-wide develop active
  tuberculosis annually 2 million die
• 10 million new cases in 2005 1 billion new
  cases in 2020.
• Emergence of drug resistant Mycobacterium
  tuberculosis

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GLOBAL TUBERCULOSIS

• 95 of cases in developing countries with an
  increase of 3 annually, 10 in African
  countries
• 80 of cases seen in 22 countries about half in
  5 countries India, China, Indonesia Nigeria and
  Bangladesh

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THE PROBLEM OF DRUG RESISTANT TB

• Emergence of drug resistance some 50 years ago.
• Mutation frequencies range from 1 in 105 to 1 in
  108 replications.
• Primary drug resistance to single drug occurs in
  previously untreated cases 9.
• Secondary drug resistance occurs in patient who
  fails to complete course of treatment and
  relapses.
• These selected strains also have spontaneous
  mutations to other drugs-produce MDR-TB in new
  hosts.
• MDR-TB difficult and expensive to treat.
• XDR-TB even worse with higher mortality.

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DRUG RESISTANT TUBERCULOSIS

• Multi-drug resistant TB (MDR TB)
• Resistance to at least isoniazid rifampin.
• Treatment requires use of second-line (SLDs)
  drugs.
• Extensively drug-resistant TB (XDR)
• resistance to isoniazid, rifampin all
  fluoroquinolones and at least 1 of 3 injectable
  2nd line drugs..

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CAUSES OF DRUG RESISTANCE

• Inadequate dosage or treatment with too few
  drugs.
• Lack of compliance
• Patients fail to take medication consistantly for
  6-12 months necessary for cure.
• Patients feel better after 3 or 4 weeks
• Drugs have unpleasant side effects
• Addicts sell TB drugs to buy narcotics

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MDR TB among new cases of TB, 1994-2002
countries with at least 1 case of XDR TB as of
January 2007

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