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Rifampin (RIF), given orally, is bactericidal, is well-absorbed, penetrates well into cells and CSF, and acts rapidly. Close contacts of an active case and others at high risk and with a negative TST or IGRA should also be considered for preventive treatment unless contraindicated. Most patients with TB can be treated as outpatients, with instructions on how to prevent transmission usually including, Avoiding visitors (except for previously exposed family members), Covering coughs with a tissue or an elbow. Presumed activity is based on drug susceptibility test results, a known source case, prior exposure to anti-TB drugs, or drug susceptibility patterns in the community. Although some patients with XDR-TB can be cured, mortality is higher, and the outcome depends on the number of effective drugs that remain as well as the extent of lung destruction caused by the bacilli. Dissemination of bacilli during primary infection is usually much more extensive in patients with HIV infection. Of the 8.7 million TB incident cases reported, in 2011, about 1.2 million people are also suffering from HIV. They disperse primarily through coughing, singing, and other forced respiratory maneuvers by people who have active pulmonary or laryngeal TB and whose sputum contains a significant number of organisms (typically enough to render the smear positive). Successful treatment of drug-resistant TB depends on the use of multiple active drugs simultaneously, so that any resistance to one drug is countered by the killing effects of a 2nd, 3rd or 4th drug. Pulmonary tuberculosis is often suspected based on one of the following: Chest x-rays taken while evaluating respiratory symptoms (cough lasting > 3 wk, hemoptysis, chest pain, dyspnea), an unexplained illness, fever of unknown origin (FUO), or a positive tuberculin skin test, IGRA done as a screening test or during contact investigation. Latent infection 3. It is the most dangerous bacterial infection responsible for severe increase in death cases. Tuberculosis (TB) is an infectious disease caused by the bacillus Mycobacterium tuberculosis (Mtb). 1. WHO: Global Tuberculosis Report 2017: Executive Summary. Drenching night sweats are a classic symptom but are neither common in nor specific for TB. Mycobacteria are small, slow-growing, aerobic bacilli. Furthermore, all drugs in the regimen must be taken scrupulously for an extended period. Imaging Spectrum of Extrathoracic Tuberculosis. It is difficult to diagnose on the basis of imaging characteristics and clinical symptoms, and biopsy is required in many cases. Surgical resection of a persistent TB cavity or a region of necrotic lung tissue is occasionally necessary. In AIDS patients, a mycobacterial illness that develops while the CD4 count is ≥ 200/μL is almost always TB. 3. This site needs JavaScript to work properly. The figures are 4,90,000s cases and 64,000 deaths among HIV-negative children per year. Thus, it is considered worthwhile in high-burden regions. to people or society. Resistance is still relatively uncommon in the US but is more common globally. Those with symptoms and any significant aminotransferase elevation (or asymptomatic elevation > 5 times normal) by definition have hepatic toxicity, and INH is stopped. INH causes hepatotoxicity in up to 4 to 5% of patients > 65 yr (compared with < 1% of patients < 65 yr). Patients with optic neuritis present initially with an inability to distinguish blue from green, followed by impairment of visual acuity. Pediatr Radiol. Its action is similar to RIF, but it affects the metabolism of other drugs less. Regimens involving less than daily dosing must be carried out as DOT because each dose becomes more important. PZA is commonly used during pregnancy, but its safety has not been confirmed. In 2016, 9287 new cases were reported to the CDC for a case rate of 2.9/100,000, which was a slight decrease from 2015. Corticosteroids are sometimes used to treat TB when inflammation is a major cause of morbidity and are indicated for patients with acute respiratory distress syndrome or closed-space infections, such as meningitis and pericarditis. Hepatitis due to RIF is less common than with INH, but drug interactions are frequent. Kanamycin and amikacin may remain effective even if streptomycin resistance has developed. Hematogenous dissemination of TB in patients with HIV infection causes a serious, often baffling illness with symptoms of both infections. Resistance to EMB is less common than that to the other first-line drugs. Reactivation may cause few symptoms and can be overlooked for weeks or months, delaying appropriate evaluation. Characteristics of m. Tb (Alexander et al., 2015) Corticosteroids that are needed for other indications pose no danger to patients who have active TB and who are receiving an effective TB regimen. The main limitations of treatment of LTBI are. In the US, about 10% of isolates are INH-resistant. Pathogenesis of tuberculosis (Alexander et al., 2015) 1. Diagnosis is most often by sputum smear and culture and, increasingly, by rapid molecular-based diagnostic tests. Overall average efficacy is probably only 50%. If both culture and smear are negative, regardless of the chest x-ray, or if the culture or smear is positive but x-ray showed no cavitation, INH and RIF are continued for 4 more mo (6 mo total). Tuberculosis usually attacks the lungs but it can also affect any parts of the body. Treatment of latent tuberculosis infection is indicated principally for, People whose TST converted from negative to positive within the previous 2 yr, People with x-ray changes consistent with old TB but no evidence of active TB, Other indications for preventive treatment include, People who, if infected, are at high risk of developing active TB (eg, HIV-infected people, people with drug-induced immunosuppression), Any child < 5 yr who is a close contact of a person with smear-positive TB, regardless of whether there was TST conversion.

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