TB disease 2024 slides Alffenaar-compressed_compressed.pdf

Tuberculosis - Infection caused by Mycobacterium tuberculosis - Affects mostly the lung but can also affect other organs - Symptoms - prolonged cough (sometimes with blood) - chest pain - weakness - fatigue - weight loss - fever - night sweats. The University of Sydne...

Tuberculosis - Infection caused by Mycobacterium tuberculosis - Affects mostly the lung but can also affect other organs - Symptoms - prolonged cough (sometimes with blood) - chest pain - weakness - fatigue - weight loss - fever - night sweats. The University of Sydney Risk factors for TB - Diabetes (high blood sugar) - 2-4 higher transition to active TB and more severe disease - Macrophage show functional defects - Weakened immune system (for example, HIV or AIDS) - Often diagnosed at the same time - Every TB patient is tested for HIV - Being malnourished - BMI10mm) positive. previous BCG vaccination Specificity – influenced by Yes Less than with TST (but test previous infection by antigens also found in M. environmental mycobacteria marinum, M kansasii and M. szulgai) Special precautions Store tuberculin re-agent at –8°C Blood must be processed within and protect from light 16 hours Suitable in children 50 years and those with abnormal liver function tests prior to therapy) - peripheral neuropathy has also been described, particularly in those with underlying nutritional deficiencies, and co-prescription of vitamin B6 (pyridoxine) is generally offered. The University of Sydney  WHO schedules for preventative treatment - Isoniazid (300mg) once daily for 6-9 months - Rifampicin (600mg) + isoniazid (300mg) once daily for 3-4 months - Rifampicin (600mg) once daily for 3-4 months - Rifapentine (900mg) + isoniazid (900mg_ weekly for 3 months - New studies looking at shorter regimens; 2 months and 1 month to decrease treatment burden in otherwise healthy people. The University of Sydney Tuberculosis: a global problem A total of 1.3 million people died from TB in 2022 Worldwide, TB is the second leading infectious killer after COVID-19 An estimated 10.6 million people fell ill with tuberculosis Only 2 in 5 people with Multidrug-resistant TB accessed treatment in 2022. Global efforts have saved an estimated 75 million lives since 2000. US$ 13 billion is needed annually for TB prevention, diagnosis, treatment and care to achieve the global target agreed at the 2018 UN high level- meeting on TB. The University of Sydney https://www.who.int/news-room/fact-sheets/detail/tuberculosis Tuberculosis: a global problem The University of Sydney Global tuberculosis report 2023 The University of Sydney Poverty related disease Global tuberculosis report 2023  Case notifications COVID If case notification goes up in high burdened settings means that more patients are treated for the disease. Once on treatment they are not likely to spread TB to others. The University of Sydney  TB in Australia The University of Sydney https://www.health.nsw.gov.au/Infectious/tuberculosis/Publications/2022-report.pdf  The University of Sydney https://www.health.nsw.gov.au/Infectious/tuberculosis/Publications/2022-report.pdf  The University of Sydney https://www.health.nsw.gov.au/Infectious/tuberculosis/Publications/2022-report.pdf Countries with high incidence of drug-resistant TB The University of Sydney Global tuberculosis report 2023  - Drug susceptible - Susceptible to isoniazid, rifampicin, Drug resistant TB pyrazinamide, ethambutol - Mono resistant tuberculosis - Resistance to 1 drug, likely isoniazid - Multidrug resistant tuberculosis - Resistance to isoniazid and rifampicin - Pre-extensively drug-resistant tuberculosis - Resistance to isoniazid and rifampicin Increasing level - + resistance to any fluoroquinolone of resistance - Extensively drug-resistant tuberculosis - Resistance to isoniazid and rifampicin - + resistance to any fluoroquinolone The University of Sydney - + resistance to bedaquiline or linezolid  Laboratory testing of the bacteria - Select drugs that are likely to be effective - Prevent further resistance development - Testing - Phenotypic testing (culture) - Takes very long as the bacteria grows very slow (24h) - Genotypic testing - DNA of Mycobacterium tuberculosis is investigated to find mutations - Detection of selected mutations - Whole genome sequencing The University of Sydney Phenotypic testing - Concentration range - Growth / no growth - If no growth => MIC - Solid and liquid media The University of Sydney The University of Sydney Drug susceptibility ECOFF wildtype S Pathogen numbers I mutations R Minimal Inhibitory Concentration (MIC) standard dose high dose use another drug The University of Sydney ECOFF = epidemiological cut-off of wild-type drug-susceptible population Tuberculosis and stigmatization - Stigma is a process that begins when a particular trait or characteristic of an individual or group is identified as being undesirable or disvalued. - Stigmatization is a complex process involving institutions, communities, and inter- and intrapersonal attitudes. - Affects women and less-educated people more - diagnostic delay - treatment noncompliance The University of Sydney  “Tuberculosis (TB) is a preventable and usually curable disease. Yet in 2022, TB was the world’s second leading cause of death from a single infectious agent, after coronavirus disease (COVID-19), and caused almost twice as many deaths The University of Sydney as HIV/AIDS.” Global commitment to ‘End TB’ The University of Sydney World Health Organisation END TB STRATEGY The University of Sydney United Nations The University of Sydney Summary - TB disease, symptoms, risk factors, diagnosis - Understanding of the global TB problem - TB screening, household contacts, prevention - Drug susceptible TB, drug resistant TB - Role of World Health Organisation The University of Sydney The University of Sydney [email protected]