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Muhammad Usman has series of Pharmacology lectures on sqadia.com. This lecture is continuity of that series. In this lecture focus of discussion of is Pharmacotherapy of Tuberculosis.
Introduction to Tuberculosis
Tuberculosis (TB) is an airborne infectious disease usually caused by the bacterium mycobacterium tuberculosis (MTB), generally affects the lungs, but can also affect other parts of the body. There is a difference between TB “infection” and TB “disease”. Tb germs are not passed by shaking hands, using public telephones. A person gets infected with TB when TB germs stay in the lungs, but they do not multiply or make you sick. A person suffers from TB disease when TB germs stay in your lungs or move to other parts of your body, multiply, and make you sick.
Symptoms, Pathogenesis, and Causes of Tuberculosis
Common Symptoms of TB Disease are Night sweats, chest pain, cough (for 2-3 weeks). If you have TB outside the lungs, you may have other symptoms. Infection occurs when person inhales droplet nuclei containing tubercle bacilli that reach the alveoli of the lungs. Infection with HIV, Diabetes mellitus, and Low body weight are some factors that increase the risk that latent disease will develop into active disease. Tb is caused by Mycobacterium and 3 of its species are mainly responsible.
Diagnosis of Tuberculosis
Pulmonary TB is diagnosed by sputum test and X-ray. In sputum test, sample of sputum is taken which is coughed up from the lungs and then tested for the bacteria. X-ray is used to detect chest abnormalities. It shows white spots in the lungs where immune system walled off bacteria. Extra pulmonary TB is diagnosed through CT-Scan, MRI, Liver Biopsy, Lumbar Puncture. Various blood tests are done for TB and hepatotoxicity. Latent TB is diagnosed by Mantoux-Tuberculin Skin Test (TST).
Types of Tuberculosis
There are 2 types of tuberculosis, Pulmonary Tuberculosis, and Extra Pulmonary Tuberculosis. In Pulmonary Tuberculosis infection occurs inside the lungs and it is curable if patients get medical help right away and follow doctor’s instructions carefully. Mostly occurs in young children and immunosuppressed persons. Some of the types of Extra Pulmonary Tuberculosis are following: Pleural Tuberculosis, Bone Tuberculosis, Lymph Node Tuberculosis, Dermal Tuberculosis, and Millinery Tuberculosis. The infection of an individual who has not been previously infected or immunized is called Primary tuberculosis. The infection that individual who has been previously infected or sensitized is called secondary tuberculosis.
Treatment of Tuberculosis
There are two phases of therapy, one is intensive phase and the other is continuation phase. There are 4 drugs regimen used in the intensive phase. Their aim is to kill actively growing bacilli rapidly. INH and RIF are continued as daily therapy for 4 months in continuation phase. Anti TB drugs include two lines. First line Anti-tuberculosis Drug include Rifampicin, Isoniazid. Second line Anti-TB drugs are subdivided into further categories. These are Fluoroquinolones, Injectable ATT, Less Effective ATT. TB can be prevented by ventilating the room, wearing mask, and finishing entire course of medication.