WORK UPS AND MANAGEMENT

Traditional and New Diagnostic Approaches DIAGNOSTICSAPPLICATIONS Traditional approaches - Symptom-based -TST -TB Culture -- AFB smear -- Chest radiograph Probable active TB Evidence of MTB Infection Bacteriologic Confirmation of active TB Probable Active TB New Diagnostic Approaches ORGANISM BASED -Colorimetric cultures systems -- phage based test -- Microscopic- based observation drug susceptibility (MODs) assay Bacteriological confirmation of active TB Probable active Tb and detection of rifampin resistance Probable active TB and detection of resistance

Traditional and New Diagnostic Approaches DIAGNOSTICSAPPLICATIONS New Diagnostic Approaches ANTIGEN BASED ASSAYS -LAM detection assay IMMUNE BASED ASSAY -Antibody based assay --MPB-64 skin test -- T- Cell assays SYMPTON BASED -Symptom based screening -Refined symptom based Diagnosis Probable active TB Diagnosis of Latent TB infection Screening child contacts of adult TB cases Probable Active TB

Diagnosis of TB A positive culture with or without a positive smear for M. Tuberculosis is the gold standard for the diagnosis of TB In the absence of bacteriologic evidence, a child is presumed to have active TB if > 3 crteria are present: Exposure to an adult/Adolescence with active TB (EPIDEMIOLOGIC) Signs and symptoms suggestive of TB (CLINICAL) Positive tuberculin test (IMMUNOLOGIC) Abnormal chest radiograph suggestive of TB (RADIOLOGIC) Other lab findings suggestive of TB (LABORATORY)

OUR PATIENT TST – 12 mm induration Chest X –ray showed evidence of primary infection Signs and symptoms of TB

Chest X- ray of the patient 11/24/10

The heart is not enlarged. There is slight haziness over the right lung base and the retrocardiac region, with nodular densities over the retrocardiac region, which may be due to lymph nodes. This may represent primary infection. Both hemidiaphragm and sinuses are normal. The visualized osseous structures are unremarkable. 11/24/2010

Management of Tuberculosis

Objectives of Drug Therapy in TB: 1.Cure the patient of TB 2.Prevent death from active TB 3.Prevent relapse of TB 4.Prevent the development of drug resistance 5.Decrease transmission

Phases of Treatment Intensive Phase - efficient killing of actively dividing organisms - relief of symptoms - terminates transmision - prevents emergence of drug resistance Continuation Phase - kills irregularly dividing bacilli - sterilizes lesions and prevent relapse

Drug Administartion The optimal dosing frequency for new patients with pulmonary TB is daily throughout the course of therapy. Alternative Regimens: (1)A daily intensive phase followed by tree times weekly continuation phase [2HRZE/4H 3 R 3 ], provided that each dose is directly observed (2)Three times weekly dosing throughout the therapy [2H 3 R 3 Z 3 E 3 /4H 3 R 3 ], provided that every dose is directly observed.

Essential Anti-Tuberculosis Drugs DRUGMOADOSE RANGE Single daily dose mkd 3X weekly mkd INH-Bactericidal agent --Acts on extracellular and intracellular bacillary populations -- presumed to inhibit biosynthesis of mycolic acid (cell wall component ) and effects glycolysis, nucleic acid synthesis Max 300 mg Max 900 mg Rifampicin-Bactericidal agent --Acts on extracellular and intracellular bacillary populations -- inhibits nucleic acid synthesis Max 600 mg Max 600 mg

Essential Anti-Tuberculosis Drugs DRUGMOADOSE RANGE Single daily dose mkd 3X weekly mkd Pyrazinamide-- weak bactericidal but with potent sterilizing activity within macrophages, areas of acute inflammation Max 2 g 50 mg Max 2 g Streptomycin- Bactericidal20-40 max 1 g Ethambutol-Bacteriostatic, but with some bactericidal action at higher doses -- acts on intra and extracellular bacillary populations -- presumed to inhibit synthesis of mycolic acid (cell wall component) Max 1.2 g Max 2.5 g

Essential Anti-Tuberculosis Drugs DRUGADVERSE REACTIONS INH -- peripheral neuropathy -Other neurological disturbance, optic neuritis, toxic psychosis, generalized convulsions -- systematic or cutaneous hypersensitivity reactions during the first week of treatment -- hepatotoxicity Rifampicin-Gastrointestinal intolerance -- if intermittent adminidtration: rash, fever, thrombocytopenia, flu like symptoms -- increases risk of hepatotoxicity if used with INH Pyrazinamide-- hypersensitivity reactions --moderate rise in trasaminase levels -- Hyperuricemia -- arthralgia, particularly of shoulders

Essential Anti-Tuberculosis Drugs DRUGADVERSE REACTIONS Streptomy cin -- sterile abscess -- vestibular, auditory function impairment -- hemolytic anemia Ethambut ol -- retrobulbar neuritis ( reduced visual acuity, contraction of visual fields, green red color blindness)

TREATMENT 21 kg Isoniazid 200 mg/5mL (10 mkd) – 5.5 mL Rifampicin 200mg/5mL (10 mkd)- 5.5 mL Pyrazinamide 500 mg/5mL (20 mkd) – 4.5 mL Ethambutol 400 mg/tab (20 mkd) - 1 tab