multi-drug resistant tuberculosis
DESCRIPTION
Problem of drug resistant T.B. globally, management of M.D.R. T.B.,TRANSCRIPT
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Multi drug resistant T.B. (MDR)Dr. Gopalrao M.D. Ph.D.Professor of Community MedicineCAR Medical College
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Global Fact sheet: T.B. Incidence: 8.8 million people are affected by TB annually world wide. 1.4 million deaths occur annually world wide. MDR-TB is defined as disease having resistance to two or more of the anti T.B. drugs with or without resistance to other anti TB drugsIt is a major threat to TB control program world wide.
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Countries having problem of MDR T.B.
RussiaPeoples Republic of ChinaIndiaWestern EuropeUnited statesUnited KingdomGermanyCentral EuropeLithuaniaLatviaEstonia
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Indian ScenarioPrevalence of MDR T.B. in new smear +ve cases
is less than 3% and 12 to 17% amongst previously treated PTB cases. • India is the highest TB burden country in the world.
• India is 17th among 22 high burden countries in terms of incidence rate • Accounts for 20% of global burden of TB.• Every year 1.8 million persons develop TB • There are point eight million new smear positive cases. • The annual risk of becoming infected with TB is 1.5 %
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Case study from Andhra PradeshStudy conducted on 75 MDR T.B. cases.
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Reported MDR cases from 18 districts of Andhra Pradesh
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561
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10
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21
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NO. OF PATIENTS
% OF PATIENTS
SOB, Cough, fever
38 50%
Cough, fever 20 27%
SOB, cough 6 8%
Cough, fever, loss of appetite
2 3%
SOB, cough, fever, loss of
appetite
2 3%
cough 2 3%
SOB, Haemoptysis
1 1%Cough, loss of appetite
1 1%
Cough, fever, haemoptysis
1 1%
SOB 1 1%
SOB, cough,haemoptysis
1 1%
Cough, fever,chest pain
1 1%
Complaint
s among
MDRTB
Patients
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Clinical factors promoting resistanceDelayed diagnosis and isolationInappropriate drug regimen.
Inadequate initial therapy Incomplete course of treatment Inappropriate treatment modificationsAdding single drug to a failing regimen Inappropriate use of chemoprophylaxis
Poor adherence and incomplete Follow upFailure to isolate MDR TB patientsFailure to employ DOTOver the counter anti TBFaked drugs
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Mechanism of ResistanceTB specific drugs
INH, PZA, ETH
Antibiotics with activity against TBRIFAminogycosidesFlouroquinolones
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INHChromosomally mediatedLoss of catalase/peroxidaseMutation in mycolic acid synthesisRegulators of peroxide response
Mechanism of resistance
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RifampinReduced binding to RNA polymerase
Clusters of mutations at “Rifampin Resistance Determining Region” (RRDR)
Reduced Cell wall permeability
Mechanism of resistance
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Treatment of MDR TBFactors determining Success
Culture of MDR TBReliable susceptibilityReliable history of previous drug regimensProgram to assure delivery of prescribed drugs
(DOT)Correct choice of modified treatment regimenReliable follow up
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New Chemotherapeutic AgentsNot many. Low interest from pharmaceutical
industryDerivatives of Rifamycin
Rifabutin: Sensitive subset of Rifampin resistant strainsRifapentine: Extended half-life but more mono-
resistance to rifamycinsKRM-1648. benzoxazinorifamycin. In vitro and animal
models.New flouroquinolones
Gatifloxacin, Moxifloxacin, levofloxacin, sparfloxacinNitroimidazoles
related to metronidazole. May work better against latent bacilli
Avoiding pro-drug problems
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ChemoprophylaxisDeterminants of intervention
Likelihood of infection with MDR TB Low Intermediate High
Likelihood of developing MDR TB Immune suppression
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Global TB control targets
2005: World Health Assembly:- To detect at least 70% of infectious TB cases- To treat successfully at least 85% of detected cases
2015: 50% reduction in TB prevalence and death rates by 2015
2015: Goal 6: Combat HIV/AIDS, malaria and other diseases Target 8: to have halted by 2015 and begun to reverse the incidence… Indicator 23: prevalence and deaths associated with TB
Indicator 24: proportion of TB cases detected and cured under DOTS
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Stop TB Strategy to reach the 2015 MDGs
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Thank You