结核病的有效诊断,治疗和控制-英文.ppt
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1、Effective Diagnosis, Treatment, and Control of Tuberculosis,World Health Organization Regional Office for South-East Asia New Delhi,2,South-East Asia accounts for nearly 40% of all tuberculosis cases,3,TB is the leading single infectious cause of death in South-East Asia,Number of deaths (1000s),Dea
2、ths from infectious agents in South-East Asia,4,TB is a Leading Killer of Women,Deaths among women,5,Tuberculosis A Global Emergency,TB kills 5,000 people a day 2-3 million each year One third of the worlds population is infected with TB TB kills more young women than any other disease More than 100
3、,000 children will die needlessly from TB this year Hundreds of thousands of children will become TB orphans this year,6,TB and AIDS,Lifetime Risk of TB,7,TB Control: The 5 components of DOTS,Political commitment,Diagnosis by microscopy,Adequate supply of SCC drugs,Directly observed treatment,Accoun
4、tability,8,Diagnosis of pulmonary tuberculosis,Patients with TB feel ill and seek care promptly Active case finding is unnecessary and unproductive Microscopy is appropriate technology, indicating infectiousness, risk of death, and priority for treatment X-ray is non-specific for TB diagnosis Serolo
5、gical and amplification technologies (PCR, etc.) currently of no proven value in TB control,9,Diagnosis of Pulmonary Tuberculosis,Three specimens optimal Spot specimen on first visit; sputum container given to patient Early morning collection by patient on next day Spot specimen during second visit,
6、10,Three sputum smears are optimal,11,Reporting on AFB Microscopy,12,Diagnosis of Pulmonary TB,13,Microscopy is more objective and reliable than X-ray,Inter-observer agreement,14,Microscopy is a more specific test than X-ray for TB diagnosis,Specificity,15,X-ray-based evaluation causes over-diagnosi
7、s of TB,NTI, Ind J Tuberc, 1974,Over- diagnosis,16,Role of Chest X-ray,No chest X-ray pattern is absolutely typical of TB 10-15% of culture-positive TB patients not diagnosed by X-ray 40% of patients diagnosed as having TB on the basis of x-ray alone do not have active TB,Toman K. Tuberculosis case
8、finding and chemotherapy. WHO, 1979,X-ray is unreliable for diagnosing and monitoring treatment of tuberculosis,17,Proportion of patients with pulmonary TB who have positive AFB smears,AFB positivity in TB patients,18,X-ray findings in TB patients with HIV infection,Early HIV,Late HIV (severe immuno
9、-compromise),19,DOTS more than doubles accuracy of diagnosis of TB in SEAR,Expected range,20,Prompt treatment of infectious cases reduces spread of tuberculosis,Smear-positive patients usually seek care Smear-positive patients are 4-20 times more infectious Untreated, a smear-positive patient may in
10、fect 10-15 persons/year Smear-positive patients are much more likely to die if untreated,Rouillon A. Tubercle 1976;57:275-99,21,Treatment Categories,22,Severe and less severe forms of extra-pulmonary TB,TB/HIV, A Clinical Manual, World Health Organization 1996,23,Recommended treatment regimens,Direc
11、t observation is recommended for all patients and is particularly essential when intermittent regimens are used,24,Doses of first-line anti-TB drugs,All these anti-TB drugs should be given as a single daily dose. Direct observation is recommended for all patients and is particularly essential when i
12、ntermittent regimens are used. Thiacetazone is not effective when given intermittently and is not recommended for use in high HIV prevalence areas.,25,Role of Isoniazid,Mainstay of anti-TB treatment Life saving in TB meningitis Bactericidal for rapidly dividing organisms Prevents emergence of resist
13、ance to other drugs Intermittent treatment more effective than daily treatment in animal model and equally effective in clinical trials Safe and effective for preventive treatment,26,Role of Rifampicin,Necessary for short-course treatment Essential for at least first 2 months of regimens of 6-9 mont
14、h duration Bactericidal for rapidly dividing and slow-growing organisms Prevents emergence of resistance to other drugs Intermittent treatment more effective than daily treatment in animal model and equally effective in clinical trials,27,Role of Pyrazinamide,Essential for 6- and 8-month regimens No
15、 benefit if given for more than 2 months Relatively ineffective at preventing emergence of resistance to other drugs,28,Pyrazinamide is essential for the first two months of 6/8-month treatment,Am Rev Respir Dis 1987;136:1339-42,Relapses,29,Pyrazinamide does not give any additional benefit if given
16、beyond two months in short-course treatment,Am Rev Respir Dis 1991;143:700-6,Cure Rate (%),30,Role of Ethambutol/ Streptomycin,Prevent emergence of resistance to other drugs given Hasten sputum conversion Bacteriostatic or weakly bactericidal against rapidly dividing organisms,31,Role of Thiacetazon
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