MDR-TBan update by Dr.T.V.Rao MD

8/19/2019 MDR-TB�an update by Dr.T.V.Rao MD

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2/43

HOW DOES TUBERCULOSISOCCUR?

The tuberculosis (TB b!cteri! !re s"re!throu$h the !ir %ro& ! "erso' ho is ill !cti)e TB th!t i')ol)es the lu'$s or !irThe b!cteri! !re co't!i'e# i' s&!ll+ !ir

#ro"lets cre!te# b* cou$hi'$ or s'ee,i'A'*o'e ho i'h!les these #ro"lets is c!-co't!ct.- A co't!ct c!' be so&eo'e *os"e'# ! lot o% ti&e ith+ such !s ! %!&i

&e&ber+ %rie'#+ or coor/er


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4/43

Tuberculosis is ! I'#i!0s $reCo'cer'

The &i'istr* o% He!lth!'# 1!&il* Wel%!res!*s th!t to #e!thsoccur e)er* three&i'utes %ro&

tuberculosis (TB i'I'#i!. It is !lso thele!#i'$ i'%ectiousc!use o% #e!th !&o'$!#ults. Let us ho"e

this &o)e ser)es !s !


5/43

ACTIVE TUBERCULOSIS

Acti)e tuberculosis (TB

#ise!se occurs he' theTB b!cteri! beco&e-!cti)e-2 the*o)erhel& the i&&u'es*ste& !'# c!use !

"erso' to beco&e ill.This usu!ll* occurs i'the lu'$+ !lthou$h TBc!' !3ect !'* "!rt o%the bo#*+ i'clu#i'$ the

l*&"h 'o#es+ br!i'+


6/43

Be$i''i'$ o% Dru$ Resist!'cTuberculosis

Dru$ resist!'ce 'ote# i' the 5678sstre"to&*ci' !s%or&!ll* stu#ie# !&o'other!"* %or ttre!t&e't o%tuberculosis . As !result+ subse9ue'tther!"eutici'ter)e'tio's utili,&ulti#ru$ re$i&e'

#ecre!se the ris/ o


7/43

M*cob!cteriu& tuberculosisM*cob!cteriu&

tuberculosis is !' !'cie'thu&!' "!tho$e'+ hichh!s "l!$ue# cou'tlesshu&!' societies #es"itethe i'tro#uctio' o%

cur!ti)e !'# "re)e'ti)ether!"* i' the l!stce'tur*. I' rece't *e!rs+i'ter'!tio'!l !tte'tio'h!s tur'e# to!r# the

e)ol)i'$ bur#e' o%


8/43

Multi#ru$resist!'t tubercu

Multi#ru$resist!'ttuberculosis (MDRTB+!lso /'o' !s V!'/:sDise!se is #e4'e# !s !%or& o% TB i'%ectio'c!use# b* b!cteri! th!t!re resist!'t totre!t&e't ith !t le!stto o% the &ost "oer%ul4rstli'e !'tiTB #ru$siso'i!,i# (I;H !'#


9/43

I'cre!si'$ i'ci#e'ce o% MDR

1i)e "erce't (=!ll TB c!ses !cthe $lobe i' 8ere esti&!te

MDRTB c!ses+i'clu#i'$ @.=>'el* #i!$'osc!ses+ !'# 8.

"re)iousl* tre!


10/43

M!$'itu#e o% MDRD

A""roi&!tel* =88+888 c!ses*e!r

A""roi&!tel* 588+888 c!ses*e!ri' Chi'!

A""roi&!tel* 78+888 c!ses*e!ri' Russi!

O'l* => ere #i!$'ose# !'#tre!te#

About @> o% !ll c!ses ere tre!te#


11/43

Cl!ssi4c!tio' o% Dru$Resist!'t Tuberculosis

ri&!r* or I'iti!l #ru$ resist!'t

Seco'#!r* or Ac9uire# #ru$ resist!'t

Dru$ resist!'t (DR


12/43

De4'itio' o% MDRTuberculosis

Multi#ru$resist!'ttuberculosis (MTB is #e4'e#

l!bor!tor*co'4r&e#resist!'ce to tto &ost "ote

4rstli'e


13/43

What ! "DR # Tu$er%u&o!!

Si'ce 88F+ ete'si)el*#ru$resist!'ttuberculosis (DRTB h!sbee' #e4'e# !sresist!'ce to both

iso'i!,i# !'# ri%!&"i'ith !##itio'!l resist!'ceto !t le!st o'eGuoro9ui'olo'e !'# o'ei'ect!ble !$e't

(!&i/!ci'+ /!'!&*ci'+ or


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MDRTB i'%ectio'MDRTB i'%ectio' &!* be cl!ssi4e# !s e

"ri&!r* or !c9uire#. ri&!r* MDRTB oi' "!tie'ts ho h!)e 'ot "re)iousl* bei'%ecte# ith TB but ho beco&e i'%ectith ! str!i' th!t is resist!'t to tre!t&

Ac9uire# MDRTB occurs i' "!tie'ts #utre!t&e't ith ! #ru$ re$i&e' th!t is 'e3ecti)e !t /illi'$ the "!rticul!r str!i' ith hich the* h!)e bee' i'%ecte#. R!"ri&!r* MDRTB !re lo i' ;orth A&eri

Wester' Euro"e i' the US i' 888+ the


15/43

Tre'#s o' MDRtuberculosis

As o% 85@+ @.F> o% 'e tuberculosis c!

h!)e MDRTB. Le)els !re &uch hi$her i'"re)iousl* tre!te# %or tuberculosis !b8>. WHO esti&!tes th!t there ere !b&illio' 'e MDRTB c!ses i' the orl# About J8> o% these c!ses occurre# i' B

Chi'!+ I'#i!+ the Russi!' 1e#er!tio' !'A%ric! !lo'e. I' Mol#o)!+ the cru&bli'$s*ste& h!s le# to the rise o% MDRTB. I'the Meico


16/43

Mech!'is& o% M. tuberculosis#ru$ resist!'ce

Cell !ll The cell !ll o% M. tuberculosis co'sico&"le li"i#s+ !'# it !cts !s ! "er&e!bilit* b!%ro& #ru$s.

.Dru$ &o#i%*i'$ K i'!cti)!ti'$ e',*&es Thetuberculosis $e'o&e co#es %or cert!i' e',*&e

&!/e it #ru$ resist!'t. The e',*&es usu!ll*"hos"hor*l!te+ !cet*l!te+ or !#e'*l!te the #ruco&"ou'#s.

@.Dru$ eu s*ste&s

7.Mut!tio's S"o't!'eous &ut!tio's i' the M.


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E!&"les o% &ut!tio's th!t&!/e M. tuberculosis #ru$

resist!'tA' e!&"le o% this is the &ut!tio' i' the r"ohich e'co#es the bet! subu'it o% the b!cterol*&er!se. This &ut!tio' &!/es the b!cilluresist!'t to Ri%!&"ici'. ;o'resist!'t TB is sto Ri%!&"ici' bec!use this #ru$ bi'#s to the

subu'it o% the R;A ol*&er!se+ !'# he'ce #tr!'scri"tio' elo'$!tio'. Whe' the r"oB $e'&ut!te#+ the resulti'$ bet! subu'it "rotei' h#i3ere't !&i'o !ci#s+ !'# thus ! #i3ere'tco'%or&!tio'. Ri%!&"ici' c!' 'o lo'$er bi'#

bet! subu'it !'# "re)e't tr!'scri"tio'.


18/43

Mut!tio's i'iti!te Dru$Resist!'ce i' Tuberculos

Other &ut!tio's &!/e the b!cteriu& resist!'t to ot#ru$s. 1or e!&"le+ there !re &!'* &ut!tio's th!t c&!/e M. tuberculosis resist!'t to Iso'i!,i#. Mut!tiole!#i'$ to I;H resist!'ce h!)e bee' i#e'ti4e# i' #i3$e'e t!r$ets i'clu#i'$ /!t+ i'hA+ !h"C !'# other $th!t re&!i' to be est!blishe#. A&i'o !ci# re"l!ce&ethe ;ADH bi'#i'$ site o% I'hA !""!re'tl* result i' I;resist!'ce b* "re)e'ti'$ the i'hibitio' o% &*colic !cbios*'thesis+ hich the b!cteriu& uses i' its cell !Mut!tio's i' the /!t $e'e c!uses the e',*&e c!t!l"eroi#!se u'!ble to co')ert I;H to its biolo$ic!ll* !

%or&. He'ce+ I;H is 'ot !ble to !3ect M. t


19/43

I&"!ct o% MDR+ DRTB

;o e3ecti)e tre!t&e't

I'cre!si'$ &orbi#it* !'#&ort!lit* ( so&e re"ortsho sur)i)!l ti&e i' #!*s

Tr!'s&issible !'# s"re!##ise!se i' $e'er!l"o"ul!tio'( es eci!ll i'


20/43

Ris/ 1!ctors to C!rr* DResist!'t TB

re)ious histor* otre!t&e'tN 1!ilure

N Re

N HIV coi'%ecti

A##ictio'sN

Co't!ct ith #ru$

resist!'t "!tie't


21/43

Whe' to sus"ect MD

TB I' All Retre!t&e't"!tie'ts All tre!t&e't

%!ilures

Tre!t&e't !#here't"!tie't hoseco'#itio' #eterior!tes

!tie't hose s&e!r#oes 'ot co')ert !%ter

three &o'ths o%


22/43

re)e'tio' o% MDR

TB E'suri'$ cure o% 'e

s&e!r "ositi)e "!tie'tsthe 4rst ti&e E'sureth!t Retre!t&e't c!sesco&"lete their tre!t&e't

Co&"li!'ce ith&!'!$e&e't $ui#eli'es!s l!i# b* ;TC

Ecelle't !#here'ce#uri'$ the i'te'si)e"h!se !'# co'ti'u!tio'

h!se


23/43

re)e'tio' o% MDRTB co't

U'i'terru"te#su""l* o% TB#ru$s totre!t&e't

"oi'ts is cruci!lTre!t&e't is

%ree o% ch!r$e

Su"er)isio' o%

ther!


24/43


25/43

M!'!$e&e't ri'c

De#ic!te# MDR TB !r#s

M!'!$e&e't te!&sith cle!r &!'!$e&e't

res"o'sibilities M!'!$e&e'tte!&s to h!)e c!"!cit* !'#e"ertiseTre!t&e't lo$istics shoul# be i'"l!ce


26/43

Ho c!' MDR TB be"re)e'te#?The &ost i&"ort!'t thi'$ ! "erso' c!'

"re)e't the s"re!# o% MDR TB is to t!/etheir &e#ic!tio's e!ctl* !s "rescribe# he!lth c!re "ro)i#er. ;o #oses shoul# b&isse# !'# tre!t&e't shoul# 'ot be stoe!rl*. !tie'ts shoul# tell their he!lth c

"ro)i#er i% the* !re h!)i'$ trouble t!/i'&e#ic!tio's. I% "!tie'ts "l!' to tr!)el+ tshoul# t!l/ to their he!lth c!re "ro)i#er&!/e sure the* h!)e e'ou$h &e#ici'e t

hile !!*


27/43

Hel" re)e't the s"re!# o% MTB

He!lth c!re

"ro)i#ers c!' hel""re)e't MDR TB b*9uic/l* #i!$'osi'$c!ses+ %olloi'$

reco&&e'#e#tre!t&e't$ui#eli'es+&o'itori'$ "!tie'ts0res"o'se to


28/43

Whe' to sus"ect MDR Tco't

!tie't hose s&ebeco&es "ositi)e

!%ter i'iti!l co')er

!tie't hose s&

'e$!ti)e but 'ot res"o'#i'$ to tre!

S*&"to&!tic co'o% !' MDR TB "!tie


29/43

Ho c!' MDR TB be "re)e'

A'other !* to "re)e't$etti'$ MDR TB is to !)oie"osure to /'o' MDRTB "!tie'ts i' close# orcro#e# "l!ces such !shos"it!ls+ "riso's+ orho&eless shelters. I% *ou

or/ i' hos"it!ls orhe!lthc!re setti'$shere TB "!tie'ts !reli/el* to be see'+ *oushoul# co'sult i'%ectio'co'trol or occu"!tio'!lhe!lth e"erts. As/ !bout

!#&i'istr!ti)e !'#


30/43

Di!$'osis o% MDRT

I' All Retre!t&e't"!tie'ts culture !'#DST 'ee#s to t!/e'

Tre!t&e't %!ilureso' 'e TB c!ses

HCW !re !t ris/he'I'%ectio' Co'trol&e!sures !re 'ot i'"l!ce

MDR TB co't!cts

N A r!re "hoto$r!"h o%


31/43

"ert MTBRI1 Se&i!uto&!te#

tech'i9ue He&i'este# CR o%

r"oB$e'es ith =#i3ere't color "ri&ers

Result ill be /'o'i' hours

Se'siti)it* o% 6J.F>+S"eci4cit* o% 6P.J>ith V o% [email protected]> !'#

;V o% 66.@>


32/43

"ert MTBRI1"ert MTBRI1 !'# re#uce the cost o% its use

i''o)!ti)e "ri)!te"ublic "!rt'ershi" is ! "!"roect !'# to eter'!l i&"le&e'ters ill rthe !cti)ities )i! the 'o'$o)er'&e't!l !'# sector. While U;ITAID %u'#i'$ ill !llo "erolle# out i' 5 reci"ie't cou'tries+ ! 'o)el 4

coll!bor!tio' le# b* U;ITAID !'# other "!rt'!chie)e# ! 78 "erce't "rice re#uctio' %or thiTB test. The "roect ill !ssist i' ti&el* "roco% = e'e"ert i'stru&e'ts i' "roect sitelo !'# &i##lei'co&e cou'tries+ utilisi'$

5+777+6J8 "ert MTBRI1 tests i' 85@85=


33/43

WHO I'iti!ti)es o' TB "U'#er the le!#ershi" o% lob!l TB ro$r!&&

the Worl# He!lth Or$!'i,!tio' (WHO+ !'# th

Sto" TB !rt'ershi"0s lob!l Dru$ 1!cilit* (the TB"ert roect ill "ro)i#e !""roi&!te&illio' "ert MTBRI1 test c!rtri#$es !'# o)"ert i'stru&e'ts i'stru&e'ts %or the r!"i##etectio' o% TB !'# ri%!&"ici' resist!'ce i'

reci"ie't cou'tries (see &!" b* clic/i'$ #!t)isu!li,!tio' o' the ri$hth!'# colu&'.Curre'tl* !ll 5 cou'tries h!)e !$ree&e'ts the roect %or the roll out. All cou'tries "l!cor#ers !'# !ll 5 cou'tries recei)e# their

su""lies. ;u&ber o% c!ses #etecte# ith TB


34/43


35/43

R!"i# Dru$ Susce"tibilit* T(DST

C!rr* o)er co't!&i'!tio' is 'ot ! "roble& bec!use o% CR re!ctio' is 'ot se'siti)e !'# c!' be #o'e i' s"ositi)e

I'ter"ret!tio'


36/43

Rapd Dru( )u!%ept$&t* Te!t +

I'#ic!tio' %or r!"i# DST


37/43


38/43

The 'ee# %or i&"ro)e# T#i!$'ostics

The r!"i# !'# !ccur!te#i!$'osis o% s*&"to&!tic"!tie'ts is the cor'ersto'eo% $lob!l str!te$ies %or TBco'trol. TB is ch!lle'$i'$ to#i!$'ose !'# #icult to

tre!t+ es"eci!ll* i' the#e)elo"i'$ orl# hichbe!rs 6=> o% the $lob!l#ise!se bur#e'. I'!ccur!te#i!$'osis h!s s"urre# ther!"i# s"re!# o% TB !'# #ru$

resist!'ce es eci!ll i'

h i l %


39/43

Wh!t is $o!l o% e)er*o'eCo'trol o% Tuberculosis

The ulti&!te $o!l o% "ro)i#i'$ ! &ore u"to#!te TB #i!$'ostic tool %or the 5stce'tur* is the %ocus o% o'$oi'$ rese!rch!'# #e)elo"&e't. Hoe)er+ thee"!'#i'$ TBHIV e"i#e&ics !'# thei'cre!si'$ o% #ru$ resist!'t TB+ h!)e le#to ! 'ee# %or i&"ro)e# #i!$'ostics th!tco&"le&e't e!ch other. While 'o si'$le#i!$'ostic test "ro)i#es !ll thei'%or&!tio' 'ee#e# %or "!tie't c!re o)erthe #ise!se "ro$ressio'+ se)er!l

t l t t l t b


40/43

re!t "l!' to co'trol tubercu

I'#i!' o er'&e't To T!c/le


41/43

I'#i!' o)er'&e't To T!c/leTuberculosis With @88 ;e e'e"ert

Di!$'ostic M!chi'es

It co&es !s ! shot i' the !r& %orI'#i!:s 4$ht !$!i'st tuberculosis+ !sthe $o)er'&e't o% I'#i! "l!'s toi'tro#uce @88 "oer%ul #i!$'ostic

&!chi'es hich !re c!"!ble o%co'#ucti'$ ! hi$hl* se'siti)e&olecul!r test. The e'e"ert TBtest &!chi'es c!' #etect 4)e ti&es&ore c!ses o% #ru$ resist!'t

A i % Vi


42/43

Atte'tio' o% Vieer ,I !& th!'/%ul to &!'* i' the orl# ho &!#e &e to !chie)e &* #esire# $o!ls %!s

thou$ht+ h!)i'$ @= &illio' he!lth "ro%essio'!ls sh!re !'# utili,e &* /'ole#$

be'e4t o% &!'/i'#+ To#!* I ish to be %reel!'cer to the orl# to cre!te i'terest Cli'ic!l !'# Di!$'ostic Microbiolo$* ith &ore e&"h!sis o' I'%ectious #ise!ses !ssoci!te# I'%ectio' ish to be *our "!rt'er i' e#uc!ti'$ &!'* &illio's ho /'oi&"ort!'ce o% I'%ectious #ise!ses

ou c!' )isit &!'* eb sites o% &i'e

.&e#&icrobes.co&

.sli#ehs!re.co&

.!uthourstre!&.co&

+scrib#.co& Be ! %rie'# o' 1!ceboo/ ith tu&&!l!"!lli )e'/!tes!r!r!o !ccess

R!o0s Microbiolo$*

R!o0s I'%ectio' c!re

Microbiolo$* co''ecte# Tr!)!'core Me#ic!l Colle$e

1or !'* !ssist!'ce o' I;1ECTIO; REALTED ISSUES CO;TACT ME AT #octort)r!o$&!il.co&

Mob X65 F8755@5=7

http://www.medmicrobes.com/http://www.slidehsare.com/http://www.authourstream.com/mailto:[email protected]:[email protected]://www.authourstream.com/http://www.slidehsare.com/http://www.medmicrobes.com/


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ro$r!& Cre!te# b* Dr.T.V.R!o M

Be'e4t o% Me#ic!l !'# !r!&e#ro%essio'!ls i' the De)elo"i'$ W

Cre!te# %ro& Worl# Wi#e Resourc

E&!il

#octort)r!o$&!il.co&

Documents

MDR-TBan update by Dr.T.V.Rao MD