Recent advances in tuberculosis
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Recent advances in treatment of tuberculosis in children, with guidelines provided by RNTCP AND iAP, for Drug Resistant TB
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Recent advances in tuberculosis
- 1. Dr. Amit Vatkar MBBS, DCH, DNB Pediatrics Fellow in Pediatric Neurology, Mumbai Trained in Neurophysiology & Epilepsy, USA Contact No. : +91-8767844488 Email: vatkaramit@yahoo.com RECENT UPDATES IN CHILDHOOD TUBERCULOSIS
- 2. Tuberculosis – the facts • Most cases occurred in – Asia (59%) and – Africa (26%) WHO report 2011
- 3. Tuberculosis estimates in India
- 4. RESISTANCE PATTERN OF TB INDIA
- 5. Pathogens found in lungs from autopsy studies of African children
- 6. TB disease and infection - definitions TB disease • Detection of M. tuberculosis and/or clinical symptoms compatible with tuberculosis Latent infection with M. tuberculosis (LTBI) • Presence of an immune response in a skin test or an IFN-γ release assay (IGRA) • Absence of clinical symptoms
- 7. Diagnosis of active tuberculosis • Patient history • Chest X-ray • Culture • Acid-fast bacilli staining • Nucleic acid amplification testing
- 13. NEW GROUPING OF DRUGS
- 14. REGIMEN OF DRUGS
- 15. TREATMENT REGIMENS IN RESISTANT TUBERCULOSIS
- 18. CONTACT
- 19. TUBERCULIN SKIN TEST • Two preparations of PPD are available - PPD-S and PPD RT23. • Two TU PPD RT23 withTween 80 is equivalent to 5 TU of PPD-S. • Current recommendation is to use 2 TU RT23. • If it is not available 5 TU is acceptable, but there a risk of false positivity. • Cut off for positive result is an induration of 10 mm. In HIV positive patients 5 mm is the cut off.
- 20. New TB diagnostic tools Between 2007 and 2010 the WHO has recommended several new diagnostic tests to improve TB diagnosis: – Fluorescent microscopy using LED technology—2009 – Liquid culture: MGIT (mycobacterium growth indicator tubes) and MODS (microscopic observation drug susceptibility assay)—2007/2009 – Nucleic Acid Amplification Test (NAAT): Xpert MTB/RIF—2010
- 23. Performance of Xpert MTB/RIF vs. other diagnostic modalities Boehme et., Lancet 2011
- 24. Liquid culture: MGIT (mycobacterium growth indicator tubes) and MODS (microscopic observation drug susceptibility assay).Advantages + Both are a lot faster than solid media (2 wks vs. 3-6 wks). + MGIT had 81.5% sensitivity and 99.6% specificity in detecting MTB. + MGIT results had high concordance with solid media: 97% for rifampin and 96% for isoniazid resistance. + MODS is close to 98% sensitive and nearly 99% specific in detecting rifampin resistance, and 98% sensitive and 96% specific for isoniazid resistance. + MODS is inexpensive. Disadvantages - Both MGIT and MODS require trained technicians, sample processing, and biosafety levels appropriate only for reference laboratory settings. - MGIT is costly (@$30,000 per machine and $5 for a tube). - MGIT also requires another test to do rapid speciation to distinguish between MTB and non-TB mycobacteria. - MODS may have standardization issues that can hamper its accuracy.
- 25. Nucleic acid amplification test (NAAT): Xpert MTB/RIF Xpert MTB/RIF Advantages Disadvantages 98% sensitivity in smear-positive samples expensive machinery: currently about $17,000 for the machine and $17 per cartridge specificity is 99%. requires electric supply and annual calibration Gives results within 2 hours Does not test resistance to drugs other than rifampicin Requires minimal sample preparation
- 27. NEONATED OF MOTHER WITH TUBERCULOSIS • INH prophylaxis (10 mg/kg) for 6 months to all the babies- diagnosed to have active TB during pregnancy, after delivery or exposed to any case of active disease after delivery. • Rule out congenital TB • practical purpose RNTCP recommends BCG vaccination at birth even if INH chemoprophylaxis is planned. • Isolation of baby is indicated only if mother is having a smear positive MDR TB. • Isolation may be considered when mother is sick, non adherent to therapy, received ATT for less than 2 weeks or suspected to have MDR TB. • Barrier nursing, using face mask and appropriate cough hygiene are advised for all the mothers.
- 28. Recommendation Xpert MTB/RIF should be used rather than conventional microscopy and culture as the initial diagnostic test in children suspected of having • children suspected of having TB • MDR TB or HIV-associated TB • extrapulmonary TB • TB meningitis
- 29. DIAGNOSIS OF ETB
- 30. STEROIDS IN ETB
- 31. DURATION OF ATT IN ETB
- 32. Dr. Amit Vatkar Pediatric Neurologist, Navi Mumbai MBBS, DNB Email: vatkaramit@yahoo.com Contact No.: +91-8767844488 Visit us at: http://pediatricneurology.in/ THANK YOU !