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Multi-drug-resistant tuberculosis is considered dangerous, know why?

TB occurs in every part of the world. In 2017, the largest number of new TB cases occurred in the South-East Asia and Western Pacific regions, with 62% of new cases, followed by the African region, with 25% of new cases.

 In 2016, 4 new diagnostic tests were recommended by WHO – a rapid molecular test to detect TB at peripheral health centers where Xpert MTB/RIF cannot be used, and 3 tests to detect resistance to first- and second-line TB medicines.

Multidrug resistance TB :

Multidrug-resistant tuberculosis (MDR-TB) is a form of TB caused by bacteria that do not respond to isoniazid and rifampicin, the 2 most powerful, first-line anti-TB drugs. MDR-TB is treatable and curable by using second-line drugs. However, second-line treatment options are limited and require extensive chemotherapy (up to 2 years of treatment) with medicines that are expensive and toxic. In some cases, more severe drug resistance can develop. Extensively drug-resistant TB (XDR-TB) is a more serious form of MDR-TB caused by bacteria that do not respond to the most effective second-line anti-TB drugs, often leaving patients without any further treatment options.

Mycobacterium tuberculosis bacteria :

The organism is a small rod-shaped organism, that enters the respiratory tract and grows on the lung tissue. the incubation period is approximately 2-10 weeks for primary infection, but a 6-month pass before the symptoms become fully recognized. in the infected lung, cells of macrophages, leukocytes, and T-lymphocytes surround the parasite, and due to the deposition of calcium salts and fibrous material, a hard nodule-tubercle is formed this may be visible in the patient's chest X-rays. the tubercle may break apart and spread bacteria to, bones and kidneys. the disease is then called miliary tuberculosis. The bacterium does not produce the toxin, but due to rapid growth, the tissue is consumed.

Causes of tuberculosis infection: 

The main cause of TB is a person with an active TB infection in their lungs coughs or sneezes and someones else inhales the expelled droplets containing TB bacteria.

Risk factors of tuberculosis are :

  1. Tobacco use,
  2. Malnutrients,
  3. Alcoholism.

Tuberculosis (TB):

Tuberculosis is the crowded populations, especially of lower socioeconomic groups. Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. tuberculosis mostly affected the lungs but can also affect other parts of the is spread from person to person through the air, sneeze or transmit respiratory fluids through the air. tuberculosis can be cured by proper treatment.

Symptoms of tuberculosis :

Tuberculosis most commonly affects the lungs. common symptoms of active lung TB are:
  1. A persistent cough of more than 2 weeks brings up phlegm and blood at the time.
  2. Breathlessness is mild, to begin with, and gradually gets worse.
  3. Lack of appetite and weight loss.
  4. A high temperature of 38 degrees (100.4 degrees F) or above.
  5. Extreme tiredness or fatigue.
  6. Night sweating.
  7. Chest pain
  8. Less commonly TB can be affected other part of the body, they are 
  9. Lymph nodes,
  10. bone and joints,
  11. digestive system,
  12. the nervous system, bladder, and reproductive system, these are known as extrapulmonary tuberculosis. extrapulmonary tuberculosis is more common in people with a weak immune system.

Less commonly extrapulmonary tuberculosis (TB) infection  can occur in another origin of the body
  • Lymph nodes.
  • Bones and joints.
  • Digestive system.
  • Nervous system.
  • Bladder.
  • Reproductive system.
TB varies according to the organs/system affected .extra pulmonary TB is more common in people with a weakened immune system, such as those with HIV.

Extrapulmonary TB:

Extrapulmonary TB comprises 10% to 15% of the total TB cases. tuberculosis of organs other than the lungs such as pleura, lymph nodes, intestine, genitourinary tract, joints and bones, meninges of the brain, etc . are called extrapulmonary TB. Pleural tuberculosis is classified as extrapulmonary tuberculosis. tuberculosis lymphadenitis and pleural effusion are most common among extrapulmonary TB.

TB lymphadenitis:

this form of TB is more common in children and adults who are less than 30 years of age and more so among women. though lymph nodes in the neck are more frequently involved, it is not rare to find TB in mediastinal and abdominal lymph nodes.Axilla/groin are infrequent sites for the occurrence of tuberculosis.

TB lymphadenitis usually presents as slowly progressive, painless enlargement of the lymph nodes in the neck and it is rare to find the involvement of more than one group of lymph nodes. individual nodes are firm and discrete through the matting of nodes that may occur and progress to abscess and sinus formation if left untreated .tuberculosis abscess is also called a cold abscess.

"The commonest form of extrapulmonary TB is tuberculosis Lymphadenitis"
in addition constitutional symptoms like fever, malaise, weight loss, anorexia, etc may or may not be present.

Bobine tuberculosis 

Bobine TB caused by Mycobacterium Bovis is equally dangerous in cows and humans .it is transmitted through milk. Bacille Calmette Guerin (BCG) is a preparation of an attenuated strain of M. Bovis that is used in the Immunization program throughout the is named for Albert Calmette and Camille Guerin who developed it in 1920.

Symptomatic diagnosis

coughing for more than 2 weeks, loss of appetite, fever and night sweating, fatigue are common symptoms of TB. if someone has these symptoms one should seek medical advice to check whether it is tuberculosis.

Tests :

  1. Sputum examination: A sample of mucus and phlegm is checked for the presence of the bacteria.
  2. Chest X-ray: this used to create an image of the TB infection, there are changes in the structure of the lungs, which are visible on the X-rays.
  3. CBNAAT (cartridges based nucleic acid amplification test)

Diagnosis of extrapulmonary tuberculosis:

The following are some of the special investigations which are helpful in diagnosing extrapulmonary tuberculosis. these may be radiological, cytological, biochemical, and immunological.
  • Fine-needle aspiration cytology (FNAC) and direct smear examination,
  • Excision/biopsy of specimen for histopathological examination,
  • Fluid for cytology, biochemical analysis, and smear examination,
  • X-ray of the involved region,
  • Ultrasonography for the involved region,
  • Culture for Mycobacterium tuberculosis (M.TB).
  • Computerized tomography (CT) scan
  • Magnetic resonance imaging (MRI) scan
  • Urine tests.

Prevention of tuberculosis :

TB infection control is a combination of a measure aimed to minimize the risk of TB transmission in community, hospital and other public places.
  1. Early diagnosis and proper treatment of TB patients.
  2. Health education about mouth etiquette and proper disposal of sputum by the patient. covering nose and mouth when coughing or sneezing. this can be done with a tissue or if the person doesn't have a tissue they can cough or sneeze into the upper sleeve or elbow. but they cannot be a cough or sneeze into their hand.
  3. the house should be proper adequately ventilated.
  4. all contacts of TB patients should be evaluated.
  5. Isonised prevention therapy is recommended to children <  6 years of age who are close contacts of a TB patient.
  6. BCG vaccination  BCG vaccination has a protective effect against meningitis and disseminated TB in the child.

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