TEBERCULOSIS.pptx77777777777777777777777777777
- 1. PAEDIATRICS TOPIC: TUBERCULOSIS IN CHILDREN presenters: MOHAMED GBLA 22023 SALIEU GBLA 22024
- 2. Global TB burden TB Definition TB Pathogenesis Signs and Symptoms Transmission of TB Risk groups Drug Resistant TB TB Prevention OVERVIEW OBJECTIVES:
- 3. Estimated number of cases Estimated number of deaths 1.6 million* • 230,000 children • 600,000 in women • 1 million men 10.8 million 133 per 100,000 • 1 million children • 3.6 million women • 6.4 million men 558,000 All forms of TB Multidrug-resistant TB HIV-associated TB 0.9 million (9%) 161,000 Source: WHO Global TB Report 2023 * Including deaths attributed to HIV/TB The Global Burden of TB, 2023 230,000
- 4. WHAT IS TB? Tuberculosis is a chronic infectious disease that can affect almost any part of the body but is mainly an infection of the lungs. Tuberculosis (TB) is a disease caused by an organism called Mycobacterium tuberculosis. About one-third of the world's population has latent TB, which means people have been infected by TB bacteria but are not (yet) ill with disease and cannot transmit the disease.
- 5. TYPES OF MYCOBACTERIA M. tuberculosis causes most TB cases Mycobacteria that cause TB: M. tuberculosis M. bovis M. africanum M. microti M. canetti Mycobacteria that do not cause TB e.g., M. avium complex M. tuberculosis
- 6. TB PATHOGENESIS When a person inhales droplet nuclei containing tb bacilli they reach the alveoli of the lungs. These tb bacilli are ingested by alveolar macrophages; the majority of these bacilli are destroyed or inhibited. A small number may multiply and are released when the macrophages die. These bacilli may spread to other parts of the lung and through lymphatic channels or through the bloodstream to distant tissues and organs body e.g pleural cavity, lymph nodes, kidneys, brain, and bone.
- 7. ILLUSTRATION When an infected person: Coughs Sneezes Sings Talks spits sputum Millions of TB bacteria is released into the air.
- 8. TB PATHOGENESIS TB bacilli in the alveoli TB bacilli multiply in the alveoli
- 9. LATENT TB STAGE Special immune cells called macrophages ingest and form a barrier shell around the TB bacilli The macrophages cells form a barrier shell, called a granuloma, that keeps the bacilli contained and under control (LTBI).
- 10. TB INFECTION STAGE Shell breaks down and tubercle bacilli escape and multiply If the immune system cannot keep the TB bacilli under control, the bacilli begin to multiply rapidly (TB disease).
- 11. EXTRA PTB INFECTION STAGE A small number of bacilli enter the bloodstream and through lymphatic drainage and spread throughout the body and reach any part of the body, including areas where TB disease is more likely to develop (brain, Pleural cavity, lymph node, abdomen, spine, bone,
- 12. CLINICAL PRESENTATION OF TB Presumptive TB case: is a person who present with any of the clinical manifestations of Tuberculosis including: cough of two or more weeks unintentional weight loss Loss of appetite fever night sweats Chest pain Any extrapulmonary symptoms like lymph node swelling, joint pains and swelling depending on the organ involvement 12
- 13. SYMPTOMS IN CHILDREN: Persistent cough and persistent fever Loss of weight or failure to thrive during the past three months. Malnutrition. Tiredness or lack of playfulness. Also note in children often illness is transmitted by someone in the household esp < 5 year (History TB contact) It is difficult to diagnose as children cannot easily cough up sputum hence the need to pay attention to these symptoms
- 14. TB TRANSMISSION TB is spread from person to person through the air via droplet nuclei M. tuberculosis may be expelled when an infectious person: Coughs Sneezes Speaks Sings Transmission completed when another person inhales droplet nuclei
- 15. TB IS NOT SPREAD Sharing drinking containers or eating utensils. Smoking or sharing cigarettes with others Saliva shared from kissing. Touching someone By having sex Through blood, urine, feaces, water, or insect bites. **** AIRBONE******
- 16. TB TRANSMISSION Probability that TB will be transmitted depends on: Infectiousness of person with TB disease Environment in which exposure occurred Length of exposure Virulence (strength) of the tubercle bacilli
- 17. WHO ARE AT RISK OF TB □ Children and Aged □ Children living with HIV. □ Children with other immune suppressive diseases ( diabetes, cancer, ect…) □ Malnourished children □ Children with chronic bronco-pulmonary diseases
- 18. ENVIRONMENT IN WHICH EXPOSURE OCCURS
- 19. TB AND HIV TB develops in one of two ways in HIV infected patient: HIV patient with LTBI will progress to active TB as the immune system is weakened Person with HIV infection without LTBI and active TB infection becomes infected with M. tuberculosis and then rapidly develops TB disease. Image credit: Mississippi State Department of Health
- 20. WAYS OF DIAGNOSING TB A good history taking and physical examination. Diagnostic ways : Latent TB: Mantoux test. If +ve,( or non-reliable) consider interferone-gamma testing(eg Quantiferon TB Gold or T-spot) Note Quantiferon TB Gold and the T-spot tests measure the delayed hypersensitivity reaction developed after contact with M.tuberculosis; they use specific, complex M. tuberculosisantigens and are better than older Mantoux tests, which 1. Xray=Chest – Look for consolidation, cavitation, fibrosis and calcification. Xray of other affected parts 2. Gene Xpert – for all presumptive cases 3. Microscopy (diagnosis and follow up) 4. Culture on the Sputum. It is best for monitoring of patients. 5. Purified protein derivative skin test. The test is usually positive in children with pulmonary TB
- 21. New diagnostic approach Xpert MTB/Rif technology: – Detects both MTB and RR – Fully Automated – Results in 2hrs – Tests for MTB and Rifampicin More reliable and has a higher detection rate. 21
- 22. LTBI VS. TB DISEASE Latent TB Infection (LTBI) TB Disease (in the lungs) Inactive, contained tubercle bacilli in the body Active, multiplying tubercle bacilli in the body Gene Xpert is usually not detected Gene Xpert is usually detected Chest x-ray usually normal Chest x-ray usually abnormal Sputum smears and cultures negative Sputum smears and cultures may be positive No symptoms Symptoms such as cough, fever, weight loss Not infectious Often infectious before treatment Not a case of TB A case of TB
- 23. TREATMENT OF TUBERCULOSIS Before Treatment stress importance of compliance/concordance (helps the pt and prevent spread of resistance). Check FBC, LFT, Renal Fxn. Test colour vision (Ishihara Chart), Visual Acuity (Snell’sChart), before and during treatment as Ethambutol may cause (Reversible) ocular toxicity. Always weigh and check the height of the pt. For Children check their Z-Score and Use the MUAC. Check for HIV 1& 2, HBV & HCV and Diabetes Mellitus
- 24. PAEDIATRIC TUBERCULOSIS TREATMENT REGIMEN Four drugs regimen: RHZE for 2mths, followed by a two drugs HR regimen for 4mths for all children with suspected or confirmed PTB or peripheral lymphadenitis living in areas of low HIV prevalence or low H resistance or HIV Negative; Three drugs regimen: RHZ FOR 2moths, followed by a two drug HR regimen for 4 mths for children with suspected or confirmed PTB or TB peripheral lymphadenitis living in areas of low HIV prevalence or low H resistance or HIV Negative; Suspected or confirmed childhood TB should be treated with a combination of anti- TB drugs, depending on the severity of disease, HIV status and level of isoniazid
- 25. In infants aged (0-3mths) with suspected or confirmed PTB or TB peripheral lymphadenitis, treat promptly with the standard regimen well dosages IN cases of suspected or confirmed TB Meningitis, spinal TB with neurological signs or osteo-articular TB, treat for 12mths with a four drug regimen RHZE for 2 mths, followed by a two drug HR regimen for 10 mths. adjusted
- 26. TREATMENT OF PTB Rx of Pulmonary TB last for Six months and can be divided into 2 phases 1. Initial Phase: 8wks on four (4) drugs depending on susceptibility): A. Rifampicin 600-900mg (child 15mg/Kg) B. Isoniazid 15mg/Kg Max 900mg + Pyridoxine 50mg/24 or 10mg (if diabetic, malnourished, chronic renal failure, HIV+ve or Alcoholic) C. Pyrazinamide 2.5g PO.or 2g <50Kg D. Ethambutol 30mg/Kg PO or Streptomycin 0.75-1g/24h IM.
- 27. CONTINUATION PHASE This is a Sixteen weeks on 2 drugs Rifampicin and Isoniazid at the same doses. Note: Give prophylaxis of Pyridoxine throughout treatment. Note also Steroids are indicated in Meningeal and pericardial disease. SIDE EFFECT OF THE ANTI TB DRUGS Rifampicin:- Hepatitis (small rise in the Liver enzyme AST is acceptable , stop if Bilirubin rises) Orange/Red discoloration of urine and tears Isoniazid:- Hepatitis, Peripheral neuropathy, agranulocytosis. Ethambutol:- Optic neuritis(colour vision is the first deterioration) Pyrazinamide:- Hepatitis, arthralgia( Acute gout; porphyria)
- 28. DSTB & DRTB Difference between DSTB & DRTB Drug Susceptible TB (DSTB) is a form of TB that responds to 1st line drugs for treatment of TB (RHZE) Drug Resistant TB (DRTB) is a form of TB that develops resistance to any 1st line drugs (RHZE). There are different types of DRTB, classification is according to the resistance pattern.
- 29. MAIN REASONS OF DEVELOPING TB DRUG RESISTANCE: DSTB treatment interruption. Inadequate, incomplete or poor treatment quality of DSTB that allows the selection of mutant resistant strains. High prevalence of drug-resistant TB in the community increases the risk of drug-resistant TB exposure in the community.
- 30. DRTB CLASSIFICATIONS Drug-resistant tuberculosis is a disease caused by M. tuberculosis strains resistant to one or more anti-TB drugs. Monoresistance: resistance to one first-line anti-TB drug only other than Rif and Isoniazid. Polydrug resistance: resistance to more than one first-line anti-TB drug (other than both isoniazid and rifampicin). Multidrug resistance (MDRTB) : resistance to at least both isoniazid and rifampicin. Extensive drug resistance (XDRTB) : resistance to any fluoroquinolone and to one of the second-line injectable drugs (capreomycin, kanamycin and amikacin), in addition to multidrug resistance. Rifampicin resistance: resistance to rifampicin detected using phenotypic or genotypic methods, with or without resistance to other anti-TB drugs.
- 31. PREVENTION OF TB 1 Vaccination --------- One the most important ways to prevent TB in children is vaccination with the bacille calmette gue’rin(BCG) vaccine. It is expected to be given to infants soon after birth or at an early age around 2-3 months 2 Health education-----educating communities, families and caregivers about the symptoms of childhood TB infection is another step towards preventing childhood TB 3 Improving a child’s immune system------ improving children’s immunity is essential for preventing TB . Ensure that children get adequate nutrition by eating a healthy and balanced diet, also make sure they get enough rest and physical activity to maintain their immune system 4 ICF----- Intensive case findings 5 IPC infection prevention control 6 TB screening, contact tracing, involve patients & community in advocacy campaigns, access to rapid TB diagnosis and treatment
- 32. HAND AND COUGH HYGIENE
- 33. COMPLICATION OF TB IN CHILDREN 1 Joint damage 2 Lung damage 3 infection or damage of bones 4 damage to the spinal cord , the brain 5 hemoptysis 6 chronic obstructive pulmonary disease(COPD)
- 34. REFERENCES World health organization WHO pocket book 2013 www.slideshare.com
- 35. THANK YOU
Editor's Notes
- #3: Drug-resistant TB poses a major threat to control of TB worldwide Globally in 2014, 123 000 patients with MDR -TB or rifampicin resistant tuberculosis (RR-TB) were notified This was equivalent to 41% of the 300 000 notified TB patients who were estimated to have MDR-TB in 2014