「Tuberculosis」の版間の差分

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==Symptoms==
 
==Symptoms==
 +
*cough ± sputum ± hemoptysis > 2weeks
 +
*fever
 +
*malaise
 +
*weight loss
 +
 +
 +
*pulmonary
 +
**80-85% of TB diagnosis are pulmonary
 +
*extra-pulmonary
 +
**hilar lymphadenopathy
 +
**pleural
 +
**intestinal
 +
**meningitis/cerebral tuberculoma
 +
**......
  
 
==Diagnosis==
 
==Diagnosis==

2021年4月15日 (木) 14:41時点における版

History

  • Died from or infected by Tb
    • John Keats (poet)
    • George O'well
    • Nelson Mandella
  • Hippocrates description
    • Phthisis (to waste away, consumption)
  • Robert Koch found the bacteria 1882

Epidemiology

est. case est. death all form 10mil 1.4mil HIV-ass 0.9 mil 208,000 MDR-Tb ≈558,000 ≈190,000

  • 8 countries account for 2/3 of all worldwide Tb
  1. India
  2. China
  3. Indonesia
  4. the Phillippines
  5. Pakistan
  6. Nigeria
  7. Bangladesh
  8. South Africa

Transmission

  • transmission-influencing factors
    • sputum status of index case
    • proximity - distance between each other
    • time
  • susceptibility of person
  • [math]\displaystyle{ R_0 \approx r \times c \times d }[/math]
    • [math]\displaystyle{ r }[/math] = transmissibility
      • to reduce [math]\displaystyle{ r }[/math]
        • ealier detection
        • rapid commencing of treatment
        • reduce aerolization (surgical masks on patients)
          • surgical masks on patients reduce infectivity by 56%
    • [math]\displaystyle{ c }[/math] = susceptibility of contacts
      • to reduce [math]\displaystyle{ c }[/math]
        • open windows
          • Tb airborne transmission risk: windows closed 97%, negative pressure room (ACH12) 39%, windows and doors fully open 33%
        • N95 respirator
        • ARTs for HIV patients
    • [math]\displaystyle{ d }[/math] = duration of infectivity
      • to reduce [math]\displaystyle{ d }[/math]
        • treat patients appropriately

Risk factors

  • HIV
  • malnutrition
    • Tb risk inversely correlates with BMI
  • diabetes
    • diabetes and Tb are syndemic
    • diabetes and Tb pathophysiologically exacerbate each other even under treatment condition in terms of hepatotoxicity
  • overcrowding
    • people per room vs Tb rate per 100,000 (in Canada)
      • 0.4-0.6 vs 18.9
      • 1.0-1.2 vs 113
  • ....

Natural history

  1. inhalation of M.tb containing droplets
  2. macrophages phagocytosis
  3. granuloma + lymphadenopathy
  4. Ghon complex - primary infection
    1. 5% local progression/disseminated Tb
    2. 95% latent Tb
      1. 10% of latent Tb reactivates in lifetime - secondary Tb

Latent Tb

  • 1/3 of the world's population have latent Tb
    • modelling approx. 1.7 bil. people
  • 10% of those latent Tb people get reactivation in their lifetime

Symptoms

  • cough ± sputum ± hemoptysis > 2weeks
  • fever
  • malaise
  • weight loss


  • pulmonary
    • 80-85% of TB diagnosis are pulmonary
  • extra-pulmonary
    • hilar lymphadenopathy
    • pleural
    • intestinal
    • meningitis/cerebral tuberculoma
    • ......

Diagnosis

Treatment&Management

Drug-resistant