「Tuberculosis」の版間の差分
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| 54行目: | 54行目: | ||
*malnutrition | *malnutrition | ||
**Tb risk inversely correlates with BMI | **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 | *overcrowding | ||
**people per room vs Tb rate per 100,000 (in Canada) | **people per room vs Tb rate per 100,000 (in Canada) | ||
***0.4-0.6 vs 18.9 | ***0.4-0.6 vs 18.9 | ||
***1.0-1.2 vs 113 | ***1.0-1.2 vs 113 | ||
| + | *.... | ||
| + | |||
| + | ==Natural history== | ||
| + | #inhalation of M.tb containing droplets | ||
| + | #macrophages phagocytosis | ||
| + | #granuloma + lymphadenopathy | ||
| + | #Ghon complex - primary infection | ||
| + | ## 5% local progression/disseminated Tb | ||
| + | ##95% latent Tb | ||
| + | ### 10% of latent Tb reactivates in lifetime - secondary Tb | ||
| + | |||
| + | ===Latent Tb=== | ||
| + | *1/3 of the world's population have latent Tb | ||
2021年4月13日 (火) 17:33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
- India
- China
- Indonesia
- the Phillippines
- Pakistan
- Nigeria
- Bangladesh
- 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%
- to reduce [math]\displaystyle{ r }[/math]
- [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
- open windows
- to reduce [math]\displaystyle{ c }[/math]
- [math]\displaystyle{ d }[/math] = duration of infectivity
- to reduce [math]\displaystyle{ d }[/math]
- treat patients appropriately
- to reduce [math]\displaystyle{ d }[/math]
- [math]\displaystyle{ r }[/math] = transmissibility
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
- people per room vs Tb rate per 100,000 (in Canada)
- ....
Natural history
- inhalation of M.tb containing droplets
- macrophages phagocytosis
- granuloma + lymphadenopathy
- Ghon complex - primary infection
- 5% local progression/disseminated Tb
- 95% latent Tb
- 10% of latent Tb reactivates in lifetime - secondary Tb
Latent Tb
- 1/3 of the world's population have latent Tb
