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DR.T.V.RAO MD
Dr.T.V.Rao MD
an update
3/13/16
MDR-TB
Dr.T.V.Rao MD
The
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3/13/16
Dr.T.V.Rao MD
3/13/16
ministry of Health
and Family Welfare
says that two deaths
occur every three
minutes from
tuberculosis (TB) in
India. It is also the
leading infectious
cause of death among
adults. Let us hope
this move serves as a
Dr.T.V.Rao MD
The
3/13/16
ACTIVE TUBERCULOSIS
Dr.T.V.Rao MD
tuberculosis (TB)
disease occurs when the
TB bacteria become
"active"; they
overwhelm the immune
system and cause a
person to become ill.
This usually occurs in
the lung, although TB
can affect any part of
the body, including the
lymph nodes, brain,
3/13/16
Active
Dr.T.V.Rao MD
Drug
3/13/16
Mycobacterium tuberculosis
Dr.T.V.Rao MD
tuberculosis is an ancient
human pathogen, which
has plagued countless
human societies despite
the introduction of
curative and preventive
therapy in the last
century. In recent years,
international attention
has turned toward the
evolving burden of
3/13/16
Mycobacterium
8
Multi-drug-resistant tuberculosis
tuberculosis (MDR-TB,
also known as Vank's
Disease) is defined as a
form of TB infection
caused by bacteria that
are resistant to
treatment with at least
two of the most powerful
first-line anti-TB drugs
isoniazid (INH) and
Dr.T.V.Rao MD
3/13/16
Multi-drug-resistant
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Increasing incidence of MDR TB
Dr.T.V.Rao MD
3/13/16
Five
percent (5%) of
all TB cases across
the globe in 2013
were estimated to be
MDR-TB cases,
including 3.5% of
newly diagnosed TB
cases, and 20.5% of
previously treated
Magnitude of MDR/XDR
10
500,000 cases/year
Approximately
100,000 cases/year
in China
Approximately
40,000 cases/year
in Russia
Only
About
Dr.T.V.Rao MD
3/13/16
Approximately
Secondary
Drug
resistant (DR)
Mono-drug
Poly-drug
resistant
resistant
Multi-drug
Extensively
Totally
Dr.T.V.Rao MD
Primary
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Classification of Drug
Resistant Tuberculosis
Dr.T.V.Rao MD
Multidrug-
12
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Definition of MDR
Tuberculosis
resistant
tuberculosis (MDRTB) is defined as
laboratoryconfirmed
resistance to the
two most potent
first-line
Dr.T.V.Rao MD
2007, extensively
drug-resistant
tuberculosis (XDR-TB) has
been defined as
resistance to both
isoniazid and rifampin
with additional resistance
to at least one
fluoroquinolone and one
injectable agent
(amikacin, kanamycin, or
3/13/16
Since
13
Dr.T.V.Rao MD
MDR-TB
3/13/16
MDR-TB infection
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Trends on MDR
As of 2013, 3.7% of new tuberculosis cases
tuberculosis
have MDR-TB.
Levels are much higher in those
15
Dr.T.V.Rao MD
3/13/16
Dr.T.V.Rao MD
Cell
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3/13/16
Mechanism of M. tuberculosis
drug resistance
2.Drug
3.Drug
efflux systems
4.Mutations:
Dr.T.V.Rao MD
3/13/16
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Examples of mutations that
make M. tuberculosis drug
resistant
An example of this is the mutation in the rpoB gene,
which encodes the beta subunit of the bacteria's RNA
Polymerase. This mutation makes the bacillus
resistant to Rifampicin. Non-resistant TB is sensitive
to Rifampicin because this drug binds to the beta
subunit of the RNA Polymerase, and hence disrupts
transcription elongation. When the rpoB gene is
mutated, the resulting beta subunit protein has
different amino acids, and thus a different
conformation. Rifampicin can no longer bind to the
beta subunit and prevent transcription.
Dr.T.V.Rao MD
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No effective treatment
Increasing morbidity and
mortality ( some report
show survival time in days)
Dr.T.V.Rao MD
3/13/16
Previous history of
treatment
* Failure
* Relapse
Dr.T.V.Rao MD
3/13/16
* HIV co-infection
*
Addictions
*
Contact with drug
resistant patient
21
patients
All
treatment
failures
Treatment
adherent
patient whose
condition deteriorates
Patient
whose smear
does not convert after
three months of
Dr.T.V.Rao MD
3/13/16
Compliance with
management guidelines
as laid by NTCP
Excellent adherence
during the intensive
phase and continuation
phase
Dr.T.V.Rao MD
3/13/16
Prevention of MDR
TB
22
23
supply of TB
drugs to
treatment
points
is crucial
Treatment
is
free of charge
Supervision
therapy
of
Dr.T.V.Rao MD
3/13/16
Uninterrupted
Management Principles
24
Dr.T.V.Rao MD
3/13/16
Counselling
Management Principles
cont
25
MDR TB wards
Management teams
with clear management
responsibilities Management
teams to have capacity and
expertise
Treatment logistics should be in
place
Dr.T.V.Rao MD
3/13/16
Dedicated
Dr.T.V.Rao MD
3/13/16
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How can MDR TB be
The most important
thing a person can do to
prevented?
Dr.T.V.Rao MD
3/13/16
Patient
whose smear
becomes positive again
after
Dr.T.V.Rao MD
3/13/16
Patient
whose smear is
negative but not
responding
to treatment
Symptomatic
contacts
of an MDR TB patient
29
How can MDR TB be prevented?
Dr.T.V.Rao MD
3/13/16
Diagnosis of MDR-TB
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In All Re-treatment
patients culture and
DST needs to taken
Treatment failures
on new TB cases
MDR TB contacts
* A rare photograph of
Dr.T.V.Rao MD
3/13/16
technique
Hemi-nested
PCR of
rpoBgenes with 5
different color primers
Result
will be known
in 2 hours
Sensitivity
of 96.7%,
Specificity of 98.6%
with PPV of 93.6% and
NPV of 99.3%
Dr.T.V.Rao MD
Semi-automated
3/13/16
Xpert MTB/RIF
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Xpert MTB/RIF
Dr.T.V.Rao MD
3/13/16
Xpert
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WHO Initiatives on TB Xpert
Dr.T.V.Rao MD
Under
MDR-TB diagnostics
Dr.T.V.Rao MD
3/13/16
The
34
Dr.T.V.Rao MD
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)35
Rapid Drug Susceptibility Test
(DST
Interpretation
All wild type bands are positive and any one mutant band
is positive : resistance
36
Rapid Drug Susceptibility Test (DST)
Dr.T.V.Rao MD
Risk
3/13/16
Indication
Closed
TB
Smear
Smear
Before
Suspected
patient
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Dr.T.V.Rao MD
38
3/13/16
ultimate goal of providing a more upto-date TB diagnostic tool for the 21st
century is the focus of ongoing research
and development. However, the
expanding TB/HIV epidemics and the
increasing of drug resistant TB, have led
to a need for improved diagnostics that
complement each other. While no single
diagnostic test provides all the
information needed for patient care over
the disease progression, several
Dr.T.V.Rao MD
The
3/13/16
40
Great plan to control tuberculosis
Dr.T.V.Rao MD
3/13/16
Dr.T.V.Rao MD
It
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3/13/16
Attention of Viewers
42
II
Dr.T.V.Rao MD
3/13/16
am thankful to many in the world who made me to achieve my desired goals faster than I
thought, having > 3-5 million health professionals share and utilize my knowledge for the
benefit of mankind, Today I wish to be freelancer to the world to create interest in Medical,
Clinical and Diagnostic Microbiology with more emphasis on Infectious diseases and Hospital
associated Infection wish to be your partner in educating many millions who know well the
importance of Infectious diseases
www.medmicrobes.com
www.slidehsare.com
www.authourstream.com
www,scribd.com
Raos Microbiology
Mob
+91 7204113154
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Dr.T.V.Rao MD
Program