TB-and-DOTS肺结核与点共46张课件

1、TB and DOTS肺结核与点31、别人笑我太疯癫，我笑他人看不穿。(名言网)32、我不想听失意者的哭泣，抱怨者的牢骚，这是羊群中的瘟疫，我不能被它传染。我要尽量避免绝望，辛勤耕耘，忍受苦楚。我一试再试，争取每天的成功，避免以失败收常在别人停滞不前时，我继续拼搏。33、如果惧怕前面跌宕的山岩，生命就永远只能是死水一潭。34、当你眼泪忍不住要流出来的时候，睁大眼睛，千万别眨眼!你会看到世界由清晰变模糊的全过程，心会在你泪水落下的那一刻变得清澈明晰。盐。注定要融化的，也许是用眼泪的方式。35、不要以为自己成功一次就可以了，也不要以为过去的光荣可以被永远肯定。TB and DOTS肺结核与点TB

2、and DOTS肺结核与点31、别人笑我太疯癫，我笑他人看不穿。(名言网)32、我不想听失意者的哭泣，抱怨者的牢骚，这是羊群中的瘟疫，我不能被它传染。我要尽量避免绝望，辛勤耕耘，忍受苦楚。我一试再试，争取每天的成功，避免以失败收常在别人停滞不前时，我继续拼搏。33、如果惧怕前面跌宕的山岩，生命就永远只能是死水一潭。34、当你眼泪忍不住要流出来的时候，睁大眼睛，千万别眨眼!你会看到世界由清晰变模糊的全过程，心会在你泪水落下的那一刻变得清澈明晰。盐。注定要融化的，也许是用眼泪的方式。35、不要以为自己成功一次就可以了，也不要以为过去的光荣可以被永远肯定。TB: A Global Emergency

3、1/3 of the world (2 billion people) infected1 person infected/second resulting in 30 million new infections, 8 million new casesLeft untreated 1/3 die, 1/3 self-cure, 1/3 remain infectiousTB kills 1 person every 10 seconds = 5000/day = 2-3 million each year 22 High Burden CountriesIndiaChinaIndonesi

4、aBangladeshPakistanNigeriaPhilippinesSouth AfricaEthiopiaVietnamRussian FederationCongoBrazilTanzaniaKenyaThailandMyanmarAfghanistanUgandaPeruZimbabweCambodiaTB and DOTS肺结核与点31、别人笑我太疯癫，我笑他TB-and-DOTS肺结核与点共46张课件TB-and-DOTS肺结核与点共46张课件TB-and-DOTS肺结核与点共46张课件TB-and-DOTS肺结核与点共46张课件When does TB infectionbe

5、come disease?Most likely to occur in first two years after infectionIf person becomes immunocompromisedHIVCancerChemotherapyPoorly controlled diabetesmalnutritionWhen does TB infectionbecome The 5 Essential Components of the DOTS StrategyGovernment commitment to a National TB ProgramPriority to dete

6、ct infectious cases by sputum smear microscopyStandardized regimens of short-course chemotherapy, given under direct observation for , at least, the intensive phaseRegular, uninterrupted supply of anti-TB medsMonitoring system for program supervision and evaluationThe 5 Essential Components of 1. Po

7、litical/Administrative CommitmentPerception of TB as a priority problem with real solutionGovernment acknowledges importance of diseasePublic commitment to National TB Program (NTP) Support for personnel, training, transportation, drugs1. Political/Administrative Co2. Accurate Diagnosis=Sputum Micro

8、scopyIdentification/cure of infectious cases (smear+) is highest priority of TB control Smear+s 4-20 times more infectious; may infect 10-15/year; more likely to die if untreatedTimely results to reduce potential for transmissionQuality assurance/training-national reference lab is key2. Accurate Dia

9、gnosis=Sputum MDiagnosis of pulmonary TBCough 3 weeksAFB X 3Broad-spectrum antibiotic 10-14 daysIf symptoms persist, repeat AFB smears, X-rayIf consistent with TBAnti-TB TreatmentIf 1 positive, X-ray and evaluation If 2/3 positive: Anti-TB RxIf negative:Diagnosis of pulmonary TBCoughChest X-ray (CXR

10、) as Diagnostic ToolNo CXR pattern is typicalMany TB cases are missed (10-15% culture+s)Many non-TB cases misdiagnosed (40% diagnosed by CXR alone do not have active TBPrevious MD training emphasized CXR as best diagnostic toolOften reaction to poor, inaccurate, or unavailable lab servicesChest X-ra

11、y (CXR) as DiagnostiX-ray-based evaluation causes over-diagnosis of TBNTI, Ind J Tuberc, 1974Over-diagnosisX-ray-based evaluation causes Microscopy is a more specific test than X-ray for TB diagnosisSpecificityMicroscopy is a more specific 3. Adequate Supply of DrugsTreatment requires regular doses

12、of combination regimens for 6 months Identification of an adequate supply of appropriate drugs for patients prior to initiation of treatment essentialIf regimens incomplete, real chance of development of drug-resistant strains which are hard or impossible to cureRequires continuum of drug management

13、 services: selection, procurement, distribution, use.3. Adequate Supply of DrugsTre4. Directly Observed TreatmentWhy? Many patients dont take medicines regularly, even if excellent health education provided Who? All patients. impossible to predict which patient will take medicine (1/3 not adherent)

14、What? Observer watches and helps patient swallow tablets Where? Anywhere! (home, clinic, work, school, etc) Who does it? HCW, community liaisons, teachers, Direct observation ensures treatment for entire course with the right drugs, in the right doses, at the right intervals4. Directly Observed Trea

15、tmentDOT is necessary even whendrug supply ensured Chaulk CP. JAMA 1998;279:943-8Treatment SuccessDOTNo DOTDOT is necessary even whenChauDOT prolongs survival ofHIV-infected TB patients SCC with DOTSCC without DOTDOT prolongs survival ofSCC wi5. Systematic Monitoring/AccountabilityRecording system i

16、s simple to use, essential, integrated component of DOTS enablingMonitoring of patient outcomesEvaluation of program performanceAnalysis of epidemiologic dataIdentification of areas for OREvery level of health system accountable for patient diagnosis and cure; “report card”TB Register5. Systematic M

17、onitoring/AccouTB and HIV/AIDSHIV negatively impacts TB and TB negatively impacts HIVHIV+ individuals infected with TB are 30 x more likely to develop TB diseaseTB is leading cause of death among HIV+, accounting for 40% of AIDS deaths HIV increases the prevalence of active TB in HIV- and HIV+ popul

18、ationsTB and HIV/AIDSHIV negatively Multidrug-Resistant TB (MDRTB)Defined as resistance to INH and RIFCaused by inconsistent or partial treatment of susceptible TB (primary)Cure rates 2 monthsRelatively ineffective at preventing emergence of resistance to other drugsRole of PyrazinamideEssential Pyr

19、azinamide essential for first two months of 6/8-month treatmentAm Rev Respir Dis 1987;136:1339-42RelapsesPyrazinamide essential for firRole of Ethambutol/ StreptomycinPrevent emergence of resistance to other drugs givenHasten sputum conversionBacteriostatic or weakly bactericidal against rapidly div

20、iding organismsRole of Ethambutol/ StreptomycRelapse rates low with directly observed treatment in both HIV(+) and HIV(-) patientsAm J Respir Crit Care Med 1996:154:1034-38Relapse ratesRelapse (%)Relapse rates low with directlAdverse reactions to anti-TB drugsIsoniazidl Peripheral neuropathyl HepatitisDrugsAdverse reactionsPyrazinamidel Joint painsl HepatitisRifampicinl Gastroentestinal (anorexia, nausea,vomiting, abdominal pain)l Hepatitisl Reduced effectiveness of oralcont