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Tuberculosis The evolution of a bacterium • World Health Organization (WH.O. declared TB a global health emergency in 1993 • 137 cases per 100, 000 • 2004 statistics: 9.4 million incident cases, 14 million prevalent cases, 8.9 million new cases, and 1.7 million deaths, mostly in developing countries (0.4 million in HIV- positive) 2 TB prevalence 2009 3 TB around the world • Endemic in Latin America, Eastern Europe, Russia, Asia and Africa • High burden countries – 22 of them including Afghanistan, Bangladesh, Brazil, Cambodia, China, Congo, Ethiopia, India, Indonesia, Kenya, Mozambique, Myanmar, Nigeria, Pakistan, Philippines, Russian Federation, South Africa, Tanzania, Thailand, Uganda, Viet Nam, Zimbabwe 4 • caused by Mycobacterium tuberculosis • usually attacks the lungs, destroying lung tissue • can also infect the nervous system, skin, bone, joints… 5 Spread • through the air, when people who have the disease cough, sneeze, or spit – inhalation of a single bacterium can cause an infection • most infections in human beings will be asymptomatic and latent • about one in ten latent infections will eventually progress to active disease, which, if left untreated, kills more than half of its victims 6 Latent TB infection • 90 % of people infected with TB develop latent infection (inactive) • 3-5% develop active TB in first year • 5-15% develop it later 7 The Difference between Latent TB Infection and TB Disease A Person with Latent TB Infection A Person with TB Disease • Has no symptoms • Has symptoms that may include: - a bad cough that lasts 3 weeks or longer - pain in the chest - coughing up blood or sputum - weakness or fatigue - weight loss - no appetite - chills - fever - sweating at night • Does not feel sick • Usually feels sick • Cannot spread TB bacteria to others • May spread TB bacteria to others • Usually has a skin test or blood test result indicating TB infection • Usually has a skin test or blood test result indicating TB infection • Has a normal chest x-ray and a negative sputum smear • May have an abnormal chest x-ray, or positive sputum smear or culture • Needs treatment for latent TB infection to prevent active TB disease • Needs treatment to treat active TB disease 8 Symptoms • symptoms include chest pain, coughing up blood, and a productive, prolonged cough for more than three weeks • systemic symptoms include fever, chills, night sweats, appetite loss, weight loss, pallor, and often a tendency to fatigue very easily – as the disease progresses lung tissue is replaced by scar tissue • non-pulmonary TB causes all kinds of symptoms 9 10 Risk Factors • chronic conditions: diabetes, cancer, renal failure, other immunosuppression • low body weight, very young or very old • HIV patients • Working with TB patients • Exposure to people in prisons, or travel to countries where TB is endemic 11 Diagnosis • usually a tuberculin skin test followed by an X-ray to see if the infection is active 12 Life Cycle 13 • Following inhalation the bacterium can reside in lung tissue for decades without becoming active • During a time of immunological stress the bacterium can begin to multiply, forming granulomas and destroying lung tissue, as well as spreading through the rest of the body – Granulomas contain the slowly diving bacteria as long as immune cells are healthy – Detectable by X-ray 14 15 TB in Canada (2009) • 1,599 new active and re-treatment tuberculosis (TB) cases (a rate of 4.9 per 100,000 population) (BC, ON and QC, 18 % are 25-34 years old; 15-21 % are Aboriginal; rate of nearly 30 per 100,000) • foreign-born individuals accounted for 63% of all reported TB cases in Canada – Canadian-born non-Aboriginal and Canadian-born Aboriginal cases made up 11% and 20%, – TB rate in the Canadian-born Aboriginal group continues to be the highest of the three groups, approximately five times the overall Canadian rate. • pulmonary TB represents 68% of all reported cases 16 Treatment • people with latent infections will develop TB when it overwhelms their immune system (10%) • ISOLATION! (forced in North America) • antibiotics, usually a combination, 6-12 months 17 Multi-drug resistant TB • Of the 1,200 to 1,450 new cases reported per year, up to 20 percent have been found to be drug-resistant 18 19 Public Health • requirement to report • education of patients • isolation 20 Current Problems with TB • Drug resistance: due to improper treatment there are drug-resistant strains of TB • Increase in TB cases in Canada’s Aboriginal peoples 21 Prevention • BCG vaccine is somewhat effective in children (used in South Africa) • people with latent infections are treated to prevent active TB • Patient education instructional video 22