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by GROUP 17 KBI
Groups members
Pramoda Wardhany 0810713032 Prasilia Ramadhani 0810713033 Prisca Anindhita 0810713034 Ermayanti Binti Sukiran 0810714007 Faizudin Hafifi Bin Maskam 0810714008 Grace Niken Samaya 0810714009 Sharanraj A/L Kupusamy 0810714032 Shobana Devi A/P Arumugam 0810714033 Sumita Sivanganam 0810714034 Tan Boon Shen 0810714035
Groups Problem
1. 2. 3. 4. What is the pathogenesis and etiology of TB? What is the pathogenesis and etiology of HIV? What is the sign and symptoms of TB and HIV? What is tuberculin skin test and how to interpretate the result? 5. What is the tool to diagnose HIV? 6. What is the relationship between TB and HIV? 7. What is the drug used for TB? 8. What is the drug used for HIV? 9. What is the mode of transmission of TB and how is the prevention? 10. What is the mode of transmission of HIV infectionand how is the prevention? 11. Resistancy?
ETIOLOGIC AGENT of TB
Acid fast bacteria Bacilli Obligate aerob Slow growing bacterium Non motile Non sporing Has dormant stage Non capsulated Every 18 hours it replicates Resistant to drying Tahan pemanasan : - suhu 37C 12 tahun - 2 jam matahari mati - sputum kena matahari 20 30 jam - sputum tidak terkena matahari 6-8 jam - sputum dalam debu 8-10 hari - 5% fenol 24 jam
Pathogenesis of TB
Bakteri yang terhirup Bakteri mencapai paru, masuk ke makrofag Bakteri berkembang dalam makrofag Mulai terbentuk lesi Bakteri berhenti tumbuh, lesi mengeras Imunitas menurun reinfeksi Lesi mencair Bakteri keluar melalui sputum
Immunity
Two types of cells are essential: macrophages, which directly phagocytize tubercle bacilli, and T cells (mainly CD4+ lymphocytes),which induce protection through the production of lymphokines, especially interferon (IFN-). After infection with M. tuberculosis, alveolar macrophages secrete a number of cytokines: interleukin (IL) 1 contributes to fever
tumor necrosis factor (TNF-) contributes to the killing of mycobacteria, the formation of granulomas, and a number of systemic effects, such as fever and weight loss Macrophages are also critical in processing and presenting antigens to T lymphocytes; the result is a proliferation of CD4+ lymphocytes, which are crucial to the hosts defense against M. tuberculosis. Qualitative and quantitative defects of CD4+ T cells explain the inability of HIVinfected individuals to contain mycobacterial proliferation
Reactive CD4+ lymphocytes produce cytokines of the TH1 pattern and participate in MHC class II restricted killing of cells infected with M. tuberculosis. TH1 CD4+ cells produce IFN- and IL-2 and promote cell-mediated immunity TH2 cells produce IL-4, IL-5, and IL10 and promote humoral immunity
The role of cytokines in promoting intracellular killing of mycobacteria has not been entirely elucidated
Induration : 0-4 mm, uji mantoux negatif Theres no MTB 3-9 mm, uji mantoux meragukan maybe because theres mistaken in cross reaction technique between atopic mycobacterium or has been got BCG vaccination. 10 mm or more, uji mantox positife Get TB or has been exposed.
HIV PATIENT
IMMUNOSUPPRESED
PURIFIED PROTEIN DERIVATE (PPD) of MTB will stimulates and increase HIV viral replication
Isoniazid (INH)
Isoniazid is the most active drug for the treatment of tuberculosis caused by susceptible strains. Isoniazid is able to penetrate into phagocytic cells and thus is active against both extracellular and intracellular organisms. Allergic Reactions are fever and skin rashes are occasionally seen. Isoniazid-induced hepatitis is the most frequent major toxic effect. Other reactions include hematologic abnormalities, provocation of pyridoxine deficiency anemia, tinnitus, and gastrointestinal discomfort
Rifampin
As a single drug selects for these highly resistant organisms. Well absorbed after oral administration and excreted mainly through the liver into bile. Rifampin imparts a harmless orange color to urine, sweat, tears. Occasional adverse effects include rashes, thrombocytopenia, and nephritis. It may cause cholestatic jaundice and also hepatitis.
Ethambutol
Ethambutol is well absorbed from the gut. Usually given as a single daily dose in combination with isoniazid or rifampin and higher dose recommended for treatment of tuberculous meningitis. The most common serious adverse event is retrobulbar neuritis causing loss of visual acuity and red-green color blindness.
Pyrazinamide
Major adverse effects of pyrazinamide include hepatotoxicity, nausea, vomiting, drug fever, and hyperuricemia.
Streptomycin
Active mainly against extracellular tubercle bacilli Streptomycin is ototoxic and nephrotoxic. Vertigo and hearing loss are the most common side effects and may be permanent.
HIV Treatment
Mengobati HIV itu sendiri: - NRTI : tetovis, emtricitalzine, amivudine & abacavir - Protease Inhibitor: atazanavir, saquinavir - Fusion and entry inhibitor: entuvirtide & maraviroc Mengobati infeksi oportunistiknya (dalam kasus ini: TB) Suportif psikososial, pemberian nutrisi
Prevention of TB
1. Using mask 2. BCG immunization 3. Make a better air condition at home 4. No public spitting
Overcome by: - Using combination of at least 2 1st line of drugs; Rifampicin, isoniazid, ethambutol and streptomycin - Fluorokuinolon, such as siprofloksasis, ofloxacin, levofloxacin (but these drugs cannot be applied to children)
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