Dots
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Transcript of Dots
Dr. Satti M. SalehChief of Infectious Diseases Department MGH
Director of IC Unit Meeqat General hospital CBAHI IC TEAM Member Medical
Director Meeqat General Hospital
HISTORY •* Mycobacterium tuberculosis
• * MoTT• * 24/3/1882( Robert Koch )
• * 1993( WHO – International Emergency)• * 2000 ( Global partenership (STOP
TB))• * DOT strategy
• * DOTS strategy • * 2006 ( THE STOP TB STRATEGY)
CLINICAL SYNDROMS
Primary TB ( 1st Exposure)
* Laten TB * Reactivation TB
* Pulmonary TB * Extra pulmonary TB
DIAGNOSIS:
AFB stain * Culture
LJmediaBactec
* Molecular Method PCR
Species determinationDrug resistant mutation
Typing * Others
BASIC CONTROLDetection of cases
* Treatment (DOT) * INH Prophylaxis for
high risk * Contact investigation
* Isolation
Standardized short-course anti-TB treatment (SCC) given under
direct and supportive observation (DOT) .
1 -INH 5mg /kg2 -RMP 10mg/kg
3 -PZA 20-25mg/kg4 -ETM 15-25mg/kg
4 Drugs for 1st 2 months1st 2 Drugs for 2nd 4
months
IsolationAIRBORNE
Negative pressureHEPA filtersHEPA mask
Special mask for patient Pulmonary TB S+A Till
sputum Negative
DRUG RESISTANT TB
Mono resistant (1 drug) * Poly Resistant ( ~ 1 not
MDR) * MDR (INH + RIF)
* Extensively resistant (XDR – all 1st line)
Other drugs1 -Amikacine
2 -Kanamycine3 -Thiacetazone
4-Quinilone5 -cycloserine6-clofazemine
TREATMENT OF LATENT INFECTION
* Tuberculin test * PPD +ve
* PPD -ve (2 step testing)
( * Avoid misclassification)
INDICATION HIV ≥ 5mm
* Immunosuppressive drugs ≥ 5mm * Close contact of TB patient ≥ 5mm
Fibrotic lesion on CXR ≥ 5mm 2years ~10mm> Recently infected
person * High risk medical conditions ~10mm
* Low risk ~ 15mm
DOTS STRATEGY
- Detect smear +ve case & reporting
- Observation of therapy( DOTs ) - Treatment monitoring ( recording,
reporting assessment) - - Short course (Drug
Supply) - Government & non – government
commitment
STOP TB STRATEGY (2006 – 2015)
* DOTs * TB + HIV
* Health System support * Engage all health care
provider * Empower people with
TB & community* Enable & promote
research
Standardized recording and reporting
Helps to keep track of each individual patient and to monitor overall
programme performance
Sustained political and financial commitment.
TB can be cured and the epidemic reversed if adequate resources and
administrative support for TB control are provided