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Tuberculosis

Tuberculosis. ד"ר מנדל גלזר מנהל מכון רוקח ומלש"ח ירושלים שירותי בריאות כללית, מחוז ירושלים מסונף לאוניברסיטה העברית מכון הריאה ב"ח הדסה ע"כ. מלש"ח – מרכז לאבחון וטיפול בשחפת. 9 מלש"חים בארץ לשכות הבריאות האזוריות ירושלים – מרכז רוקח.

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Tuberculosis

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  1. Tuberculosis ד"ר מנדל גלזר מנהל מכון רוקח ומלש"ח ירושלים שירותי בריאות כללית, מחוז ירושלים מסונף לאוניברסיטה העברית מכון הריאה ב"ח הדסה ע"כ

  2. מלש"ח – מרכז לאבחון וטיפול בשחפת • 9 מלש"חים בארץ • לשכות הבריאות האזוריות • ירושלים – מרכז רוקח

  3. מרכז רפואי על שם ד"ר י.ל. רוקח

  4. מלש"חים אחרים לשכת הבריאות מרפאות קהילה משרד הבריאות בתי חולים כלליים מלש"ח צה"ל בי"ח ספציפיים מרכז קליטה עובדים זרים מבוטחי כל הקופות

  5. History Terms • Consumption • Phthisis [ Greek ] • Phthisis Pulmonalis • Scropula • Tabes Mesenterica • Koch’s Disease

  6. TB History • 1020 – Ibn Sina [ Avicena ] described in first as contagious disease • 1839 - Senabsin - name Tuberculosis • 1859 – First sanatorium in Germany • 1882 – R.Koch found bacilli • 1905 – Nobel Price 1906 – A. Galmette and Camele Gurien – first immunisation

  7. TB History • 1907 – National TB Association foundedinUS and Canada • 1921 – First human vaccination usedinFrance • 1946 – Streptomycin was developed • 80’s – Drug resistance appeared • The 20th_ TB kill’s more than 100 million people

  8. Incidence • 8,8 million new cases and 1,4 million died in 2010. • 19-43% of the world`s population are infected by M.Tuberculosis. • >95% of cases occur in developing countries.

  9. TB - USA

  10. Tuberculosis . Infectious disease caused by Mycobacterium Tuberculosis • Transmitted from a person with active lung disease • Airborne transmission • Exposure time, host susceptibility dependant

  11. MT COMPLEX . Mycobacterium Tuberculosis • Mycobacterium Bovis • Mycobacterium Africanum • M.Microti, M.Pinnipedii, M.Carpae

  12. MTB • Small rod-like bacillus • Aerobic • Divides every 16-20 hours • Can identify under regular microscopy • Ziehl-Neelsenstain • Fluorescent microscopy • Rhodamine, Ahramine stain

  13. Mycobacterium TB

  14. Sputum ZN Stained

  15. TB

  16. Tuberculosis • Active Disease • Latent [ LTI ]

  17. Tuberculosis • MDR [ Multi drug resistance ]- Rifampicin, Isoniazid • XDR [ Extensive drug resistance ] – Rif., Ison., Fluoroqinolones, Aminoglicosides • HIV

  18. Lung TB

  19. TB Diagnostics • Sputum • Bronchoscopes • Gastric Aspiration • Histopathology [ Biopsy ]

  20. Rapid TB Tests • NAA [ Nucleic Acid Amplification ] • Gen-Probe MTD • Enhanced MTD • Amplicor MT Test

  21. TB in Children • Under 5year triad of close contact, positive TST, suggestive findings on the x-ray [ primary complex, opacification with hilar or subcarinal lymphadenopathy ] or physical examination are useful for diagnosis for active TB • Gastric aspiration

  22. Relative Risk for TB • AIDS 110- 170 • HIV 50 - 110 • Transplant 20 - 74 • CA Head/Neck 16 • TNF Inhibitor 1,7 – 9 • Solitary Granuloma 2 • Apical Fibronodules 6 - 19 • Resent TB Inf [ under 2 years ] 15

  23. Relative Risk for TB • CRF – Hemodialysis10-25 • Silicosis 30 • Anti – TNF 1,7 - 9 • Young age [under 5] 2,2 - 5 • Glucocorticoids 4,9 • DM all types 2 – 3,6 • Smoker 1 p/d 2 – 3 • Underweight [ 85% ] 2 - 3

  24. Close Contact - Disease Risk • Under 1 year old 50% • 1 - 2 years 12% – 25% • 2 – 5 years 5% • 5 – 10 years 2% • Adolescent , young adults 10% - 20% • Other adults 3% - 5%

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