CHRONIC COUGH

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

Menyebar ke organ lain

Kematian

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

The etiology of HIV:

Characteristics of HIV virus

Retrovirus Envelope present Double stranded RNA Positive in polarity transmitted as single-stranded, positivesense, enveloped RNA viruses possesses a reverse transcriptase, and integrase, as well as other proteins.

The Pathogenesis of HIV Infection

To begin an infection, the HIV particle must encounter and bind to the CD4 receptor that is present on the surface of a subset of T cells (and also some other immune system cells called macrophages, but not on most other cells in the body). The interaction between HIV and the CD4 molecule, along with another molecule called a co-receptor, allows HIV to enter the cell. The virus enzyme reverse transcriptase then converts the RNA to DNA. Another viral enzyme called integrase inserts the virus DNA into the cells DNA in a step known as integration. Next, the cellular machinery, with the help of virus protein named Tat, makes many RNA copies of the virus in a process called transcription. The RNA copies are then used to make virus proteins, and the RNA copies and virus proteins are assembled into new virus particles. The long chains of virus proteins in the virus particle have to be cut into smaller pieces by another viral enzyme called protease. The new HIV particles are released from the cell by a process called budding and then can go on to repeat the cycle and infect more and more CD4+ T cells.

TUBERKULIN SKIN TEST

Skin test used to determine whether or not a person has been exposed to the bacterium that causes TB. TST are carried out for diagnosis of TB & before BCG vaccination. Pada bagian atas lengan bawah kiri bagian depan intracutaneus injection penilaian uji tuberkulin setelah 48-72 jam after injection.

 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 & TB RELATIONSHIP

HIV PATIENT

IMMUNOSUPPRESED

SUSCEPTIBLE TO OPPORTUNISTIC INFECTION

PURIFIED PROTEIN DERIVATE (PPD) of MTB will stimulates and increase HIV viral replication

Drug Used for Tuberculosis

First line: Isoniazid (INH) Rifampicin Ethambutol Pyrazinamid

Second line: Amikacin, Aminosalicylic acid, ciprofloxacin

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

The Mode of Transmission of TB

Mode of transmission: 1. Airborne 2. Skin contact 3. Sputum

Prevention of TB
1. Using mask 2. BCG immunization 3. Make a better air condition at home 4. No public spitting

The Mode of Transmission of HIV infection

1. Blood to blood product (blood transfusion, wound) 2. Unprotected sexual intercourse (make a sexual contact with person who got HIV) 3. Mother to child (during birth and breast feeding) 4. Sharing of contaminated needles

Prevention of HIV infection

Abstinence Be faithful Condom using Do not sharing contaminated

needle

The resistance of TBC toward anti-tbc drugs

Can cause by: -non continuous treatment (less than 6 months) - mutation to drug resistance
(rate: 1mutation every 10 cell division)

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)

The resistance against antiHIV drugs

Can cause by mutation
- changes in viruss genetic structure - changes in proteins mostly enzymes Help HIV reproduce/replicate - replicates at an extremely rapid rate - does not contain the proteins needed to correct the mistakes it makes during copying.

THANK YOU!