HEALTH PROMOTION: Public Health Research Project: Select a health topic or commu
ID: 253262 • Letter: H
Question
HEALTH PROMOTION: Public Health Research Project:
Select a health topic or community health problem and a specific population affected by the issue. You must choose a target group.
Provide the facts on the topic (Pathophysiology, symptoms, diagnosis, treatment, prevention methods)
How the issue affects your chosen population (include statistical information)
State the role that the Healthy People 2020 initiative is taking regarding the issue
Address your opinion on the topic and how you feel the problem should be resolved
Format: Power point presentation. You can use Microsoft Publisher for these formats.
Explanation / Answer
Tuberculosis
Causative organism : Mycobacterium tuberculosis
Transmission through droplets during Sneezing Cough Laughing.
Tiny droplets remain suspended in air for long and get access to terminal air passages.
nNatural infection generally seen in humans and related species.
nGuinepigs- most used in lab.
nM. bovis – more severe infection in cattle than humans.
nSo M.bovis was known to be derived from consumption of unpasturized milk.
nNot all that are infected gets disease.
nInfection depends on exogenous factors but disease –endogenous.
nCMI and innate immunity determines mainly.
nReinfection – of previously infected person occurs in areas of high endemicity.
nPrimary TB is generally non infectious. But secondary TB is highly infectious to individual and society.
nInfection rates highest among late adolescence and early adulthood.
nFemales- 25-34 yrs peak age.
nOlder people are at high risk due to worn immunity.
Who are at risk ?
Human immunodeficiency virus (HIV) infection
Previous TB
Prolonged corticosteroid therapy and other immunosuppressive therapy
Recent infection with M. tuberculosis (within the past 2 years)
Substance abuse (especially intravenous drug use)
Diabetes mellitus
End-stage renal disease
Cancer of the head and neck
Hematologic and reticuloendothelial diseases
Intestinal bypass or gastrectomy
Chronic malabsorption syndromes
Low body weight (10% or more below ideal)
nClinical illness just after infection is common in childhood with in age of 4- Primary TB.
nLater in life if exposed they get disease with in an year or two.
nSometimes dormant bacilli wait for activation and then cause-Secondary TB.
Pathogenesis
Interaction starts with inhalation of droplet
Majority are trapped by URT defenses and expelled.
Only the smaller ones can reach alveoli(10%)
Non specifically activated macrophages try to contain the bacilli.
Virulence and number of bacilli decide the future
Non activated monocytes tend to reach the bacilli and spread them systemically. (asymptomatic till this stage )
2-4 weeks later two host mechanisms are seen Delayed type hypersensitivity and CMI.
DTH is described as tissue damaging response arises due to Mycobacterial antigens and destroys the non activated macrophages.
CMI described as macrophage activating response occurs due to the signals from the activated macrophages.
Balance between DTH and CMI determine the course of disease.
Diagnosis
Demonstration of bacilli in sputum by microscopy
Isolating by culture
Transmitting infection to experimental animals
Demonstration of Hypersensitivity
Molecular diagnostic methods
Lab diagnosis for Pulmonary tuberculosis
§Sputum is collected early morning before meal
§Sputum of 3 consecutive days
§Laryngeal swabs incase sputum is not available
§Microscopy, new slides, ZN staining
§Fluorescent microscopy is convenient
§Culture, LJ, BACTEC 460
§Sensitivity tests- Minimum Inhibitory Concentration
§Animal Inoculation
§PCR
Lab diagnosis for extra pulmonary tuberculosis
§CSF from tuberculous meningitis patients
§Bone marrow and liver biopsy
§Pus, pleural exudates
§Urine in renal tuberculosis
Prevention
§Adequate nutrition, general health measures
§Live attenuated vaccine – BCG
§Immunity lasts for 10-15 yrs
Treatment
§Antituberculous drugs are of 2 types
§1 Bacteriostatic (Ethambutol E)
§2 Bactericidal Rifampicin (R), Pyrazinamide (Z), Isoniazid (H)
§Streptomycin is not active against intracelluar bacilli
§Old practice of administering drugs for 2-3 yrs is replaced by shorter course of 6-7 months
§HRZE daily for initial 2 months and HR daily for next 4 months
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