Drug interactions

Rifampicin stimulates the activity of the cytochrome P450 liver enzyme system, which metabolizes PIs and NNRTIs.This can lead to decreased blood levels of PIs and NNRTIs. PIs and NNRTIs can also enhance or inhibit this same enzyme system, and lead to altered blood levels of rifampicin. The potential drug interactions may result in ineffectiveness of ARV drugs, ineffective treatment of TB or an increased risk of drug toxicity. Isoniazid can cause peripheral neuropathy. The NsRTIs (didanosine,...

How Does Tb In Children Differ From Tb In Adults

The commonest age of presentation of childhood TB disease is between 1 and 4 years. As already emphasized, young age is a risk factor for infection, for progression from infection to disease, and for spread of disease to other parts of the body, i.e. dissemination. Most children with TB are not infectious to others. The commonest type of TB in children is smear-negative PTB. This is because cavitating TB is infrequent in children.The majority of children with PTB are too young to provide a...

IoTb management of hepatitis

Most anti-TB drugs can damage the liver. Isoniazid and pyrazinamide are most commonly responsible. Ethambutol is rarely responsible. When a patient develops hepatitis during anti-TB treatment, the cause may be the anti-TB treatment or something else. It is often difficult to find out. Try to rule out other possible causes before deciding that the hepatitis is drug-induced. Hepatitis presents with anorexia, jaundice and often liver enlargement. If you diagnose drug-induced hepatitis, stop the...

Pericardiocentesis

This is only safe under the following conditions a) echocardiography has confirmed a moderate to large pericardial effusion b) the operator is experienced. Therapeutic pericardiocentesis is necessary if there is cardiac tamponade (acute life-threatening cardiac impairment). In populations with high TB HIV prevalence,TB is the most likely treatable cause of pericardial effusion. It may be safer for the patient to start presumptive anti-TB treatment than to undergo diagnostic pericardiocentesis....

Hypoadrenalism

Cytomegalovirus can cause necrotizing adrenalitis. This is difficult to distinguish from TB of the adrenal glands or pseudoadrenal crisis (rifampicin).Treatment is with steroid supplements. Soft-tissue infections, e.g. pyomyositis, and sinusitis These are common in HIV-positive patients. They are diagnosed and treated in the usual way. I2*UM PREVENTION OF HIV-RELATED OPPORTUNISTIC INFECTIONS There are some general measures that may help in reducing exposure to selected pathogens in HIV-positive...

Use Of Antitb Drugs In Special Situations

* Streptomycin during pregnancy can cause permanent deafness in the baby. * Do not give streptomycin in pregnancy. Use ethambutol instead. * Isoniazid, rifampicin, pyrazinamide and ethambutol are safe to use. * Second-line drugs such as fluoroquinolones, ethionamide and protionamide are teratogenic, and should not be used. * All anti-TB drugs are compatible with breastfeeding. * Rifampicin, isoniazid and pyrazinamide are safe and can be given in normal dosages. Patients with severe renal...

An Expanded Framework For Effective Tuberculosis Control

WHO has declared that TB is a global emergency, because TB is out of control in many parts of the world.The following are the main reasons why TB is out of control a) governments in many parts of the world have neglected the disease b) inadequate TB control programmes have led to an increased burden of disease (inadequately treated TB patients live longer with chronic disease and infect other people) and the emergence of drug-resistant TB c) high rates of population growth have contributed to...

Sepsis And Concomitant Tb

Sepsis can occur as a coinfection with TB. An inadequate clinical response after treatment of sepsis, e.g. pneumonia, may be due to the presence of concomitant HIV-related TB. DISTINGUISHING OTHER HIV-RELATED PULMONARY DISEASES FROM PULMONARY TB This is a common, and often difficult, diagnostic problem. Several diseases in HIV-positive individuals may present in a similar way, with cough, fever, sometimes chest signs, and CXR shadowing. Pneumonia is the most frequent and important differential...

Background Information On Tuberculosis And

This chapter provides background information on tuberculosis (TB), human immunodeficiency virus and acquired immunodeficiency syndrome, and the interaction between them. TB is a bacterial disease caused by Mycobacterium tuberculosis (and occasionally by Mycobacterium bovis and Mycobacterium africanum).These organisms are also known as tubercle bacilli (because they cause lesions called tubercles) or as acid-fast bacilli (AFB).When sputum containing tubercle bacilli is stained with certain dyes...

Diagnosis of HIV infection in adults

With 6.1 Clinical recognition of HIV infection in TB patients 91 6.2 HIV 6.2.1 HIV antibody 6.2.2 Tests to detect the virus itself 93 6.2.3 Objectives of HIV antibody testing in TB patients 94 6.2.4 Strategy for HIV antibody testing in TB patients 94 6.2.5 Diagnosis of HIV infection in individual TB patients 95 6.3 HIV counselling 95 7 Diagnosis of HIV infection in children with 99 7.1 Clinical recognition of HIV infection in children with TB . 99 7.2 HIV 8 Standardized tuberculosis case...

Persistent headache

Headache Chart

The flow chart below shows the management approach to the TB HIV patient with headache.The following features may accompany headache reduced level of consciousness, confusion, convulsions. It is possible, but rare,for TB meningitis to develop after a TB patient has already started anti-TB treatment. For example, a cerebral tuberculoma could rupture into the subarachnoid space releasing TB bacilli not yet killed by anti-TB drugs. A commonly recommended treatment regimen for TB meningitis is as...